Tooling around town on chores this morning, I heard a news item on NPR news that made me sit up and take notice (well, OK, sit up a little straighter, anyway).
The item--the details of which can be found here--was about a deal signed between Merck & Co. and Cigna Corp (a health care insurer) linked to two of Merck's prezscription diabetes drugs, Januvia and Janumet.
As described in the Reuters news report:
Under the agreement, Merck will provide discounts on Januvia and Janumet to Cigna if a greater portion of the insurer's diabetic members reach blood-sugar goals, even if the patients are taking drugs other than Merck's.
As I listened to the news report on NPR, my first thought was "Good, at least one drug manufacturer and one insurer are smart enough to be looking for ways to reduce costs to consumers--perhaps we'll see more of this kind of thinking."
And, as outlined in the Reuters report, Cigna is "in discussions" on similar performance-based contracts with others.
While I think that government action will still be required to really solve the healthcare problems in this country, it's nice to know that the "free market" is making some strides in that direction.
But something about the story nagged at me, and it only took a few minutes of thinking to figure out what it was.
Can you say "potential, and serious, conflict of interest"?
Very simply put: because Merck wants the sales of their drugs to be high--and as a result Cigna already lists Januvia and Janumet as "preferred drugs" for the conditions it treats--Merck would like nothing better than to see positive results from the reports given back to them by Cigna. And Cigna, looking to cut expenses (the results of which may or may not make their way back into consumers' hands), would like nothing better than to report positive results with the use of Januvia and Janumet by its members.
If you accept that either of these players in this story sometimes act in nefarious ways--a position which, at least, is not out of the question based on past actions--then this contract is ripe for manipulation in a manner which serves both parties interests. That is, imagine Merck pressuring Cigna to report good compliance and results, and Cigna cherry-picking the data to do so.
Even if we were to accept, for the moment, that neither company would act in a nefarious manner, the concept of conflict of interest still applies, as it does in pharmaceutical studies in general. It's far to easy, if there is a preferred outcome, for the results of a study to end up biased towards a specific result, even if there is no conscious effort to induce bias.
It's why, in clinical trials of drugs, the gold-standard is the "double blind" test protocol. Humans are too easily driven to a determination by their own biases, even when they consciously try to keep them under control.
So, on one hand, I find the creativity of these two companies in trying to keep costs down laudable--even if they are motivated, as it appears, by "enlightened self-interest", as Alexander Pope would call it.
On the other hand, the chances of a rigged outcome, purposeful or not, disturb me.
What do other DKosers think?