Latest Drugwonks' Blog
Here's CMS Medical Director on the CMS policy to restrict ESAs in a one size fits all way:
The American Society of Clinical Oncology, which represents cancer doctors, and the drugs' makers, are continuing to submit new evidence to bolster their argument that the restrictions will boost the risk of blood transfusions, he said.
FERVENT REACTION
Straube said he has seen no convincing evidence to support reversing the decision. A recent poll released by cancer and blood doctors suggesting doctors believe the policy is leading to more blood transfusions will have little sway, he said.
That survey of about 500 oncologists and blood doctors asked about views on Medicare policy and its impact on care.
Straube said there is no evidence in properly controlled trials that blood transfusions could rise based on the policy.
"People don't use surveys to make national coverage decisions," he said. "These were opinions."
Straube said he was "disappointed" and surprised by the fervent reaction of the cancer doctor community.
"Our staff looked at over 800 evidenced-based articles published in the literature," he said. "I doubt seriously whether most clinicians read all 800."
Lest I incur the righteous wrath of Healthcare Renewal, let me restate what I found after going through all the evidence-based articles...
There is no evidence in properly controlled trials that blood transfusions won't rise nor that blood transfusions are safer or could be associated with less cancer. So why is the burden of proof on clinicians and patients? Similarly, where is the evidence that the additional risk of cancer -- the relative risk of which must be established in the context of the existing cancer under treatment and with the recognition that in all the properly conrolled trials excess mortality was not always associated with higher hemoglobin levels -- is not worth the benefit from the patient perspective?
According to Straube, the opinion of a patient or physician no longer counts. Only the judgement of staff who look at evidence-based articles matter. And as for those studies, there is no consistency in trial design, population size, tumor stage, etc. There is a lot of mixing and matching and none of those studies look at the safery and effectiveness of blood transfusions.
Is this how we want medicine to be paid for and practiced in the United States? Should we ignore individual differences in response to drugs and disease in favor of population based studies.
It's a pretty straightforward question. Let me know. Leave the ad hominem attacks out.
http://www.reuters.com/article/Regulation08/idUSN0850178720080208
The American Society of Clinical Oncology, which represents cancer doctors, and the drugs' makers, are continuing to submit new evidence to bolster their argument that the restrictions will boost the risk of blood transfusions, he said.
FERVENT REACTION
Straube said he has seen no convincing evidence to support reversing the decision. A recent poll released by cancer and blood doctors suggesting doctors believe the policy is leading to more blood transfusions will have little sway, he said.
That survey of about 500 oncologists and blood doctors asked about views on Medicare policy and its impact on care.
Straube said there is no evidence in properly controlled trials that blood transfusions could rise based on the policy.
"People don't use surveys to make national coverage decisions," he said. "These were opinions."
Straube said he was "disappointed" and surprised by the fervent reaction of the cancer doctor community.
"Our staff looked at over 800 evidenced-based articles published in the literature," he said. "I doubt seriously whether most clinicians read all 800."
Lest I incur the righteous wrath of Healthcare Renewal, let me restate what I found after going through all the evidence-based articles...
There is no evidence in properly controlled trials that blood transfusions won't rise nor that blood transfusions are safer or could be associated with less cancer. So why is the burden of proof on clinicians and patients? Similarly, where is the evidence that the additional risk of cancer -- the relative risk of which must be established in the context of the existing cancer under treatment and with the recognition that in all the properly conrolled trials excess mortality was not always associated with higher hemoglobin levels -- is not worth the benefit from the patient perspective?
According to Straube, the opinion of a patient or physician no longer counts. Only the judgement of staff who look at evidence-based articles matter. And as for those studies, there is no consistency in trial design, population size, tumor stage, etc. There is a lot of mixing and matching and none of those studies look at the safery and effectiveness of blood transfusions.
Is this how we want medicine to be paid for and practiced in the United States? Should we ignore individual differences in response to drugs and disease in favor of population based studies.
It's a pretty straightforward question. Let me know. Leave the ad hominem attacks out.
http://www.reuters.com/article/Regulation08/idUSN0850178720080208
Oh well, so much for, um, pulling one's own weight.
According to a story in the Chicago Tribune, “Executives at an Indianapolis health-care system, frustrated by rising benefit costs, proposed a new program to get employees fired up about staying healthy.
Rather than offering incentives, Clarian Health Partners would fine employees who didn't try to quit smoking or lower their cholesterol or blood pressure. The threat of hiking their medical premiums by as much as $30 per paycheck surely would get their attention, executives reasoned.
