“Hot Topics in Primary Care”

The other day I received a special edition of a reputable family medicine journal in the mail. Let’s flip through.

The first article reviews clinical cases where continuous glucose monitors came in handy and encourages primary care doctors to utilize them. The author sits on the advisory board for five device and pharma companies, including Abbott which makes the Freestyle Libre monitor. Abbott graciously sponsored the article itself.

The next piece encourages PCP vigilance in the early detection of Alzheimer disease. Fair…except that the authors sit on the advisory board for Eisai Pharmaceuticals, maker of Leqembi which is controversially approved for early-stage Alzheimer disease. Leqembi deserves a post of its own, but essentially is viewed skeptically by neurologists because it carries a significant risk of brain hemorrhage and also doesn’t really work.

I was optimistic when the next article centered on “the importance of asthma care.” On closer inspection, it serves to stimulate pulmonology referrals so more patients (mostly children in this case) can start on pricey biologic drugs to modulate their immune systems. The article is funded by AstraZeneca, manufacturer of Tezpire and Fasenra which are featured prominently. True, these aren’t the only biologic drugs discussed. But the other ones (Xolair, Nucala, Cinqair, and Dupixent) are also sold by companies with whom an author discloses financial relationships.

Turning the page, I ventured to play a game. I would read the fine print to identify the article’s funding source, then guess the topic. This piece was supported by Corcept Therapeutics, maker of Korlym which lowers cortisol. Might this be an article enjoining PCP’s to pick out eligible patients? The title reads, “Hypercortisolism is More Common Than You Think–Here’s How to Find It.”

The authors successfully put Korlym on my radar, and from KFF I learned, “[The] chief executive of…Corcept said Korlym’s average cost per patient is $180,000 annually and concedes that ‘we have an expensive drug. There’s no getting around that.'” This is dubious, since Korlym is actually a re-patented abortion drug which has been around since 2000 and is sold for a fraction of the price.

The journal proceeds with two articles on COPD guidelines and one highlighting new formulations of insulin, all written by clinicians tied to the relevant drug companies. Another sheds any pretense of impartiality by featuring its drug in the title: “The Role of Finerenone in Optimizing Cardiovascular-Kidney-Metabolic Health: Everything PCPs Should Know.” It would be one thing if an unaffiliated physician who finds finerenone valuable to patients wrote this article. But authors financially involved with the drug manufacturer, writing an article “supported by funding from Bayer”?

Ultimately this journal edition is little more than a sophisticated advertisement–which is insulting, but the real issue is how patients seeking objective advice can’t rely on it. No drug should be boycotted, and some patients do benefit from the latest and greatest technology. But the vast majority of illness in the US is foodborne chronic disease. Lifestyle medicine–which is safer, cheaper, and more effective for most conditions–should be the bedrock of primary care, and patients deserve no less.