Schwitzer health news blog

A TV news role model dies

During my years at CNN, I had my problems with people on the assignment desk. But not with Bev Broadman - who actually listened - even with a phone in each ear. And who solved problems rather than causing them.

Bev died last week.

Others who knew her better, or at least more recently, have posted remembrances.

Anderson Cooper's post.

Bob Franken's post.

Best of all, though, is this video tribute on the CNN site, in which she was taped talking about "teamwork...not being a prima donna."

Great attributes sometimes lost in the glitter and glamour of TV news. Bev didn't care for the trappings - only for the news. What a role model for today's journalists - young and old.

The bandwagon for gastric banding

See "Industry Giants Push Weight Surgery" in the WSJ today.

Excerpts:

Medical-device makers, venture capitalists and surgeons are racing to turn gastric banding, a once-controversial weight-loss procedure, into the next big elective surgery in the U.S.

"There's no question that advertising and the commercialization of the band is what's driving it," says J.K. Champion, a bariatric surgeon in Atlanta.

Unlike the band makers, physicians and clinics can make advertising claims that aren't subject to the strict rules imposed by the Food and Drug Administration.

An end-run around the anatomy. An end-run around regulations. Fat chance this will stop anytime soon.

WSJ Health Blog's March Madness drug company CEO brackets

At a conference yesterday, Scott Hensley of the Wall Street Journal Health blog showed off a story I had missed. Since it's the last day of March and basketball's Final Four is now set, the time is just right to look at it. See the Journal's “Our March Madness: The Drug Company CEO Bracket”.

They explain:

Restless shareholders, listless labs and a tidal wave of generic competition confront the top executives at drug makers around the globe. Big Biotech has plenty of problems of its own. Did we mention pushback on prices?

So we wonder who among the leaders of the current executive pack will win the test of endurance to remain the last CEO standing? Take a look at our second annual bracket by clicking on the image at the right. Feel free to start your own office pool.

The posting is fun. It's interactive. You can vote on the poll. And the user comments are worth reading. One wrote: "A more relevant question is - which CEO has the most integrity?"

Top 5 reasons to question a new antidepressant

I just heard psychiatrist Dan Carlat give a talk that touched on Wyeth's new antidepressant Pristiq. Much of what he said is captured in a post on his terrific blog.

In short, here are his top 5 reasons to forget about Pristiq. You can read the details on his blog.

1. It’s a blatant patent extender.
2. It's not very effective.
3. It is not more easily dosed than Effexor XR (as the company claims).
4. It has no meaningful metabolic advantages.
5. Wyeth’s own lead investigator is unimpressed.

25 Shocking Facts About Pharma

The Nursing Online Education Database has posted an article entitled, "25 Shocking Facts About the Pharmaceutical Industry."

Here's a part of their list. You can read the full entries by going to their site.

• The price of drugs is increasing faster than anything else a patient pays for.
• Your doctor may have an ulterior motive behind your prescription.
• Pharmaceutical companies spend more on marketing than research.
• Brand name meds often have a 1,000% mark-up price.
• Drug reps often have no medical or science education.
• Pharmaceutical companies are helping, hurting the AIDS epidemics.
• Doctors can choose to reveal or keep private their prescription records.
• Good PR trumps patient care.
• Abbott Laboratories charged Medi-Cal nearly $10 for saline solution.
• Guilty of Medicare fraud: Pharmaceutical companies are also being tried in federal courts as an answer to their exploitation of Medicare.
• Combined wealth of top 5 pharmaceutical companies outweighs GNP of sub-Saharan Africa.
• Pfizer is fifth-best wealth creator.
• Americans pay more for prescription meds than anyone else in the world.
• "New" Drugs aren't really new:
• Some drug companies are taking advantage of underdeveloped countries to perform clinical trials.

Happy 10th Birthday to Assoc. of Health Care Journalists

The Association of Health Care Journalists is celebrating its 10th birthday. AHCJ has become a leader in quality improvement in health journalism - and a leader in the entire journalism industry.

That effort - and many others - like our University of Minnesota health journalism MA program - are striving to improve the flow of meaningful health and medical news information to the public.

Lord knows we need it.

Tobacco conflict of interest behind lung cancer study

Gardiner Harris of the New York Times has just raised important new questions about the integrity of pro-screening work promoted by a leading researcher and published by the New England Journal of Medicine. Excerpt of his story:

In October 2006, Dr. Claudia Henschke of Weill Cornell Medical College jolted the cancer world with a study saying that 80 percent of lung cancer deaths could be prevented through widespread use of CT scans.

