Medicine’s Financial Contamination

Editorial Board
The New York Times
Originally posted September 14, 2018

Here is an excerpt:

Sloan Kettering’s other leaders were well aware of these relationships. The hospital has said that it takes pains to wall off any employee involved with a given outside company from the hospital’s dealings with that company. But it’s difficult to believe that conflicts of this magnitude could have truly been worked around, given how many of them there were, and how high up on the organizational chart Dr. Baselga sat. It also strains credulity to suggest that he was the hospital’s only leader with such conflicts or with such apparent difficulty disclosing them. After the initial report, but before Dr. Baselga’s resignation, the hospital sent a letter to its entire 17,000-person staff acknowledging that the institution as a whole needed to do better. It remains to be seen what additional actions will be taken — and by whom — to repair the situation.

Financial conflicts are hardly confined to Sloan Kettering. A 2015 study in The BMJ found that a “substantial number” of academic leaders hold directorships that pay as much as or more than their clinical salaries. According to other surveys, nearly 70 percent of oncologists who speak at national meetings, nearly 70 percent of psychiatrists on the task force that ultimately decides what treatments should be recommended for what mental illnesses, and a significant number of doctors on Food and Drug Administration advisory committees have financial ties to the drug and medical device industries. As bioethicists have warned and as journal publishers have long acknowledged, not all of them report those ties when and where they are supposed to.

The info is here.

Financial ties between researchers and drug industry linked to positive trial results

British Medical Journal
Press Release
Originally released January 17, 2017

Here is an excerpt:

More than half (58%) of principal investigators had financial ties to the drug industry - including travel expenses, honorariums, payment for advisory work, or stock ownership.

The results show that trials authored by principal investigators with financial ties to drug manufacturers were more likely than other trials to report favourable results.

Even after accounting for factors that may have affected the results, such as funding source and sample size, financial ties were still significantly associated with positive study outcomes.

The authors point to possible mechanisms linking industry funding, financial ties, and trial results such as bias by selective outcome reporting, lack of publication, and inappropriate analyses.

The pressor is here.

Doctors Net Billions From Drug Firms

By Peter Loftus
The Wall Street Journal
Originally posted September 30, 2014

Drug and medical-device companies paid at least $3.5 billion to U.S. physicians and teaching hospitals during the final five months of last year, according to the most comprehensive accounting so far of the financial ties that some critics say have compromised medical care.

The figures come from a new federal government transparency initiative. The 2010 Affordable Care Act included a provision dubbed the Sunshine Act, which requires manufacturers of drugs and medical devices to disclose the payments they make to physicians and teaching hospitals each year for services such as consulting or research. The Centers for Medicare and Medicaid Services compiled the records into a database posted online Tuesday, though the agency said that about 40% of the payment information won't identify the recipients because of data problems.

The entire article is here.

For Med Students, Love From the Drug Rep

By Pauline Chen
The New York Times - Well
Originally published October 3, 2013

Here is an excerpt:

A significant proportion of medical schools and teaching hospitals end up the beneficiaries of such promotional largesse. But in recent years, leaders in medical education and, more notably, a growing contingent of medical students, have called for changes in a professional culture that accepts interactions with industry as the “norm.” In 2007, the American Medical Students Association published the PharmFree Scorecard, a rating system that grades medical schools on the strength of their policies regulating interactions between industry and students and faculty. Around the same time, the Association of American Medical Colleges and several medical schools issued policy statements calling for a decrease in the influence of industry in education.

Observers hailed these initiatives as transformative, but in the years since it’s not been all that clear that a transformation has actually occurred.

The entire story is here.

Ista Pharmaceuticals To Pay $33.5 Million To Settle Claims Company Paid Doctors To Push Drug

By Jonathan Stempel
Reuters
Originally published May 24, 2013

Ista Pharmaceuticals Inc pleaded guilty on Friday to charges it used kickbacks and improper marketing to boost sales of a drug meant to treat eye pain and agreed to pay $33.5 million to settle criminal and civil liability, the U.S. Department of Justice said.

The unit of eye care company Bausch & Lomb pleaded guilty to conspiracy to offer kickbacks to induce physicians to prescribe Xibrom, a drug meant to treat pain after cataract surgery, and conspiracy to promote that drug for unapproved uses, including after Lasik and glaucoma surgeries.

Ista agreed as part of a criminal settlement to a $16.63 million fine and an $1.85 million asset forfeiture. It also agreed to a $15 million civil settlement to resolve allegations that its marketing of Xibrom caused false claims to be submitted to government health care programs.

As part of the settlement, Ista will be barred from participating in Medicare and Medicaid, and Bausch & Lomb agreed to strengthen its compliance and ethics procedures.

The entire story is here.

