An AP story wraps this into the historical context of the highly-criticized AMA-Sunbeam deal and the American Academy of Pediatrics-infant formula deal.
And the story states: "The Coke deal is not the only corporate alliance for the family physicians group. In 2005 it received funding from McDonalds for a fitness program. And its consumer Web site includes advertising for a variety of products, including deli meats and air freshener."
I've told my students that covering health care conflicts of interest could be a fulltime beat - and you still wouldn't keep up.
In the first half of this year, the drug giant Eli Lilly paid 3,971 doctors and other medical professionals an average of about $11,230 each. The payments were for participating in an average of 12 speaking or consulting engagements during those six months, according to a company spokeswoman.
Dr. Manoj V. Waikar, for example, a physician among the top five earners this year, received $74,850 for consulting and speaking at 51 events, according to Lilly's on-line faculty registry. The company caps payments at $75,000 for each health care provider in any calendar year.
He's an adjunct instructor at Stanford. Stanford's ban on regular faculty members participating in drug company speakers' bureaus doesn't apply to adjuncts - as long as they're not using the Stanford name.
As blogger Merrill Goozner writes:
Waikar gave 51 talks last year to earn that $75,000. That's one a week, week after week, all year at $1,500 a pop. Think about it. Same slides, same talk. Just show up for two hours and the check is in the mail. Do that for three companies and you're earning over $200,000 annually. And you were wondering how the man earns a living on an adjunct faculty's salary.
Meantime, it doesn't take the NY Times to dig into conflict of interest issues. A student journalist with the Minnesota Daily points out how medical students receive free textbooks from drug companies promoting their products. Case in point: an otolaryngology text given out by a company making an ear infection drug - with the company's logo on it, and with the beginning of each chapter crediting the drug company.
The student journalist also pointed out that the University of Minnesota has no policy to ban such practices.
It's good that this student journalist starts looking at conflict of interest issues now. If she stays on this beat, she's going to be busy on COI stories for a long time.
The Atlanta Business Chronicle reports that some physicians are discontinuing membership in the American Academy of Family Physicians over the previously-discussed Coke deal.
An article in PLoS Medicine by David Henry, Lisa Bero, Ray Moynihan and colleagues analyzes Australia's move to require disclosure of medical industry funding of any event. Their summary points:
* There are moves internationally to ensure greater disclosure of gifts and educational events for doctors paid for by pharmaceutical manufacturers. However, there is no agreement on appropriate standards of disclosure. In Australia, since mid-2007, there has been mandatory reporting of details of every industry-sponsored event, including the costs of any hospitality provided.
* Examination of the Australian data shows that although expenditure at individual events is often modest, cumulative expenditure is high, particularly in the case of medical specialists prescribing high cost drugs--oncologists, endocrinologists, and cardiologists.
* Although a significant advance, the new Australian reporting standards do not allow assessment of the educational value of sponsored events, and do not include details of speakers or educational content for most events. However, doctors in training are often present at these events.* At present, the standards of disclosure are inadequate and should not be tied to an arbitrary monetary value of gifts or sponsorship. Reporting standards should require the names of the speakers presenting, whether sponsors played a role in suggestion or selection of speakers or the development of the content of presentations, and the nature of any direct or indirect financial ties between the speakers and the sponsors.
Last month we alerted you to news that the American Academy of Family Physicians had a six-figure deal with Coke to "develop consumer education content on beverages and sweeteners for its consumer-oriented website, FamilyDoctor.org."
Well, that deal doesn't sit well with all docs. One has started a Facebook petition to end the deal. His stated mission:
Coca Cola does not deserve to be in a partnership with family medicine, when their marketing and business practices promote obesity in our patients. I want my Academy to end this agreement.
Released in the New England Journal of Medicine today:
With this editorial, which is being published simultaneously in all International Committee of Medical Journal Editors (ICMJE) journals, we introduce a new disclosure form that has been adopted by all journals that are members of the ICMJE. We encourage other journals to adopt this reporting format, and we are placing the form in the public domain.
