Well, it is hard to imagine but this week Catherine DeAngelis, MD, editor of JAMA and general industry basher went for a trifecta of commentaries on industry relationships with physicians. With no surprises, all the commentaries say basically the same thing: That the academics know better than everyone else and that if we only gave these academics all the money, with no conditions, the world of medicine would be a much better place.
Oh, if you don’t comply they are going to get their friends in the press and government to intimidate you.
These series of commentaries are more about utopia than the real world. The commentaries are all written by the caldron of anti industry activist under the guise of JAMA.
Bellow is an analysis of all three commentaries and some history on the Authors:
New Developments in Managing Physician-Industry Relationships
This is a remarkable analysis of how David Rothman, the President of Institute of Medicine as a Profession (IMAP) has worked with Community Catalyst using funds from the Pew Charitable Trust and the Attorney General Prescriber Grant Program (settlement funds from the Neurotin case) created the Prescription Project, with the purpose of intimidating Deans of Medicine to adopt severely restrictive conflict of interest policies.
“Change has come from the top down. The deans office has typically taken the lead in inspiring, formulating, and enacting new policies. Almost everywhere, the dean has ready allies on the faculty. In particular, chairs of pharmacy and therapeutics committees, seasoned in industry strategies to influence purchasing and prescribing decisions, have often been supporters. Many deans have also been assisted by faculty, such as a professor of medicine who carried a supply of inexpensive pens in her white coat and, whenever she saw a colleague holding a pen with a drug company logo, took it away and substituted one of her own unmarked pens. So too, deans have been prodded to tighten their conflict-of-interest policies by medical students (AMSA, who get their funding from same sources as Rothman) and house staff. But in the end, medical centers are hierarchical places, and at universities like Yale, Stanford, Pennsylvania, and Pittsburgh, it was the deans who appointed (their friends) and charged the task force to draft new policies, and together they presented and defended the documents before the governing committees (the faculty practice group, the department chairs and the faculty council). With approvals forthcoming, the new policies were announced. In no case that we know of was a dean’s support for a rigorous policy derailed, voted down, or even substantially weakened.” (With only one voice getting heard you win every time)
What motivated the leadership?
Deans and faculty leaders had read journal articles on the power of gifts to physicians. (Published in JAMA and NEJM by DeAngelis and Angell)
They had scanned the media stories (placed by IMAP and Prescription Project) and were eager to preempt the issue rather than be publicly embarrassed.
Beyond that, many of them expressed a vigorous and unqualified commitment to the principles of professionalism.
They insisted that scientific knowledge and patient need, not marketing, had to drive medical decision making. Athletes might display company brands on their clothing, but physicians should follow a higher standard to protect their own and their profession’s integrity.
They define success in the following terms:
- Do attitudes and practices change over time?
- Do house staff and medical students experience the change in terms of an intensified commitment to professionalism?
- Do disclosure requirements affect appointments to formulary committees or teaching assignments?
- As visits from pharmaceutical representatives decline, do physicians’ prescriptions for generics increase?
- What effect on research funding might occur?
- Does the pharmaceutical industry devise new strategies that undercut the policies, and if so, how do the AMCs respond?
- Last, but certainly not least, will AMCs make sufficient progress to obviate the need for government intervention?
The end of the article is a veiled threat to get in line with the cult of “professionalism” or they will use “Government Intervention” against you.
About the Author: David J. Rothman, PhD (President of Institute of Medicine as a Profession, IMAP, Associate Director of Prescription Project); Susan Chimonas, PhD (Associate Research Scholar at IMAP).
David has devoted his life since the 60’s to separating industry from medicine.
Industry-Sponsored Clinical Research
This is Marcia Angell’s standard treatment against industry funding of medical research. She has selectively ignored the last thirty years of drug development and what it means to the patients, but hey it’s not “pure”.
The attack against Alan Schatzberg, MD is endless, she goes on to describe how terrible it is that he is doing research, paid for by the government on a product that he has the patent on, citing the letters to NIH and Stanford from Senator Grassley as evidence against Schatzberg. (Do you think Prescription Project is involved?)
“Given the conflicts of interest that permeates the clinical research enterprise, it is not surprising that industry-sponsored research has consistently been shown to favor the sponsors’ drug.” (What she misses is that there is lots of research that does not favor the sponsors’ drug but is still sponsored.)
Her analysis is “Looking at the picture altogether, it would be naive to conclude that bias is only a matter of a few isolated instances. It permeates the entire system”. (Bias is with us in all shapes and sizes including in her writing, what utter nonsense)
My favorite is her solution:
“I have proposed that an Institute for Prescription Drug Trials be established within the NIH to administer clinical trials of prescription drugs, including the premarketing trials that will be submitted to the FDA as a part of new drug applications.” (Just send me your money I know what to do with it).
Her arguments discount a whole body of research in translational medicine and clinical trials. One very interesting analysis of this issue was written in a research report this summer: The Truth About Drug Innovation: Thirty-Five Summary Case Histories on Private Sector Contributions to Pharmaceutical Science. This is a must read for those who say what contribution has industry made in research, perhaps the better question is how can we work together to save lives.
About the Author: Marcia Angell, MD, according to her bio on Wikipedia:
Angell is a critic of the pharmaceutical industry. With Arnold S. Relman, she argues, "The few drugs that are truly innovative have usually been based on taxpayer-supported research done in nonprofit academic medical centers or at the National Institutes of Health. In fact, many drugs now sold by drug companies were licensed to them by academic medical centers or small biotechnology companies." In 2004, she published The Truth About the Drug Companies: How They Deceive Us and What to Do About It.
Industry Support of Medical Education
Arnold Relman, MD states the ACCME has promulgated voluntary guidelines (actually they are not voluntary) aimed at promoting the quality and independence of educational programs they deliver. Nevertheless, given the major financial contribution from industry, there has been much discussion in the public media (placed by IMAP and Prescription Project) and within the profession (by his friends), about the influence of industry on medical education and consequently on the behavior of medical practitioners. (I guess in his mind “free” education is a bad thing. Does that make kids public school a bad thing? They are paid for.)
He goes on to cite CEJA (rejected by the AMA House of Delegates), and AAMC task force which did not reject industry support of medical education as justification for eliminating commercial support of CME.
He did concede that neither the AMA or AAMC are prepared to cut off industry support of CME, but each organization did go against gifts.
So what about CME? His solution is for physicians to pay for their education and for faculty to donate their time, make it part of their full time position. That faculty in teaching hospitals should be expected to teach in the CME programs sponsored by their institutions, just as they teach in residency and medical school programs. (I like free labor, what will the doctors think? Utopia abounds.)
Oh, his financial disclosures are: none (sure)
Arnold S. Relman is professor emeritus of Medicine and of Social Medicine at the Harvard Medical School. Dr. Relman served as the editor of the Journal of Clinical Investigation from 1962 to 1967 and as editor of the New England Journal of Medicine from 1977 to 1991.
It is interesting to note that Arnold Relman, MD and Marcia Angell, MD have written many articles together including "America's Other Drug Problem: How the Drug Industry Distorts Medicine and Politics" and have fought this fight against industry for a very long time.
This may shock you but Angell and Relman are married, so perhaps they are working together on this (Cathrine called and ask if we could beat out a trash commentary on industry, you write this one, I write the other). What do you think…?
All these commentaries taken together are a testament of the coordination of the anti-industry intelligentsia.