Small print at the end of the study, published in The New England Journal of Medicine, noted that it had been financed in part by a little-known charity called the Foundation for Lung Cancer: Early Detection, Prevention & Treatment. A review of tax records by The New York Times shows that the foundation was underwritten almost entirely by $3.6 million in grants from the parent company of the Liggett Group, maker of Liggett Select, Eve, Grand Prix, Quest and Pyramid cigarette brands.

The foundation got four grants from the Vector Group, Liggett’s parent, from 2000 to 2003.

Dr. Jeffrey M. Drazen, editor in chief of the medical journal, said he was surprised. “In the seven years that I’ve been here, we have never knowingly published anything supported by” a cigarette maker, Dr. Drazen said.

Well, Dr. Drazen, knowingly or not, your journal did publish the work. Now what?

This should rock the world of medical science and medical journals.

Stay tuned. Kudos to reporter Harris for digging and shining light on this episode.

March madness in medical news on network TV

Reviews of network TV health news stories on HealthNewsReview.org so far in March would suggest it’s more like Halloween season than Easter. The stories have been so bad, it’s scary. Examples & excerpts:

Medical breakthrough? New procedure fights tumors
ABC's Good Morning America
March 18, 2008
Rating: 1 star

Excerpt of our summary: “This short story presents little in the way of useful information to the consumer. It does not adequately describe the availability of the treatment, the strength of the available evidence to support its use, or any harms of the procedure. The story does not quantify the benefits of the treatment nor does it adequately describe the advantages and disadvantages of the alternatives.

Furthermore, by using such terms as "breakthrough", "great success" and "promising", the story exaggerates what is and isn't known about the procedure and glosses over the fact that the studies have yet to be published in a peer-reviewed journal.”

Special candy fights cavities
ABC's Good Morning America
March 14, 2008
Rating: 1 star

Excerpt of our summary: “This was a 3-minute ad - not a piece of journalism. So much good can be done with 3 minutes of network TV time.

But this story failed to:

* discuss costs
* discuss evidence - of harms or benefits
* present any independent expert's opinion

It even featured the two co-anchors sucking lollipops at the very end. Wow.”

Decoding your DNA
NBC Today show
March 14, 2008
Rating: 1 star

Excerpt of our summary: “This is one example where even a low "one- star" ratings score is deceptively high. This story was lacking in many significant ways… News? Or advertising? If the former, it failed badly. If the latter, it was a steal - free, long, and unchallenged on network TV. We don't like using harsh terms in our reviews. We try to be constructive. At times like this it feels impossible.”

Breast Cancer Drug Good Later Than Thought
CBS The Early Show
March 11, 2008
Rating: 2 stars

Excerpt of our summary: “(The reporter did not) talk with oncologists who could put the study results in context. We are not told how results could alter clinical practice guidelines for women with early-stage breast cancer who have taken tamoxifen for 5 years. The cost of the drug is also not mentioned. Cost is an important consideration for women considering an additional multi-year therapy.”

A man's eye-opening surgery
March 4, 2008
NBC Today Show
Rating: 0 stars

Excerpt of our summary: “Its use of a dramatic stunt--a surgery done in real time with interviews before and after the procedure--implies the surgery is fast, uncomplicated and complete in a single session. This is not an accurate portrayal of the full treatment.

It uses a single surgery--done on an employee of the same TV network by a surgeon with a commercial interest in selling the device and procedure--to explain the procedure.

Whether the employee paid for this service or whether he received it free or at a discount is not known. If the patient has not paid full price as an independent consumer, his comments should not be considered objective. If he did pay full price, the network should have avoided even the perception of a conflict of interest by finding someone else to profile.

By creating a dramatic demonstration of a medical procedure and implying its success--without context, independent comment or reporting of potential harms and research findings--this segment violates almost every important principle behind responsible medical reporting.”

You can do a good job in covering health news on TV. These were not examples of that possibility.

Medical emergencies on commercial airlines

About two weeks ago my flight to Tampa was uneventful - until about the time we started our approach for landing. A flurry of activity among the flight attendants was quickly followed by an announcement from one of them that someone on board was having a heart attack. Then, several minutes later, one of the flight attendants rushed quickly up the aisle, announcing out loud as she passed my row - "Now we've got another one!" Two heart attacks in perhaps two minutes on one plane?