They were right, but the proposal also generated so much resentment that Clarian Health never rolled out the program.â€
Here’s a link to the complete article:
http://www.chicagotribune.com/business/chi-sun_health_0210feb10,0,1758041.story
Wonder how these folks in the Circle City feel about another type of health care mandate – government-run health care?
According to a story in the Chicago Tribune, “Executives at an Indianapolis health-care system, frustrated by rising benefit costs, proposed a new program to get employees fired up about staying healthy.
Rather than offering incentives, Clarian Health Partners would fine employees who didn't try to quit smoking or lower their cholesterol or blood pressure. The threat of hiking their medical premiums by as much as $30 per paycheck surely would get their attention, executives reasoned.
They were right, but the proposal also generated so much resentment that Clarian Health never rolled out the program.â€
Here’s a link to the complete article:
http://www.chicagotribune.com/business/chi-sun_health_0210feb10,0,1758041.story
Wonder how these folks in the Circle City feel about another type of health care mandate – government-run health care?
According to a story on the Forbes website, “Just 5 percent of Web pages devoted to breast cancer contain inaccurate information. But pages focused on complementary or alternative medicine are 15 times more likely to make misleading claims and contain other false information, a new study says.
Moreover, standard measures of quality developed to assess the accuracy of Web pages don't really work, said the authors of the study, published in the March 15 issue of the journal Cancer.
According to the study, 44 percent of women recently diagnosed with breast cancer search the Internet for relevant information about the disease. Many visit the Internet before seeing a physician, which means they may be forming opinions and making treatment choices without professional input, the study authors said.â€
Here’s a link to the complete article:
http://www.forbes.com/forbeslife/health/feeds/hscout/2008/02/11/hscout612512.html
When it comes to breast cancer or any cancer – or any health condition – caveat emptor is dangerous practice.
Moreover, standard measures of quality developed to assess the accuracy of Web pages don't really work, said the authors of the study, published in the March 15 issue of the journal Cancer.
According to the study, 44 percent of women recently diagnosed with breast cancer search the Internet for relevant information about the disease. Many visit the Internet before seeing a physician, which means they may be forming opinions and making treatment choices without professional input, the study authors said.â€
Here’s a link to the complete article:
http://www.forbes.com/forbeslife/health/feeds/hscout/2008/02/11/hscout612512.html
When it comes to breast cancer or any cancer – or any health condition – caveat emptor is dangerous practice.
My eldest son has Juvenile Myoclonic Epilepsy that is marvelously under control due to the golden combination of the right medication in the proper dose, along with strict and compliant adherence.
So it came as somewhat of a shock at the end of last month when the FDA issued an altert to health care providers on the “Risk of Suicidal Thoughts and Behavior with Antiepileptic Medications.â€
Here is a link to the FDA alert:
http://www.fda.gov/bbs/topics/NEWS/2008/NEW01786.html
As with many recent FDA risk communications initiatives, the unintended consequences may very well outweigh the need for the communication.
To that end I recommend to you an article from the New York Times, “Making Sense of the Great Suicide Debate.â€
According to the article, “Many doctors who treat epilepsy patients said they were bewildered by the recent reports and concerned that regulators were scaring patients away from valuable medications based on limited evidence ... In the case of the epilepsy drugs, the F.D.A. found 4 suicides among some 44,000 people taking the drug in 199 studies, and none among some 28,000 on placebo.â€
Here is a link to the complete article:
http://www.nytimes.com/2008/02/10/weekinreview/10carey.html?_r=1&ref=health&oref=slogin
The regulatory policy issue at play here is FDA risk communications and the important (and mostly unaddressed) question of unintended consequences.
Is it important for the FDA to communicate with health care providers and patients (and parents of patients) when relevant safety data becomes available? Yes. But is the agency weighing the risks and benefits of such communications with the appropriate finesse – as they do when they review a drug application – that’s the question.
And it’s a good question for the FDA’s new Risk Communications Advisory Committee to consider when they meet for the first time on February 28.
So it came as somewhat of a shock at the end of last month when the FDA issued an altert to health care providers on the “Risk of Suicidal Thoughts and Behavior with Antiepileptic Medications.â€
Here is a link to the FDA alert:
http://www.fda.gov/bbs/topics/NEWS/2008/NEW01786.html
As with many recent FDA risk communications initiatives, the unintended consequences may very well outweigh the need for the communication.