We ask authors to disclose four types of information. First, their associations with commercial entities that provided support for the work reported in the submitted manuscript (the time frame for disclosure in this section of the form is the life span of the work being reported). Second, their associations with commercial entities that could be viewed as having an interest in the general area of the submitted manuscript (the time frame for disclosure in this section is the 36 months before submission of the manuscript). Third, any similar financial associations involving their spouse or their children under 18 years of age. Fourth, nonfinancial associations that may be relevant to the submitted manuscript.
We saw it in Minnesota. Now John Fauber continues his excellent work on the topic for the Milwaukee Journal-Sentinel, raising questions about what the U of Wisconsin med school has done, "allowing orthopedic surgeons and other doctors who implant devices to earn large sums of money making presentations for medical device companies."
Liz Kowalczyk of the Boston Globe reports:
At least 60 Massachusetts doctors collectively have earned more than a half-million dollars this year as speakers paid by pharmaceutical giant Eli Lilly & Co. - including two Boston Medical Center physicians whose participation is being reviewed for possible violation of a hospital policy against marketing activities by its doctors. ...
Hospital spokeswoman Gina Digravio initially told the Globe last week that the two doctors did not violate the hospital's policy, because they said they "fully determined their presentations.'' The two-year-old rule bars doctors from giving industry-sponsored talks unless the "lecture's content, including slides and written materials, are determined by the clinician.'' Lilly, however, says on its website that it alone provides the information presented by speakers. Spokeswoman Carole Puls said the company provides slides and other materials.Later in the week, the hospital revised its position, saying, "we have instructed the doctors to refrain from any further presentations pending a review by the medical campus provost.''
As Merrill Goozner points out on his blog, this is:
"a story we should see in abundance if Congress passes the Physician Payments Sunshine Act, which is in the House and Senate versions of health care reform legislation. ...
The story was made possible by the fact that Lilly is one of the first companies to voluntarily list physician payments on its website. Enterprising reporters in other parts of the country should take note, especially as more companies move to put their disclosures online."
Psychiatrist Daniel Carlat has been blogging this week about drugmaker Schering-Plough making "aggressive use of hired guns to get psychiatrists to prescribe its new antipsychotic" SAPHRIS (asenapine) for the treatment of both schizophrenia and bipolar disorder.
Carlat writes:
"Oddly, the company just sent me a SAPHRIS Speaker Bureau invitation packet. I guess my 2007 New York Times Magazine memoir describing the tangled ethics of promotional speaking has not yet become required reading at Schering-Plough. ...
They offered me $170,000 for 125 presentations (of 45 minutes each)...What a fiasco for the company. Talk about a bad stumble as they are about to launch their new antipsychotic. I haven't heard any official Schering-Plough comment on this matter yet, but here is how I predict the statement will read: "Speaker programs are intended to enhance a healthcare professional's knowledge and patient care expertise." Wait--they can't use that line, because it was already used by Eli Lilly. I guess they'll have to make up their own sophisticated BS."
How (im)pure is continuing medical education and the marketing of drugs to physicians?
See the New York Times piece and Dan Carlat's blog perspective on the marketing of the antidepressant Lexapro.
While many news organizations will undoubtedly report on positive news for the drugs known as aromatase inhibitors for breast cancer because of a study in this week's New England Journal of Medicine, few will probably pick up on a letter to the editor of the Annals of Oncology raising questions about aromatase inhibitor recommendations.
Päivi Hietanen of the Finnish Medical Journal wrote the letter. Hietanen asks if an expert panel provided an unbiased opinion about aromatase inhibitors in the management of women with early breast cancer.
That's a question the ECRI Institute asks in a story reported by the St. Paul Pioneer Press. Excerpts:
The ECRI report argues that physicians develop preferences for certain medical device brands as they gain familiarity with the product. Other factors might also inform brand loyalties, said the nonprofit group's president, including the influence of sales representatives as well as paid consulting relationships between manufacturers and doctors.