I let privacy concerns over-rule curiosity and didn't look back to verify what was going on. Nor did I follow up with the airlines about that incident.
That same week, the BMJ cover was headlined "In-Flight Emergencies." A physician's article, "A wing and a prayer: the tale of an in-flight emergency," was one feature. In it, he argues that emergency protocols should be upgraded on all airlines. In his experience of trying to help a man with chest pain on a flight to Africa, he said the onboard medical equipment was limited and the crew mishandled the evacuation of the patient from the plane after landing.

Another feature in that week's BMJ analyzed how common in-flight medical emergencies are and what doctors are expected to do in such circumstances.

Then, about 11 days ago, USA Today published a long and thoughtful piece "on the growing number of medical emergencies on commercial jets, a trend that largely has escaped public notice because airlines aren't required to report such incidents."

For one who never saw the movie, "Snakes On A Plane," with no intention of ever doing so, real life is dramatic enough.

Mudslinging? Does "metabolic syndrome" mean anything?

There's another important debate in the BMJ this week. The question is: Should medicine dump the "metabolic syndrome"?

The American Heart Association states on its website:

The metabolic syndrome is characterized by a group of metabolic risk factors in one person. They include:

* Abdominal obesity (excessive fat tissue in and around the abdomen)
* Atherogenic dyslipidemia (blood fat disorders — high triglycerides, low HDL cholesterol and high LDL cholesterol — that foster plaque buildups in artery walls)
* Elevated blood pressure
* Insulin resistance or glucose intolerance (the body can’t properly use insulin or blood sugar)
* Prothrombotic state (e.g., high fibrinogen or plasminogen activator inhibitor–1 in the blood)
* Proinflammatory state (e.g., elevated C-reactive protein in the blood)

People with the metabolic syndrome are at increased risk of coronary heart disease and other diseases related to plaque buildups in artery walls (e.g., stroke and peripheral vascular disease) and type 2 diabetes. The metabolic syndrome has become increasingly common in the United States. It’s estimated that over 50 million Americans have it.

In the BMJ this week, diabetes and metabolism specialist Edwin Gale says YES, the metabolic syndrome should be dumped, claiming that this "diagnosis" has little practical value.

But clinicians George Alberti and P Z Zimmet say NO - it should not be dumped because it increases the detection of people at high risk of diabetes and heart disease. They characterize the syndrome’s critics as living in a specialized academic world, out of touch with the "real world" of primary care.

BMJ editor Fiona Godlee writes:

"Is there anything edifying in this refined form of mud slinging? The BMJ invites the combatants into the pit (though we do ask them to bring their own mud), so it’s fair to assume we think there is, even though the 7th century Chinese sage Seng Ts’an said "The struggle between ‘for’ and ‘against’ is the mind’s worst disease." I for one came away from reading these two well argued pieces with a conclusion (and you will no doubt draw others). Since there is uncertainty as to whether it’s clinically useful for GPs to measure people’s waists, we need a randomised trial. Alberti and Zimmet say that focusing on the syndrome results in better management of people with type 2 diabetes, but they give no reference so I assume no "real world" trial has yet been done."

I applaud the BMJ for fostering this debate. In another part of her editor's note, Godlee notes:

We must constantly doubt the products of academia—Robert Merton called this "organised scepticism."

Sounds better than mudslinging.

Pfizer Enlists a Labor Union (SEIU) to Promote Lipitor

On her terrific Health Beat blog, Maggie Mahar reports:

A couple of weeks ago Dr. Alicia Fernandez, an associate professor of clinical medicine at UC San Francisco, received a very unusual letter from The International Association of EMTS and Paramedics, an affiliate of The National Association of Government Employees (IAEP/SEIU).

The letter began by noting that Fernandez is part of the union’s approved physician network, and then launched into what can only be described as a shameless sales pitch for Lipitor, Pfizer’s blockbuster cholesterol-lowering drug.

First, the alarming statistics presented in the letter:

* 1 in 3 adults has some form of CVD (cardio-vascular disease)
* About every 26 seconds, an American will suffer a coronary event
* Stroke is a leading cause of serious, long-term disability in the United States
* Every 45 seconds, someone will suffer a stroke.

