Prescription drug problems have hit the presidential radar screen. With an announcement of a plan to rein in the pharmaceutical industry this weekend at a campaign stop in Laconia, NH, John Edwards became the first major 2008 presidential candidate to take on the drug companies.  Here’s coverage in the Associated Press and Concord Monitor. Check out the full Edwards platform here on the campaign website.  Though much of it’s pulled from measures stripped from the FDA reauthorization bill passed earlier this year, Edwards’ proposal, which includes provision for a comparative effectiveness drug-testing center, full disclosure of safety and comparative effectiveness information on drug labeling and ads, empowering the FDA to go after drug companies that run misleading ads, and a two year moratorium on consumer ads for new drugs, is smart, and represents a leap forward in the candidates’ health care conversation.

On one hand, the fact that pharmaceutical marketing and industry reform is showing up in the presidential platforms only now is curious.  After all, talk of health care reform is as ubiquitous on the presidential campaign trail as American flag lapel pins, and the cost of prescription drugs is an issue that has emotional resonance with a pharmacy nation like ours.  Conventional (or perhaps campaign) wisdom has led candidates to focus on coverage, access and Medicare—how to cover more people without charging anyone else—these are the big ticket items. Catch is, conflicts of interest and undue marketing influence on prescribers have the power to affect the cost of those items, and recent reports indicate that they have.

On the other hand, it’s no surprise: health care groups, pharma included, have been some of the most aggressive lobbyists and generous contributors to presidential contenders, according to the Wall Street Journal Health blog, which has done a good job of keeping track.  And today the New York Times reported that health care groups have given $6.5 million to Democratic candidates and $4.8 million to Republicans so far. 

Pfizer has been the pharmaceutical company with the deepest pockets, giving the most to Hillary Clinton ($12,150), followed by Rudy Guiliani ($8,600).  Predictably, Edwards has received the least health care sector contributions to date (the Health blog points to his career as a plaintiff’s lawyer as explanation.)

So far, the headlines have focused on Edward’s DTCA moratorium, and the Monitor piece makes clear why: On the stump, it’s easier to lampoon the endless Flomax ads during the World Series or summon, as Edwards did, goofy images of allergen-free skipping fields. That’s fine—a two-year hold on ads for new drugs certainly won’t hurt matters, and may even decelerate the dubious consumer-marketing machine pharma’s driving.

But voters and the media should remember that DTCA is just a portion of a bigger problem—companies spend nearly twice as much in direct-to-physician marketing each year.  A candidate committed to these issues should address the rough reality that drug ads are just the tip of a really big iceberg: the potential for conflict of interest spills into academic medical centers, university research, continuing medical education, and physician marketing.  We must address those areas, too, if we are to truly tackle our nation’s prescription problem.