The ties become so strong that when hospitals recruit orthopedic surgeons and heart specialists to their medical staffs, they find they also have "generally 'recruited' the vendors those MDs favored," the report states. "Exacerbating the situation are device manufacturers' sales representative inside the surgical suite during procedures 'assisting' the physicians as they learn how to use new products."For hospitals trying to negotiate discounts with suppliers, physician preference items can be a problem when doctors' allegiances limit a medical center's ability to shop around for the best price. Hospitals have been reluctant to push back against doctors on these decisions, the report says, because unhappy doctors can threaten to move their practice to another hospital and take their patients with them.
The solution, according to ECRI Institute, is for hospitals to work cooperatively with physicians to make purchasing decisions that incorporate scientific evidence about the relative merits of devices as well as the value a particular product delivers.
Start lining up the awards for the series on conflict of interest published by the Milwaukee Journal-Sentinel this year.
"As fears were growing about the link between hormone therapy and breast cancer, a drug company paid the University of Wisconsin to sponsor ghostwritten medical education articles that downplayed the risks, records obtained by the Journal Sentinel show.
The five articles were funded by Wyeth, the company that made the top-selling hormone therapy products. The articles, published in 2001, appeared under the names of doctors who specialized in diseases common to menopausal women, but actually were written by professional writers paid by the company.The articles came shortly before a long-term $1.5 million arrangement between Wyeth and UW to educate doctors and patients around the country about hormone therapy. The initiative promoted the benefits and softened the risks of drugs that produced sales of more than $1 billion a year."
The article also showed two faces of health care on this issue. Excerpt:
"The company's ultimate goal is to sell more drugs, said Steven Miles, a physician and professor at the Center for Bioethics at the University of Minnesota Medical School.
"These ghostwritten articles are advertising masquerading as scientific reviews," he said. "It's dishonest."One of the listed authors, Leon Speroff, then a professor of obstetrics and gynecology at Oregon Health Sciences University...said the practice of ghostwriting remains commonplace, and he defended it.
"There is nothing dishonest about it," he said.
He laughed at the idea that someone might be offended by the lack of transparency.
"If you don't like the way it works, that's your business," Speroff said."
In another in a continuing series of stories about doctors, drug companies and conflicts of interest, John Fauber of the Milwaukee Journal-Sentinel writes about the disease-mongering promotion of low testosterone or "Low T." Excerpts:
"A rash of television commercials in recent months have told millions of middle-age men that their diminished sex life and somber mood may be the result of low levels of testosterone.
Setting the stage for the ads was a series of medical journal articles that first appeared four years ago. The articles, which were sponsored by the University of Wisconsin School of Medicine and Public Health, read more like promotions than rigorous research, touting the benefits of testosterone and downplaying the risks.While the TV commercials were intended for consumers, the medical articles were written for thousands of doctors who could earn continuing medical education credit by reading them. Presumably, they also would write more testosterone prescriptions.
Both the ads and the articles were paid for by Solvay Pharmaceuticals, the company that dominates the testosterone therapy field and which allegedly conspired to pay off generic drug makers to keep their testosterone products off the market.
The campaign seems to have paid off.
Over the last few years, prescriptions for testosterone, especially Solvay's AndroGel, have boomed despite concerns that it may increase the risk of prostate cancer and cardiovascular disease. Aside from the potential health risks, there is a lack of science that the expensive drugs provide real benefit for middle-age and older men whose testosterone levels are declining as a result of normal aging. ...
UW was an active participant in the testosterone surge. Solvay paid about $1 million to fund UW-sponsored doctor education in 2005, 2006 and 2007 such as dinner meetings around the country and newsletters designed to reach more than 50,000 physicians. UW directly received about $115,000 of that amount."
Here's how Solvay bought space on WebMD to promote AndroGel in an ad that is meant to look like normal editorial content.