Then, the endorsement: “Lipitor is available to our members through their prescription plan. IAEP leadership stands behind LIPITOR as the lipid-lowering agent of choice when it is prescribed by a physician. This confidence in LIPITOR is based on its proven efficacy and is supported by its vast clinical experience of more than 15 years…"

The letter went on, at length, to praise Lipitor’s benefits and to downplay the drug’s risks. In clinical trials, the letter states, “the most common adverse events were constipation, flatulence, dyspepsia and abdominal pain.” But while other risks may not be as “common” they are certainly worth mentioning. They include memory loss which can look like Alzheimer’s and severe muscle pain.

A few days ago, Fernandez received a second, identical letter. Never before in her professional experience had she received a drug ad from a union.

“I’ve never seen anything like this. I’ve never seen Labor endorse a drug product,” she told me. “This is incredible.” Unfortunately, Fernandez adds, this is not the first time that she has seen a drug company use a progressive organization to promote its product. ...

Why would Pfizer need the union’s help in peddling its drug? Lipitor, after all, is the best-selling drug in the world, with sales of almost $13 billion in 2006.

But recently, Lipitor has been attracting some decidedly negative publicity.

Read her blog for the rest of the entry. Drug promotion becomes curiouser and curiouser.

Nasty bloodsucking bedbug epidemic revisited

Just a few days after I blogged about hype of the "nasty bloodsucking bedbug epidemic," now the Wall Street Journal has a big spread, proclaiming:

Several years after Americans woke up to a bedbug problem, the pest-control industry is rolling out an arsenal of methods that promise an easy yet thorough assault on the bloodthirsty pests.

Hmmm. Is there a public relations campaign underway putting bed bugs and new products on our radar screen?

Laws to overcome Pharma's influence

Two items in the news recently highlighted proposed legislation to limit the influence of drug companies on physicians - and therefore, on consumers as well.

The Boston Globe reports on a proposed state law that would ban all gifts to doctors from drug companies.

"Other states have passed laws attempting to limit the pharmaceutical industry's influence. In Minnesota, legislators enacted a ban on gifts in excess of $50 from pharmaceutical companies. In Vermont, legislators have passed laws requiring pharmaceutical company representatives to disclose the dollar value of gifts over $25 to doctors. Peggy Kerns, director of the ethics center at the National Conference of State Legislatures in Denver, said Murray's legislation is the first attempt at an outright ban on gifts to doctors that she had heard of."

Then, the Integrity in Science Watch project reports that:

Legislation that would send government-funded educators into doctors’ offices with independent information about prescription drugs received a boost last week at a Senate Committee on Aging hearing. “Pharmaceutical sales reps (known as detailers) are currently one of the only ways doctors can learn about the latest drugs on the market,” said Sen. Herb Kohl (D-WI). “These sales reps often confuse educating with selling, and evidence shows that doctors’ prescribing patterns can be heavily influenced by the biased information often put forth by these sales representatives.” Experimental programs that send scientific professionals with clinical training into physicians’ office to provide them with objective, unbiased information – sometimes known as academic detailing – are now underway in five states and the District of Columbia. Kohl and Sen. Dick Durbin (D-IL) will introduce legislation that would create a federal academic detailing program later this spring.

The program is a potential moneysaver for the federal government, which added a senior citizen drug benefit to Medicare in 2003 and spent an estimated $47 billion on the program last year. Pennsylvania’s academic detailing program reduced the total cost of patient prescription by $60 per physician in the six months after an academic detailer’s visit, according to Nora Dowd Eisenhower, head of the state’s Department of Aging. Jerry Avorn of Harvard Medical School told the committee that an experimental academic detailing program that reached 400 doctors in four states saved $2 for every $1 in costs. “Research has shown that when doctors have full access to comprehensive and unbiased data on all the drugs available, they prescribe the best drug--not just the newest one--and healthcare spending is lowered,” said Kohl. The pharmaceutical industry spends an estimated $7 billion a year on direct-to-physician marketing, employing over 80,000 detailers to reach the nation’s 700,000 practicing physicians.

Newspaper lets hospital buy news coverage

I've blogged in the past about TV news operations accepting sponsored news deals with local medical centers. In these deals, oftentimes the news only includes perspectives from that sponsoring hospital.

Now, in the first instance I'm aware of, the trend has come to newspapers. The HometownAnnapolis.com website of The Capital newspaper yesterday announced:

Partnership should improve health coverage

Published March 16, 2008
By TOM MARQUARDT

In today's editions we are experimenting with a new concept that could alarm some readers: Anne Arundel Medical Center, or AAMC, has paid us to provide content for our Health & Fitness page once a month.