To that end I recommend to you an article from the New York Times, “Making Sense of the Great Suicide Debate.â€
According to the article, “Many doctors who treat epilepsy patients said they were bewildered by the recent reports and concerned that regulators were scaring patients away from valuable medications based on limited evidence ... In the case of the epilepsy drugs, the F.D.A. found 4 suicides among some 44,000 people taking the drug in 199 studies, and none among some 28,000 on placebo.â€
Here is a link to the complete article:
http://www.nytimes.com/2008/02/10/weekinreview/10carey.html?_r=1&ref=health&oref=slogin
The regulatory policy issue at play here is FDA risk communications and the important (and mostly unaddressed) question of unintended consequences.
Is it important for the FDA to communicate with health care providers and patients (and parents of patients) when relevant safety data becomes available? Yes. But is the agency weighing the risks and benefits of such communications with the appropriate finesse – as they do when they review a drug application – that’s the question.
And it’s a good question for the FDA’s new Risk Communications Advisory Committee to consider when they meet for the first time on February 28.
By way of Forbes, a real "call it like I see it" piece by Paul H. Rubin, Professor of Law and Economics at Emory University and former Chief Advertising Economist at the Federal Trade Commission and Chief Economist at the U.S. Consumer Product Safety Commission. The topic is the important role of drug reps and, more broady, drug marketing> Rubin's article is both important and timely -- and should serve as an education for those who opt for soundbites rather than sound public health policy.
On My Mind: A Free Lunch
Paul H. Rubin
There's nothing wrong with letting drug reps schmooze with doctors. What's the matter with Americans? They think there is something incestuous about the connection between drug companies and doctors.
Politicians tell them that the drugmakers wine and dine physicians while pushing the latest antibiotic or statin. Utterly corrupted, doctors impose those medications on patients, whether or not the drugs are better than cheaper alternatives.
A pending U.S. Senate bill would require drug companies to report gifts to doctors of more than $25; the House is investigating marketing practices. New York State's legislature plans to hold hearings this year on the relationship between doctors and drug companies. One congressional critic has even compared the drug industry with the tobacco industry, and Senator John McCain has called drugmakers the "bad guys."
What drugs are these legislators taking? Drug company reps offer overworked doctors useful, lifesaving information in an efficient manner. The drug companies are of course motivated by profit, but economists have known since Adam Smith that the profit motive is the best way to induce someone to do something useful. (Disclosure: I consult for the drug industry from time to time, most recently for Pfizer.)
Marketing and research are both information activities; they work together to get effective drugs to patients. The two activities are not in competition for resources. The denouncers of drug companies don't understand this. One of the senators sponsoring the bill suggests that "the millions of dollars these companies spend on marketing ... could be put into research." In fact, drug companies would not switch money from marketing to research. If they cannot market drugs in the best way, they will reduce spending on research. What's the point of inventing a new drug if doctors and patients don't know about it?
Academic physicians think that doctors should obtain information by reading medical journals. Practicing doctors do not have time to comb through the International Journal of Medical Sciences or the Annals of Internal Medicine. A meal with a pharmaceutical salesperson is a time-efficient way for a busy doctor to learn about new drugs, or perhaps a better therapeutic alternative, or a drug with easier dosing or fewer side effects than the old drug. Physicians interact with more than one drug rep, so they have competing sources of information.
Another argument made by supporters of the Senate bill is that promotion leads physicians "to prescribe the expensive new drugs that are being marketed to them when a more affordable generic would do," in the words of one senator. There are three things wrong with this argument. First, manufacturers of generics do not promote those drugs, so it might be
difficult for the physician to learn about generics at all. Second, new drugs lead to better health outcomes. They keep people out of the hospital. A 2007 study by business professor Frank Lichtenberg of Columbia University estimated that a prescription for a new drug (5 years from FDA approval) costs an average $18 more than an older one (15 years on the market) but reduces other medical costs, including hospital and office visits, by $129. Finally, by leading consumers to purchase newer drugs, marketing increases investment in innovation and thus makes research more likely.
A widely cited 2000 article in the Journal of the American Medical Association summarized 29 published studies critiquing the interaction between doctors and drug reps. Notable feature of these articles, as quoted in the summary paper: "No study used patient outcome measures."
That is, in all of the medical literature on drug sales, there was no evidence of harm to patients caused by doctors and drug reps breaking bread. These articles were written by physicians who by their oaths put patient welfare at the top of the list, but they were critical of the industry based on analyses that totally ignore this measure.
A recent report shows that the life expectancy of Americans is at its highest level ever and will continue to increase. It is truly amazing that this society keeps coming up with ways to demonize and penalize an industry that has provided us with so many benefits.
