Peer Review and Likey What Amounts to An Incomprehensible Rant.

Today I read an article in the New York Times that details a series of papers published in peer reviewed medical journals that had been ghost written for researchers by pharmaceutical companies wishing to advance their treatment options. Such a story to me indicates that A. we need health care reform desperately to incentivize our system more effectively and fairly and B. the scientific review process should not be taken lightly. Personally, I would much rather have a reviewer who questions something they do not understand and insists that I explain to them why it is true over a reviewer that gives something a cursory glance and approves it without really analyzing the data or results. It is likely pervasive throughout many fields that some referees are a bit lax or simply not terribly demanding, but I truly feel if something is unclear to a referee they should force the author to justify it. This means referees run the risk of looking foolish, but is it not better to clarify a point at the risk of possibly asking a dumb question than to allow a work that is not rigorous or justified to appear in the scientific literature? Anyway, hopefully this incident will make medical reviewers more cautious especially when looking at articles that recommend treatments provided by particularly powerful, wealthy companies.

It is not a bad thing to have an innovative company that makes much needed medicines for a wide array of diseases, but your management should accept that the product will stand on its own merit and the scientific process should not be jeopardized for increased profits. Such tactics do not simply weaken the health care system, but also the public's trust in the science and treatments produced by their scientists and physicians. Healthy skepticism is something scientists believe in greatly, but outright refusal to listen is never a
good thing.

Decisions to do such things speak to the culture of greed and the difficulties our nation faces in having all their industries currently controlled by people who are far more familiar with finance and balance sheets than the actual products companies produce. Such thinking often encourages focussing on rather short term gains with current products over long term investments in real development of new technologies and ideas. This has manifested itself in a US economy whose gains over the past 20 years have been largely fictional, while the cost of living increases have been all too real.

Speaking of health care reform, a friend and I here in Germany have been discussing the merits and drawbacks of the American system versus the German system. Both of us agree that wealthy nations should provide a basic standard of care for all their citizens and that the incentive structure in the US is totally wrong, but we also feel the German system could benefit from more private innovation and influence.

The notion of an optimal health care system is a difficult problem without question, and one I do believe we need to solve sometime soon. It seems to be necessary that every American should have to pay something into the system for some kind of basic universal coverage, but that those that can affordmore should be able to have it. Innovation comes at a cost unfortunately, and hence tragically will simply not be available to everyone in its early stages. This is a hard thing to admit but one must accept in a functioning economy that wealth acts as an important incentive and comes with certain advantages we simply cannot realistically extend to all and expect to see real progress.

However, in the name of fiscal conservatism our country constantly sees resistance to putting money into education, a healthy food supply, preventative health care measures, efficient and effective alternative energies, and smart infrastructure for all cities. We then seem to expect to have an advanced workforce, cheap energy, healthy people and viable local economies. There is a cost to living well in a society, a cost I fear we continue to put off because it might mean redefining our notion of luxury and wealth. How can one instigate a societal shift in what kinds of services, products and expenses are worthwhile?