Newspapers don't normally sell access to news pages, and certainly we would not give away content privileges on any other news page. I'm sure County Executive John Leopold would love to have his staff write the stories for the front page, but that's not going to happen for any price.

But partnering with the hospital on the Health page seemed to make sense. We don't have a health reporter to write about medical issues and often use stories from syndicated services that quote doctors from other cities.

The local hospital is giving us stories about local physicians and programs it has to offer - in their words, without an effort to balance the copy with comments from other hospitals or from doctors who don't practice at AAMC.

The stories are written in newspaper style and the hospital staff is responsible for the page's design. To be open and transparent about the partnership, a disclaimer is clearly displayed at the top of the page.

I'm not entirely comfortable with the arrangement, purely for journalistic reasons. But in the end I think the reader benefits - and that's my goal.

Instead of generic stories originating from another city, the reader will have local news featuring people they recognize, doctors they use and services that are available to them. The hospital staff is getting to the stories we are not able to write because of other priorities.

Is the page more readable now? You tell me.

Wow. "Partnering" - or being paid by a hospital to provide their news? Actually, he calls it content, not news. Whew. Because we used to call that advertising.

Also a relief - "the stories are written in newspaper style and the hospital staff is responsible for the page's design." So they'll look professional! Just like, or maybe even better than, real news.

And who cares if we give readers only one side of a story? Maybe a side that is so incomplete it can hurt them? And so what if we don't disclose the financial conflicts of interest of the doctors who might appear in the stories written and designed by the hospital itself? And so what if there are other opinions or other approaches from other doctors on the other side of town that don't get covered?

The main thing is: "Is the page more readable now?"

Troubling questions about failure to disclose conflicts of interest

The Cancer Letter (subscription required), a terrific publication about federal cancer policy and funding, opens new questions about disclosure of conflicts of interest in this country.

The Integrity in Science Watch project summarized it this way:

In the wake of allegations that a prominent lung cancer researcher failed to disclose a patent licensed to General Electric on interpreting CT scans in an article that claimed early CT scanning could substantially reduce lung cancer mortality, the New England Journal of Medicine last month ruled the patents “not relevant” to the subject of the article and refused to print a correction. Now, a follow-up investigation by the Cancer Letter, an industry newsletter, uncovered numerous instances when Weill Medical College researcher Claudia Henschke failed to disclose the patents in a series of continuing medical education (CME) seminars, including one held by the Radiological Society of North America (RSNA) a month after the article appeared in October 2006. The NEJM article could also be read for CME credit.

The Accreditation Council for Continuing Medical Education in 2005 adopted strict rules for disclosing granted and pending patents held by any presenter at a CME activity. “Royalties by themselves establish the financial relationship of the person with a commercial interest and create the potential for conflict of interest. Therefore, the relationship is relevant in CME,” Murray Kopelow, the chief executive of ACCME, told the Cancer Letter. The Center for Science in the Public Interest later this week will ask the ACCME to order all the CME providers where Henschke failed to disclose to send proper disclosures to anyone who participated in those activities. And Sen. Charles Grassley (R-IA) said he plans to launch a Congressional inquiry in physician patenting activity. “It’s becoming clear that patents and royal payments to doctors deserve a lot more scrutiny from Congress, the FDA, professional journals and other watchdogs,” Grassley said.

This one is complex - involving researchers' disclosure, medical journals' policies, and the whole big, murky mess of continuing medical education.

And it's important - for the sake of honest, transparent, open disclosure of questions at the very heart of the integrity of scientific medical research.

Kudos to the bulldogs at the Cancer letter, who say that although their publication is subscription only, they'll send this particular article to any interested party if you e-mail them at: kirsten@cancerletter.com or paul@cancerletter.com.

Medicare to pick up tab for more heart scans

Earlier this week, Merrill Goozner may have given us the spot-on scary political reality when he put his touch on the story of Medicare approving new payments for expensive heart scans. Excerpt:

I suspect there will be a lot more of these decisions over the next nine months as Bush administration appointees hoping to line up their next jobs grant top-of-the-wish-list favors to special interests.

