[Fwd: The Tomato Effect - Ignoring therapies that work]

[Guest guest]

This article was posted on the rheumatic.org list. and on the AMALGAM

list It sheds light on

a murky issue.

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W. Maver, F.S.A., M.A.A.A.

Reprinted from The World Research News, 1st quarter 1998 issue, with

permission.

The premise is that there are innovative medical therapies existing

today that offer solutions to some of our most pressing health

problems and that at the same time offer a significant reduction in

health care costs. These therapies are largely being ignored or in

some cases ridiculed.

To most of us involved in scientific research, this seems an odd

notion at first. Surely, one would think, discoveries and

breakthroughs offering great promise in the treatment of disease

would be at once communicated and embraced by the scientific/medical

community. However, those who study the history of scientific

progress conclude otherwise. Science frequently fails to demonstrate

the dispassion we attribute to it.

Historical citations of science resisting new ideas are too numerous

to review in any depth, from Copernicus to Galileo to Darwin, Mendel,

Ohm, Young, Pasteur, lister, Fleming ... the list goes on and on. It

is perhaps more instructive to briefly examine the reasons for resis

tance to innovation in medicine.

Tomato Effect - The tomato effect in medicine occurs when a highly

efficacious therapy for a certain disease is ignored or rejected

because it does not '.make sense " in the light of accepted theories

of disease mechanism and drug action. Doctors at the University of

New Mexico School of Medicine introduced the tomato effect in JAMA.

May 11, 1984. Its name is derived from the history of the tomato in

North America. By 1560, the tomato was becoming a staple of the

continental European diet. However, it was shunned in America until

the 1800's. Why? Because we knew it was poisonous. Everyone knew

tomatoes belong to the nightshade family. The leaves and fruit of

several plants in this family can cause death if ingested. The fact

that Europeans were eating tomatoes without harm was not relevant. It

simply did not make sense to eat poisonous food.

Peer Review - Ile peer review process probably has done more to

discourage innovative research than any other factor that I have

observed. The March 9, 1990 issue of JAMA was devoted entirely to the

topic of peer review. One article in particular, by Horrobin (himself

editor of a peer reviewed medical journal) , cited 18 examples of

peer review attempting to suppress medical innovation. The article

observed: " ... some of the most distinguished of scientists may

display sophisticated behavior that can only be described as

pathological. Editors must be conscious that, despite public

protestations to the contrary, many scientistreviewers are against

innovation unless it is their innovation. Innovation from others may

be a threat because it diminishes the importance of the scientist's

own work.

" Peer review in the grant giving process is so restrictive that most

innovative scientists know they would never receive funding if they

actually said what they were going to do. Scientists therefore have

to tell lies in their grant applications. Such views have explicitly

been stated by at least two Nobel Laureates. "

The (JAMA) article contends that medicine has lost sight of the basic

purpose of peer review, asserting, " the true aim of peer review in

biomedical science must be to improve the quality of patient care. "

Wrong Economics - When a new therapy comes along that is cheaper,

safer and more effective, it is seen as a competitive threat to those

engaged in the therapy it will displace. Those who stand to be most

economically disadvantaged naturally endeavor to block its

acceptance.

International Barriers - A combination of communication problems

(language barriers) and national chauvinism (if it wasn't discovered

here it can't be of much value) keep some innovative practices

developed in Europe and Asia from reaching the United States.

Cumbersome Bureaucracy - It has been estimated that the FDA approval

process takes an average of 12 years and costs $231 million. This

presents unique difficulties for independent researchers and for

therapies that do not lend themselves to patentability.

It is my observation that there is a role for the insurance industry

in advocating evaluation of innovative medical thera pies. Actuaries

should be almost immune to the tomato effect. We are focused almost

exclusively on statistical results as opposed to theory. Since the

insurance industry pays most of the bills, it should have great

economic motivation to see safe., effective and inexpensive therapies

extensively evaluated and widely disseminated. Consideration of an

industry-wide fund for innovative research could deal with the

problem of peer review. The insurance industry is a sleeping economic

giant. When it awakens to the cost containment possibilities

available through innovative therapies, we will see enormous changes

in the practice of medicine.

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Volume 6 No. 3 The Road Back Foundation " Antibiotic Therapy for

Rheumatic Diseases Summer 1998

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