At Undark, Ronnie Cohen writes—Policing Big Pharma’s Influence Over Doctors’ Treatment Guidelines. Pharmaceutical companies often fund clinical trials and sponsor physician lectures and travel. How does that affect what we’re prescribed?
DR. SAMIR GROVER was taken aback when, early in his gastroenterology career, he saw one physician speak two times and present contradictory conclusions about the same medication. Each time, the speaker presented identical data on a drug used to treat inflammatory bowel disease. First, he recommended the pharmaceutical. A week later, he deemed it ineffective. “How could this exact same data be spun in two very different ways?” asked Grover, a professor at the University of Toronto. One fact did change — the drug manufacturer that sponsored and paid for the lecture.
It’s no secret that drug makers pay doctors to hype their products to other doctors. But few outside the halls of hospitals witness physicians bending a single set of facts in opposing ways. After watching similar acts of statistical wizardry throughout his nine years of medical practice, Grover set out to investigate a more sweeping question about conflicts of interest. Do they infect clinical practice guidelines? Professional societies produce thousands of these documents every year. They steer the decisions of health care professionals and insurance companies about how to prevent and treat an ever-widening range of conditions — from diabetes, hypertension, and heart disease to arthritis, hepatitis, cancer, and depression.
Grover and his colleagues’ paper and a companion study recently published in JAMA Internal Medicine suggest that simply following clinical practice guidelines could lead doctors — even those who shun all industry gifts — to unwittingly dispense financially tainted medicine. More than half of the authors of guidelines examined in the two studies had financial conflicts of interest. In many cases, the doctors who wrote the guidelines were paid by the same companies that produced the drugs they recommended. In addition, a significant portion of the doctors who took pharmaceutical money failed to disclose the payments, many of which amounted to $10,000 or more.
The consequences of financial entanglements can be profound, warned Dr. John P.A. Ioannidis, a professor at the Stanford University School of Medicine. “Writing guidelines is like prescribing something to millions of people,” he said. For their part, medical societies acknowledge the need for impartiality in the guideline-development process. Yet many view the task of disentangling industry from clinical practice guidelines as challenging, maybe impossible. Grover believes that panels can do better, particularly when it comes to disclosing conflicts. Still, he said, “it would be very hard to find experts, particularly for high-grossing medicines, to be completely devoid of conflict.” […]
“When any creativity becomes useful, it is sucked into the vortex of commercialism, and when a thing becomes commercial, it becomes the enemy of man.”
~~Arthur Miller, The New Yorker, September 16, 1961
On this date at Daily Kos in 2007—The Wages of Bigotry:
When they’re trying to get you to vote for that referendum that bans same-sex marriage*, they tell you that it’s all about The Sanctity of Marriage, and Protecting Religious Freedom, and that of course it’s not about Screwing Over Gay People. It’s not going to disenfranchise anyone, they say—it’s about setting some common-sense limits.
Actions have consequences, though, and the people of Michigan are about to realize that their 2004 vote to prohibit same-sex marriage did, in fact, relegate an entire class of citizens to permanent second-class status. Because the Michigan Court of Appeals held today that the gay marriage ban also bans same-sex domestic partner benefits. […]
So even a quasi-autonomous public entity like the University of Michigan is now prohibited from offering some of its top employees domestic partner benefits. Unmarried opposite-sex partners, of course, can continue to enjoy the benefits. But gay employees and their families are SOL, even if they’ve been receiving family benefits for years. Is that what Michiganders expected when they passed their marriage ban? Who knows. But regardless of what they expected, this is what you actually get when you vote for a feel-good “protection of marriage” referendum. No matter what its purveyors tell you, if you read it closely enough, somewhere buried in the fine print, you’ll find the wages of bigotry. Today, we’re reminded that they eventually come due.