The New York Times website reported Wednesday that the Center for Medicare and Medicaid Services has reversed a proposed policy to cut off paying for heart scans, which can cost $600 or more. The preliminary decision announced last December found no clinical evidence that heart scans identify heart disease any better than other non-invasive procedures, like a stress test. According to the paper:

Medicare’s initial proposal, which would have ended payment for the scans unless the patients were enrolled in studies to determine the technology’s effectiveness, had met with fierce resistance from the doctors who perform these scans and the companies that make the equipment. They strongly defended the use of these scans as an important alternative to traditional angiography. ...

Lobbying by docs and equipment makers. Pay first, evidence later. It's the American way.

Sleep may be not be the big problem special interests claim it is

I've blogged about the cloud of doubt that should hang over the annual proclamations made by the National Sleep Foundation during the highly-promoted National Sleep Awareness Week. The reason: special interests like sleeping pill makers fund the effort.

Now the Washington Post reports:

Americans are not as sleep-deprived as they think they are and, in fact, appear to be getting more Z's these days than they got a few years ago, according to an independent analysis of government statistics.

The new findings run counter to the widespread public perception that Americans are getting less and less sleep because of increasing workplace demands and the plethora of distractions available around the clock on the Internet and cable television.

"Many Americans work too much, but most do not seem to be cutting corners on their sleep to do so," said John P. Robinson, a sociologist at the University of Maryland, who led the analysis with faculty colleague Steven Martin.

Their report, "Not So Deprived: Sleep in America, 1965-2005," scheduled for release by the university today, finds that Americans on average got 59 hours of sleep per week in 2005, the latest year for which precise statistics are available. That is three hours more than in 2000.

The new numbers contrast significantly with the 2008 "Sleep in America" poll, the oft-quoted survey conducted annually by the Washington-based National Sleep Foundation, which advocates for better diagnosis and treatment of sleep problems.

Released last week, that survey concluded that Americans get an average of 48 hours of sleep per week.

The difference, experts said, reflects the two groups' methodologies. The Sleep Foundation survey asks Americans to estimate how much sleep they typically get. By contrast, the Maryland analysis draws upon detailed "time-use" data collected by the U.S. Census Bureau for the Department of Labor Statistics. In that approach, individuals must account for every minute of the previous day.

"This gives us a much better picture of where the time goes than when people just make an estimate," Robinson said.

The nasty bloodsucking bedbug epidemic

If you survived the last TV ratings period and DIDN’T see a story about the horrible epidemic of bedbugs right in your town - maybe right in your own bed - then just stay tuned until the next sweeps period.

David Segal of the Washington Post was on NPR’s “On the Media” program talking about the hyperbolic news coverage of the bedbug panic.

2008 Poynter Ethics Fellows

I may be a bit slow in blogging this week.

I'm one of the 2008 Ethics Fellows of the Poynter Institute in St. Petersburg, Florida. We're in the midst of a week-long dive into the deep end of journalism ethics decision-making.

I'll be sharing some lessons from this terrific workshop in the weeks to come. And I'm thankful for the opportunity to think and study alongside some caring and dedicated journalists from across the country.

The butterfly in your bedroom

Just as the nation awakes from another National Sleep Awareness Week, funded in part by sleeping pill manufacturers (a fact often not reported by journalists who dutifully report from the news release), we are reminded of rising sleeping pill usage patterns.

The Wall Street Journal reported last week:

"The increased use of sleeping pills has “been particularly sharp for young adults,” William Marder, SVP and general manager of Thomson Healthcare, told the Health Blog. A lot of the uptick, he said, is driven by the availability of newer sleep aids, such as Sanofi-Aventis’ Ambien and Sepracor’s Lunesta."

That would be the same Ambien and Lunesta that have been so heavily advertised on TV and in print, perhaps making sleep pill use appear to young people like it's a harmless trip to butterfly land.

How much will we spend for so modest a benefit?

A great letter to the editor appeared in the Wall Street Journal yesterday:

I am still trying to recover from the Food and Drug Administration's recent decision to go against its advisory panel's recommendation and approve Avastin to treat advanced breast cancer ("Genentech Clears Hurdle on Cancer Drug Avastin," Leading the News, Feb. 23).