On My Mind: A Free Lunch
Paul H. Rubin
There's nothing wrong with letting drug reps schmooze with doctors. What's the matter with Americans? They think there is something incestuous about the connection between drug companies and doctors.
Politicians tell them that the drugmakers wine and dine physicians while pushing the latest antibiotic or statin. Utterly corrupted, doctors impose those medications on patients, whether or not the drugs are better than cheaper alternatives.
A pending U.S. Senate bill would require drug companies to report gifts to doctors of more than $25; the House is investigating marketing practices. New York State's legislature plans to hold hearings this year on the relationship between doctors and drug companies. One congressional critic has even compared the drug industry with the tobacco industry, and Senator John McCain has called drugmakers the "bad guys."
What drugs are these legislators taking? Drug company reps offer overworked doctors useful, lifesaving information in an efficient manner. The drug companies are of course motivated by profit, but economists have known since Adam Smith that the profit motive is the best way to induce someone to do something useful. (Disclosure: I consult for the drug industry from time to time, most recently for Pfizer.)
Marketing and research are both information activities; they work together to get effective drugs to patients. The two activities are not in competition for resources. The denouncers of drug companies don't understand this. One of the senators sponsoring the bill suggests that "the millions of dollars these companies spend on marketing ... could be put into research." In fact, drug companies would not switch money from marketing to research. If they cannot market drugs in the best way, they will reduce spending on research. What's the point of inventing a new drug if doctors and patients don't know about it?
Academic physicians think that doctors should obtain information by reading medical journals. Practicing doctors do not have time to comb through the International Journal of Medical Sciences or the Annals of Internal Medicine. A meal with a pharmaceutical salesperson is a time-efficient way for a busy doctor to learn about new drugs, or perhaps a better therapeutic alternative, or a drug with easier dosing or fewer side effects than the old drug. Physicians interact with more than one drug rep, so they have competing sources of information.
Another argument made by supporters of the Senate bill is that promotion leads physicians "to prescribe the expensive new drugs that are being marketed to them when a more affordable generic would do," in the words of one senator. There are three things wrong with this argument. First, manufacturers of generics do not promote those drugs, so it might be
difficult for the physician to learn about generics at all. Second, new drugs lead to better health outcomes. They keep people out of the hospital. A 2007 study by business professor Frank Lichtenberg of Columbia University estimated that a prescription for a new drug (5 years from FDA approval) costs an average $18 more than an older one (15 years on the market) but reduces other medical costs, including hospital and office visits, by $129. Finally, by leading consumers to purchase newer drugs, marketing increases investment in innovation and thus makes research more likely.
A widely cited 2000 article in the Journal of the American Medical Association summarized 29 published studies critiquing the interaction between doctors and drug reps. Notable feature of these articles, as quoted in the summary paper: "No study used patient outcome measures."
That is, in all of the medical literature on drug sales, there was no evidence of harm to patients caused by doctors and drug reps breaking bread. These articles were written by physicians who by their oaths put patient welfare at the top of the list, but they were critical of the industry based on analyses that totally ignore this measure.
A recent report shows that the life expectancy of Americans is at its highest level ever and will continue to increase. It is truly amazing that this society keeps coming up with ways to demonize and penalize an industry that has provided us with so many benefits.
Here’s an (audio-only) link to last night’s NewsHour with Jim Lehrer, where I debated Gail Shearer of Consumer’s Union on the topic of pharmaceutical DTC advertising – and the specific debate swirling around Dr. Robert Jarvik’s inability to scull.
http://www-tc.pbs.org/newshour/rss/media/2008/02/07/20080207_jarvik28.mp3
Feedback, as always, welcome.
http://www-tc.pbs.org/newshour/rss/media/2008/02/07/20080207_jarvik28.mp3
Feedback, as always, welcome.
According to reports in the Bangkok Post, the World Health Organization led a mission (at the request of the new Thai government) to Bangkok to formulate a report on compulsory licensing and to provide technical advice on various aspects of TRIPS.
But the WHO team is likely to provide more than just “technical†assistance considering that the WHO’s new chief IP official is anti-industry ideologue German Velasquez.
Consider the article Velasquez penned in Le Monde diplomatique not so diplomatically entitled “Unhealthy Profits,â€
“After Doha, it is clear that if drugs are considered as goods, health will remain an extension of the market, with remedies and treatments available only to those with enough purchasing power.â€
Here’s a link to the complete article (in English):
http://mondediplo.com/2003/07/10velasquez
And here’s another reason to consider the WHO Bangkok mission as slanted -- there wasn’t a single representative from WIPO (the World Intellectual Property Organization).
Hello?
