Yesterday I debated Peter Lurie (Deputy Director of Public Citizen’s Health Research Group) at The First Annual Summit on Disclosure, Transparency and Aggregate Spend for Drug, Device and Biotech Companies (keynote speaker was Senator Charles Grassley). Our session was billed as a “cage match.” We agreed on many points – and disagreed – very strongly – on others.
Here’s what I had to say:
Four months ago the New York Times reported that:
“The Journal of the American Medical Association cited “concerns about misleading reporting of industry-sponsored research” to justify its stricter standards for any such research to be considered for publication. The new policy, requiring researchers with no financial connections to the sponsor to vouch for the data and perform statistical work, was promptly criticized in an editorial in The British Medical Journal as “manifestly unfair” because it created a “a hierarchy of purity among authors.”
Considering that JAMA accepts advertising from the pharmaceutical industry and openly promotes the sales and marketing of reprinted articles – the concept of a “hierarchy of purity” is a nice turn of a phrase. It sounds better than “hypocrisy.”
Facts are an even better indicator. Consider an analysis published in The International Journal of Obesity and financed not by industry but by the National Institutes of Health. After analyzing weight-loss research conducted over four decades, they’ve found that the quality of data reporting in industry-sponsored research does indeed seem to be different from that in other research: It’s better.
The researchers found that the quality of data was significantly better in industry-supported research than in nonindustry-supported research, particularly in studies involving drug treatments. The researchers conclude:
According to the New York Times, “This suggests that, while continued efforts to improve reporting quality are warranted, such efforts should be directed at nonindustry-funded research at least as much as at industry-funded research.”
So, all of the righteous indignation about “bad” industry tainting “good” researchers is mostly hyperbole. But it makes for great copy.
When it comes to the future of medicine and the treatment of patients, we all need to move beyond one-dimensional attitudes – despite the fact that it makes for great speeches on CSPAN and headlines for “investigative” journalists.
New York Times reporter Gina Kolata recently reported that some prominent medical researchers are starting to shun any financial support from industry — not because they think it leads to bad research but because they’re tired of having their integrity impugned. By stigmatizing industry-sponsored research, is the “hierarchy of purity” doing more harm than good?
Is there an unintended negative consequence of transparency? Yes, when it is usurped by those who would put politics ahead of the public health.
A recent editorial on Nature Biotechnology put it this way, “The great unspoken reality is that relationships between companies and researchers are not only becoming the norm, but they are also essential for medicine to progress.”
Transparency is important. It is urgently important. Transparency permits trust. Sunshine is the best disinfectant – but what’s good for the goose must also be good for the gander.
But let’s be honest. The Sunshine Act with all of its high-minded language about transparency is really just about slamming the pharmaceutical industry.
That’s politics trumping the public health.
Why isn’t anyone concerned about the payments physicians get from insurance companies to switch patients from brand name to generic medicines, or from trial lawyers to be expert witnesses?
If physicians and academicians are paid by industry for their medical expertise – and those payments are important to disclose – why aren’t payments for that same expertise important to disclose when they’re being used by insurance companies and lawyers?
When is a conflict not a conflict? The answer, it seems – it when it’s convenient to the Brotherhood of the Conflict of Interest Priesthood, the COI Polloi.
Who’s pure and who isn’t? Here’s the answer – nobody is 100% pure. Not even Ivory Soap is 100% pure – and it floats! And politicians are certainly not 100% pure. Not even ones from
In the February 7th edition of The Lancet, Richard Horton points out that the battle lines being drawn and between clinician, medical research and the pharmaceutical industry are artificial at best -- and dangerous at worst. Dangerous, because all three constituencies are working towards the same goal -- improved patient outcomes.
His main point is that we must dismantle the battlements and embrace of philosophy of "symbiosis not schism." It's what's in the best interest of the patient.