Although Avastin is ushering in a new wave of "targeted" cancer therapies, which minimize the gut-wrenching side-effects that many of us previously endured with our cancer treatment, the cost to our health-care system is astronomical. What is the true cost of this drug? While the average charge a provider may pay for Avastin may be $7,700 a month, it certainly isn't what a patient is billed. My experience in reviewing hundreds of medical claims involving Avastin shows that the average monthly patient charge when given in an oncologist's office is closer to $18,000 a month, while many hospitals charge more than $35,000 a month. With 38,000 American women eligible for this drug and an average treatment of six months, we suddenly have several billion dollars added to our annual health-care tab.

If the FDA has been given the power to make decisions that have such huge ramifications, it must be accountable for the cost-benefit ratio of these decisions. In this case, a study showed there was no survival benefit yet the cost will be billions of dollars per year. Is there any wonder why our health-care expenditures are expected to double to over $4 trillion within 10 years?

Peter S. Dumich, M.D.
Augusta, Ga.

We don't know jack

Journalists Jeanne Lenzer and Shannon Brownlee have a column in this week’s BMJ, “Do we really know the truth about antidepressants?” But the question could be applied to any drug on the market.

They explain that not all drug trials have to be registered and access to full data is constrained by trade secrecy laws that permit companies to withhold all information about drugs that do not win approval for a new indication, even when the drug is already on the market for other indications.

Trade secrecy protection?

Where does consumer protection enter in?

Why aren’t these failed trials made public?

It’s a very thoughtful piece by two of this country’s best health journalists.

Four related stories in one day – impact of the drug ad assault

In an interesting piece of work, MIT’s Dan Ariely reports on research that suggests that people given identical pills receive greater pain relief from the one they think costs more. He says this might explain why people lack confidence in generic pills and believe that more expensive brand name equivalents work better.

Meantime, Reuters reports that generic drug use may have slowed the growth of U.S. prescription drug costs last year to its lowest level in more than a decade.

However, USA Today reports that drug ads are pushing more Americans to ask their doctors about drugs that are advertised. And, as a result, more docs are then recommending prescriptions.

And the Associated Press reports:

“In a David vs. Goliath battle, Pennsylvania is among a handful of states trying _ with modest results at best - to counter the pharmaceutical industry's multibillion-dollar marketing and cut costs for prescription-aid programs for senior citizens, who are bombarded with "ask your doctor" advertising.”

More on news organizations promoting unnecessary testing

A physician who teaches evidence-based medicine, and who is also a freelance health journalist, has been reading my thoughts about journalists advocating screening tests in the absence of evidence.

She wrote me: "Here's one of the more annoying recent examples, one that I actually used in class to illustrate the issue of patients coming in and requesting specific tests based on what they read in the newspaper."

So I'm adding Parade Magazine to my list of offenders.

Here we go again - another industry-funded Sleep Awareness Week

Don't let the special interest campaign catch you napping!

Dozens upon dozens of stories about Americans lacking sleep are popping up from news organizations all over the country this week, driven by another of the National Sleep Awareness Week campaigns of the National Sleep Foundation.

Few - if any - of these stories will tell you that it is industry special interests - sleeping pill makers, sleep labs, mattress makers - who are paying for this campaign. They do it every year. And news organizations fall into line like sheep and report the "new" findings every year.

Examples:

USA Today reports:

U.S. workers are silently suffering from a dramatic lack of sleep, costing companies billions of dollars in lost productivity, says a study out Monday.

Nearly three in 10 workers have become very sleepy, or even fallen asleep, at work in the past month, according to a first-ever study on sleep and the workplace by the non-profit National Sleep Foundation. The late-2007 survey was based on a random sample of 1,000 workers.

AP reports:

Hey you! Dozing at your desk! Wake up, go home and get more sleep! That could be the message from a survey released Monday by the National Sleep Foundation. The survey of 1,000 people found participants average six hours and 40 minutes of sleep a night on weeknights, even though they estimated they'd need roughly another 40 minutes of sleep to be at their best.

CNN, WebMD, UPI, the St. Louis Post-Dispatch and many, many more news organizations are reporting the same stuff - handed to them by the industry-funded campaign.

Yawn.

Wake me when the next disease-mongering campaign comes around.

What is there to debate about medicine's conflicts of interest?

As proof that you can foster debate over just about anything, the BMJ hosts a journal debate over the question of "Has the hunt for conflicts of interest gone too far?"

Harvard professor Thomas Stossel says "Yes," arguing that restrictions on doctors’ and academics’ interaction with commercial companies are damaging research.

But UCSF professor Kirby Lee says "No," believing that scrutiny of potential conflicts of interest is a price worth paying to maintain public trust.