This is Geneva bureaucratic politics at its worst – and blatant disregard for the spirit of international cooperation in both protecting intellectual property rights and advancing public health.
But the WHO team is likely to provide more than just “technical†assistance considering that the WHO’s new chief IP official is anti-industry ideologue German Velasquez.
Consider the article Velasquez penned in Le Monde diplomatique not so diplomatically entitled “Unhealthy Profits,â€
“After Doha, it is clear that if drugs are considered as goods, health will remain an extension of the market, with remedies and treatments available only to those with enough purchasing power.â€
Here’s a link to the complete article (in English):
http://mondediplo.com/2003/07/10velasquez
And here’s another reason to consider the WHO Bangkok mission as slanted -- there wasn’t a single representative from WIPO (the World Intellectual Property Organization).
Hello?
This is Geneva bureaucratic politics at its worst – and blatant disregard for the spirit of international cooperation in both protecting intellectual property rights and advancing public health.
I find the hypocrisy on the Victoria Hampshire case amusing, predictable and disgusting. But it's just symptomatic of a larger trend fueled largely by hypocrisy.
Let's grant that Dr. Hampshire did find a serious problem with Pro-Heart and that Wyeth responded not by addressing the facts of the matter instead challenged Dr. Hampshire because she received $160 for prescribing a competitor's products through a website that gave her a cut of the drug sales.
Once the supposed "conflict" was identified, all the alarms went off at the FDA. Senator Grassley and the media depicted this as some sort of intimidation of a whistleblower.
How is Wyeth's behavior and the hell that Dr. Hampshire went through any different than when the roles reversed on any well meaning physician or researcher who follows the data but then is undercut by the COI canard? Is it only a COI when a drug company is involved?
How about this...recently the Josiah Macy Foundation released a report demanding that industry funded CME must end and that any academic who receives industry funding should be barred from participating in CME events because of this COI stuff.
Turns out that the report, was prepared as thecarlatblog.com notes by the brightest minds in medicine "The report was the product of a conference attended by many of the brightest minds in medicine", including Catherine DeAngelis, editor-in-chief of JAMA, David Blumenthal of Mass General and head of the Soros funded Institute on Medicine as a Profession which is leading the purge of academics who deign to work with industry; Harvey Fineberg, president of the Institute of Medicine, and David Leach, recent executive director of the Accreditation Council for Graduate Medical Education. Dan Duffy a senior adviser to the ABIM Foundation is a spin-off of the American Board of Internal Medicine, which profits from compulsory certification by internists and internal medicine subspecialists. As of 2005, the ABIM Foundation had over $60 million in its reserves, and its leadership has declared “professionalism,†as it defines it, as its mission.It was chaired by Suzanne Fletcher, emeritus primary care professor at Harvard Medical School
The conference was held in lovely Bermuda not in downtown Baltimore.
Next month, the IOM is holding a meeting on the issue of COI in CME as part of a study funded in part by...the Josiah Macy Foundation and the ABIM Foundation.
Last year the IOM held a meeting, also paid for, in part, by Macy and ABIM. Here were some of the participants:
Suzanne Fletcher
Dan Duffy
David Korn, VP for Research, AAMC and colleague of David A. Davis
Eric Campbell, Phd who works under David Blumenthal at the Massachusetts General Hospital -- and is also associated with the Soros funded IMAP -- where he regularly compiles based on surveys what physicians have what financial connections with industry. These surveys are also paid for by IMAP. High profile medical journals publish the data. The New England Journal of Medicine appropriately prevents him from interpreting the results, but in response to press inquiries he clearly imparts that these relationships are dangerous and was quoted comparing company gifts to physicians to baseball umpires being wined and dined by team management. The JAMA let him conclude that
“financial relationships are prevalent and therefore must be disclosed and managed.â€
Who is on the IOM Conflict of Interest Committee?
Eric Campbell for one.
