Maybe we should outsource new drug evaluation to India

The pharmaceutical industry in the US is becoming the victim of its own success. The industry has been so successful at influencing all of its relevant constituencies that broad swathes of the medical establishment have lost their ability to claim objectivity. The result is that the public is increasingly skeptical of pharmaceutical companies and their products. This has contributed to the environment in which trial lawyers can pursue Big Pharma the way they pursued Big Tobacco.Consider the following partial list of sources of influence:

• FDA is largely funded by "user fees" paid by the drug companies
• FDA advisory panels that recommend drugs for approval have come under scrutiny for members' ties to the industry
• Esteemed scholarly journals are dependent on pharma companies for ad revenue, subscriptions and reprints. They print articles reporting on studies that are funded by pharmaceutical companies, written by authors whose labs are supported by the pharmaceutical company sponsors
• Medical societies that develop treatment guidelines are influenced directly and indirectly by pharmaceutical company money

As this influence has become known it's turning into a liability for the pharmaceutical companies. They have --with the tacit or explicit cooperation of many in the medical establishment-- undermined the credibility and objectivity of the very sources whose credibility they seek to exploit.

So here's a radical solution to at least one part of the problem: Outsource drug evaluation to India. Set up a cadre of medical researchers and advisers to replace the US based FDA advisory panels. The medical talent is available. The key is to keep it free of real or perceived influence by the industry. This can be done by paying above-market salaries and forbidding any direct or indirect interaction with industry. Funding would be through the US government, not tied to user fees.

Objectivity and credibility would be improved, ultimately benefiting everyone including the drug companies. Costs would fall. And the US establishment would have a chance to clean house over the decade or so that it will take.

Other solutions are needed as well:

• Physicians need to realize they are being influenced and that their credibility is at stake
• The publishing industry needs to be restructured to restore its objectivity. Open access is a partial cure
• FDA needs direct unrestricted government resources, rather than being dependent on the industry it regulates