Here is the sampling of the orientation of others on this supposedly objective panel:
Bernard Lo, MD, Chair. He is an ethicist from UCSF who participated in the 1990s Clinton health plan. He has not published extensively on FCOI, although he published a survey of FCOI policies in The New England Journal of Medicine in 2000 (“Conflict of interest policies for investigators in clinical trials†volume 343, pp 1617-1620). In that publication he states:
“We suggest that university-based investigators and research staff be prohibited from holding stock, stock options, or decision-making positions in a company that may reasonably appear to be affected by the results of their clinical research.â€
Robert P Kelch, MD, Executive VP, University of Michigan Health System whose last publication listed on Pub Med is entitled: “Maintaining the public trust in clinical research,†a summary in the New England Journal of Medicine in 2002 of the AAMC COI guidelines. Its conclusion states:
“One cannot work simultaneously as an inventor-entrepreneur and a physician or other health care provider and maintain the trust of patients and the public.â€
And my favorite:
George Lowenstein, PhD, Professor of psychology at Carnegie Mellon University and in the vanguard of the “social science research†that concludes physicians, contrary to their beliefs, do not know when they are being manipulated by sales techniques. At the AAMC symposium on “The scientific basis of influence and reciprocity†Loewenstein “stressed the following conclusions (pp. 23-24):â€
“Conflicts of interest will inevitably bias physician behavior, however honorable and well-intentioned specific physicians may be. Bias may distort their choices, or they may look for and unconsciously emphasize data that support their personal interests.
The only viable remedy is to eliminate COIs whenever possible – e.g. eliminate gifts from pharmaceutical companies to physicians. This should include gifts of any size, because even small gifts can result in unconscious bias."
So perhaps Dr. Hampshire was likewise suffering from unconscious bias or false consciousness. Or more generally, does that transcendent property only adhere to cash from drug firms and not trips to Bermuda from the same Foundation that is underwriting both the study designed to influence the IOM study and the IOM study itself?
As I have written before, the issue of COI is largely a red herring. COI is all about the Left's discomfort with perceived corporate influence in medicine. The giveaway of course is this absurd idea that doctors don't know when a pen will corrupt them psychobabble that is the scaffolding of this purge.
The compiling of gift and speaking registries, the movement to centralize all commercial support of research and education, conduiting it through central AHC administrations instead of to individual faculty members, ban all corporate samples and gifts to physicians and prohibit company sales representatives from visiting AHC faculty are all assaults on the free exchange of information and a threat to very canons of science. This assault on the free speech of academics -- which as I will show is nothing more than a thinly veiled and funded effort by trial attorneys to make it easier to sue doctors and overturn the FDA pre-emption doctrine with respect to what is on a drug label -- will not stand.
The Academic Senate of the University of California System, recently rejected such proposals (“Proposed Guidelines Regarding Vendor Relationsâ€), declaring them “vague, overbroad, addressing perceived rather than real concerns and in violation of academic freedom†(reported in Nature 448: 394, 2007). So to did the University of Medicine and Dentistry of NJ.
This is just the beginning of a fight to take back medicine from the ideologues and tort lawyers.
Ambrose Bierce defined hypocrisy as "prejudice with a halo." Exactly. Time to knock that halo off.
Let's grant that Dr. Hampshire did find a serious problem with Pro-Heart and that Wyeth responded not by addressing the facts of the matter instead challenged Dr. Hampshire because she received $160 for prescribing a competitor's products through a website that gave her a cut of the drug sales.
Once the supposed "conflict" was identified, all the alarms went off at the FDA. Senator Grassley and the media depicted this as some sort of intimidation of a whistleblower.
How is Wyeth's behavior and the hell that Dr. Hampshire went through any different than when the roles reversed on any well meaning physician or researcher who follows the data but then is undercut by the COI canard? Is it only a COI when a drug company is involved?
How about this...recently the Josiah Macy Foundation released a report demanding that industry funded CME must end and that any academic who receives industry funding should be barred from participating in CME events because of this COI stuff.
Turns out that the report, was prepared as thecarlatblog.com notes by the brightest minds in medicine "The report was the product of a conference attended by many of the brightest minds in medicine", including Catherine DeAngelis, editor-in-chief of JAMA, David Blumenthal of Mass General and head of the Soros funded Institute on Medicine as a Profession which is leading the purge of academics who deign to work with industry; Harvey Fineberg, president of the Institute of Medicine, and David Leach, recent executive director of the Accreditation Council for Graduate Medical Education. Dan Duffy a senior adviser to the ABIM Foundation is a spin-off of the American Board of Internal Medicine, which profits from compulsory certification by internists and internal medicine subspecialists. As of 2005, the ABIM Foundation had over $60 million in its reserves, and its leadership has declared “professionalism,†as it defines it, as its mission.It was chaired by Suzanne Fletcher, emeritus primary care professor at Harvard Medical School
The conference was held in lovely Bermuda not in downtown Baltimore.
Next month, the IOM is holding a meeting on the issue of COI in CME as part of a study funded in part by...the Josiah Macy Foundation and the ABIM Foundation.
Last year the IOM held a meeting, also paid for, in part, by Macy and ABIM. Here were some of the participants:
Suzanne Fletcher
Dan Duffy
David Korn, VP for Research, AAMC and colleague of David A. Davis
Eric Campbell, Phd who works under David Blumenthal at the Massachusetts General Hospital -- and is also associated with the Soros funded IMAP -- where he regularly compiles based on surveys what physicians have what financial connections with industry. These surveys are also paid for by IMAP. High profile medical journals publish the data. The New England Journal of Medicine appropriately prevents him from interpreting the results, but in response to press inquiries he clearly imparts that these relationships are dangerous and was quoted comparing company gifts to physicians to baseball umpires being wined and dined by team management. The JAMA let him conclude that
“financial relationships are prevalent and therefore must be disclosed and managed.â€
Who is on the IOM Conflict of Interest Committee?
Eric Campbell for one.
Here is the sampling of the orientation of others on this supposedly objective panel:
Bernard Lo, MD, Chair. He is an ethicist from UCSF who participated in the 1990s Clinton health plan. He has not published extensively on FCOI, although he published a survey of FCOI policies in The New England Journal of Medicine in 2000 (“Conflict of interest policies for investigators in clinical trials†volume 343, pp 1617-1620). In that publication he states:
“We suggest that university-based investigators and research staff be prohibited from holding stock, stock options, or decision-making positions in a company that may reasonably appear to be affected by the results of their clinical research.â€
Robert P Kelch, MD, Executive VP, University of Michigan Health System whose last publication listed on Pub Med is entitled: “Maintaining the public trust in clinical research,†a summary in the New England Journal of Medicine in 2002 of the AAMC COI guidelines. Its conclusion states:
“One cannot work simultaneously as an inventor-entrepreneur and a physician or other health care provider and maintain the trust of patients and the public.â€
And my favorite:
George Lowenstein, PhD, Professor of psychology at Carnegie Mellon University and in the vanguard of the “social science research†that concludes physicians, contrary to their beliefs, do not know when they are being manipulated by sales techniques. At the AAMC symposium on “The scientific basis of influence and reciprocity†Loewenstein “stressed the following conclusions (pp. 23-24):â€
“Conflicts of interest will inevitably bias physician behavior, however honorable and well-intentioned specific physicians may be. Bias may distort their choices, or they may look for and unconsciously emphasize data that support their personal interests.
The only viable remedy is to eliminate COIs whenever possible – e.g. eliminate gifts from pharmaceutical companies to physicians. This should include gifts of any size, because even small gifts can result in unconscious bias."
So perhaps Dr. Hampshire was likewise suffering from unconscious bias or false consciousness. Or more generally, does that transcendent property only adhere to cash from drug firms and not trips to Bermuda from the same Foundation that is underwriting both the study designed to influence the IOM study and the IOM study itself?
As I have written before, the issue of COI is largely a red herring. COI is all about the Left's discomfort with perceived corporate influence in medicine. The giveaway of course is this absurd idea that doctors don't know when a pen will corrupt them psychobabble that is the scaffolding of this purge.
The compiling of gift and speaking registries, the movement to centralize all commercial support of research and education, conduiting it through central AHC administrations instead of to individual faculty members, ban all corporate samples and gifts to physicians and prohibit company sales representatives from visiting AHC faculty are all assaults on the free exchange of information and a threat to very canons of science. This assault on the free speech of academics -- which as I will show is nothing more than a thinly veiled and funded effort by trial attorneys to make it easier to sue doctors and overturn the FDA pre-emption doctrine with respect to what is on a drug label -- will not stand.
The Academic Senate of the University of California System, recently rejected such proposals (“Proposed Guidelines Regarding Vendor Relationsâ€), declaring them “vague, overbroad, addressing perceived rather than real concerns and in violation of academic freedom†(reported in Nature 448: 394, 2007). So to did the University of Medicine and Dentistry of NJ.
This is just the beginning of a fight to take back medicine from the ideologues and tort lawyers.
Ambrose Bierce defined hypocrisy as "prejudice with a halo." Exactly. Time to knock that halo off.
In what one hopes will be the death knell for bloated one-size fits population approaches to designing individual treatment, the ACCORD study tried to see if getting everyone down to A1C level of 6 is better than a 7 when most diabetics have a tough time getting their A1C under control. Most people achieved the limit but in the process many high risk people who in the process of reducing their glucose levels suddenly died. The control group had fewer but more fatal heart attacks . That came with great effort on their part.
Some thoughts and observations:
1. After going through the 100 page protocol of the study and the ten year time frame you get the sense that if THIS is what comparative effectiveness research will look like, good luck. It will be a waste of time, money and effort compared to investing in research that attempts to figure out what is the best way to control or prevent disease in individuals.
2. Avandia is redeemed once again in a real world setting, such as it is. As the National Heart Blood and Lung Institute noted: Because of the recent concerns with rosiglitazone (Avandia), which is one of several medications used in ACCORD, researchers specifically reviewed data to determine whether there was any link between this particular medication and the increased deaths. To date, no link has been found. (For more on this issue, see http://public.nhlbi.nih.gov/newsroom/home/GetPressRelease.aspx?id=287 .)
3. But don't expect a mea culpa from Steven Nissen, the media or anyone else involved in this sorry story.
4. The Vice Chair of the Accord Steering committee? John Buse, the very same Buse that Senator Grassley and Rosa DeLauro are 'defending' against Dr. Yamada decade old criticism that Buse was way off base about the cardiovascular risks of....Avandia. Who owes who an apology?
5. Oh, The ACCORD trialists adjusted the protocols to ensure the trials met the endpoints. That is, it change how the trial was run to hit the A1C targets. Imagine if a drug company tried to do that!
Some thoughts and observations:
1. After going through the 100 page protocol of the study and the ten year time frame you get the sense that if THIS is what comparative effectiveness research will look like, good luck. It will be a waste of time, money and effort compared to investing in research that attempts to figure out what is the best way to control or prevent disease in individuals.
2. Avandia is redeemed once again in a real world setting, such as it is. As the National Heart Blood and Lung Institute noted: Because of the recent concerns with rosiglitazone (Avandia), which is one of several medications used in ACCORD, researchers specifically reviewed data to determine whether there was any link between this particular medication and the increased deaths. To date, no link has been found. (For more on this issue, see http://public.nhlbi.nih.gov/newsroom/home/GetPressRelease.aspx?id=287 .)
3. But don't expect a mea culpa from Steven Nissen, the media or anyone else involved in this sorry story.
4. The Vice Chair of the Accord Steering committee? John Buse, the very same Buse that Senator Grassley and Rosa DeLauro are 'defending' against Dr. Yamada decade old criticism that Buse was way off base about the cardiovascular risks of....Avandia. Who owes who an apology?
5. Oh, The ACCORD trialists adjusted the protocols to ensure the trials met the endpoints. That is, it change how the trial was run to hit the A1C targets. Imagine if a drug company tried to do that!
Check out today’s house editorial in the Washington Times, “Get out of the FDA's way.â€
Some tidbits to tantalize your interest …
In respect to the FDA’s Critical Path program and the Reagan/Udall Foundation:
“A program to establish guidelines on how to use genetic tests called biomarkers to predict who responds best to cancer drugs could be delayed for months as the foundation scrounges for money. Worse, Rosa DeLauro is on record as claiming biomarkers are weak measures of a drug's effectiveness even as the director of the NIH National Human Genome Research Institute, Dr. Francis Collins, hails them as the next revolution in medicine.â€
And as to where public opinion falls on this matter:
“Most Americans agree with Dr. Collins. A recent survey released by the Center for Medicine in the Public Interest found that nearly 90 percent of all Americans support the Critical Path Initiative and the development of biomarkers. But the congresswoman's attack on the FDA reflects poorly on both her political and scientific judgment. The FDA cannot meet its responsibilities if it has to protect itself from politicians like Rep. Rosa DeLauro.â€
Here’s a link to the complete editorial:
http://www.washingtontimes.com/article/20080207/EDITORIAL/47442621/1013/editorial
It's worth a look.
Some tidbits to tantalize your interest …
In respect to the FDA’s Critical Path program and the Reagan/Udall Foundation:
“A program to establish guidelines on how to use genetic tests called biomarkers to predict who responds best to cancer drugs could be delayed for months as the foundation scrounges for money. Worse, Rosa DeLauro is on record as claiming biomarkers are weak measures of a drug's effectiveness even as the director of the NIH National Human Genome Research Institute, Dr. Francis Collins, hails them as the next revolution in medicine.â€
And as to where public opinion falls on this matter:
“Most Americans agree with Dr. Collins. A recent survey released by the Center for Medicine in the Public Interest found that nearly 90 percent of all Americans support the Critical Path Initiative and the development of biomarkers. But the congresswoman's attack on the FDA reflects poorly on both her political and scientific judgment. The FDA cannot meet its responsibilities if it has to protect itself from politicians like Rep. Rosa DeLauro.â€
Here’s a link to the complete editorial:
http://www.washingtontimes.com/article/20080207/EDITORIAL/47442621/1013/editorial
It's worth a look.
Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.