Pfizer Settles U.S. Charges of Bribing Doctors Abroad

By Katie Thomas

The New York Times

Originally published August 7, 2012

The Securities and Exchange Commission announced on Tuesday that it had reached a $45 million settlement with Pfizer to resolve charges that subsidiaries of Pfizer and Wyeth, which it acquired in 2009, bribed overseas doctors and other health care workers to increase sales of their drugs.

At the same time, the Justice Department announced that another subsidiary, Pfizer H.C.P. Corporation, had agreed to pay a $15 million penalty to settle similar charges.

The allegations, which date to 2001 and in the case of Wyeth are said to have continued after Pfizer’s acquisition of the company, involve violations of the Foreign Corrupt Practices Act, which forbids paying bribes to government officials. In many countries, doctors are government employees.

The entire story is here.

Senator questions $2m NIH grant to disgraced psychiatric researcher

By Bob Roehr
British Medical Journal
Originally published June 1, 2012

Dr. Nemeroff

The US senator Charles Grassley has called on the National Institutes of Health to justify its decision to award a five year $2,000,000 grant to the prominent but disgraced psychiatric researcher Charles Nemeroff, "despite past ethical problems."

"It is troubling that NIH continues to provide limited federal dollars to individuals who have previously had grant funding suspended for failure to disclose conflicts of interest," Grassley wrote in a 29 May letter to the director of the NIH, Francis Collins.

He asked Collins to provide full documentation of communications concerning Nemeroff and the grant within two weeks.

The information is here.

Thanks to Ken Pope for this information.

There are other blog entries here and here about Dr. Nemeroff.

Sanctioned Psychiatrist Gets First NIH Grant in 3 Years

by Jocelyn Kaiser
ScienceInsider
May 22, 2012

Dr. Nemeroff

A psychiatrist whose failure to disclose drug company income contributed to a furor over conflicts of interest in biomedical research has just received his first National Institutes of Health (NIH) grant in 3 years.

Charles Nemeroff's lax reporting of at least $1.2 million in drug company payments to his employer, Emory University, and similar payments to other academic psychiatrists prompted a 2007 Senate investigation.

Nemeroff stepped down as chair of psychiatry at Emory, and NIH suspended a $9-million grant he held for a depression study. In December 2008, Emory barred him from applying for NIH funding for 2 years.

The rest of the story is here.

A prior blog post about Dr. Nemeroff can be found here.

As Beef Cattle Become Behemoths, Who Are Animal Scientists Serving?

By Melody Petersen
The Chronicle of Higher Education
Originally published on April 15, 2012

Here are some exerpts:

Scores of animal scientists employed by public universities have helped pharmaceutical companies persuade farmers and ranchers to use antibiotics, hormones, and drugs like Zilmax to make their cattle grow bigger ever faster. With the use of these products, the average weight of a fattened steer sold to a packing plant is now roughly 1,300 pounds—up from 1,000 pounds in 1975.

It's been a profitable venture for the drug companies, as well as for the professors and their universities. Agriculture schools increasingly depend on the industry for research grants, a sizable portion of which cover overhead and administrative costs. And many professors now add to their personal bank accounts by working for the companies as consultants and speakers. More than two-thirds of animal scientists reported in a 2005 survey that they had received money from industry in the previous five years.

Yet unlike a growing number of medical schools around the country, where administrators have recently tightened rules to better police their faculty's ties to pharmaceutical companies, the schools of agriculture have largely rejected critics' concerns about industry cash. Administrators have set few limits on how much corporate money agricultural professors can accept. Faculty work with industry is governed by confidentiality rules that veil it from public view.

The entire story is here.

Payments to Doctors by Pharmaceutical Companies Raise Issues of Conflicts

By EMILY RAMSHAW and RYAN MURPHY

The Texas Tribune

Published by the New York Times

Thousands of Texas doctors, researchers and medical experts — including more than 100 who are employed by the state and are paid with taxpayer dollars — routinely supplement their salaries with income from pharmaceutical companies.

Drug companies pay medical professionals for a wide range of activities, from speaking engagements to consulting. While legal, the practice raises questions about potential conflicts, and whether the interests of patients may be compromised.

From 2009 to early 2011, at least 25,000 Texas physicians and researchers received a combined $57 million — and probably far more — in cash payments, research money, free meals, travel and other perks, according to data culled from 12 drug companies and provided by the nonprofit investigative news organization ProPublica.

Dozens of these medical professionals were paid more than $100,000 each during that period. And 114 were professors, physicians, psychiatrists or researchers who were already paid a salary by the state — in some cases more than a half-million dollars a year. These state employees brought in nearly $3 million combined from pharmaceutical companies from 2009 to early 2011, according to a Texas Tribune analysis of the ProPublica data.

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But the financial relationships raise questions about the influence of drug companies on prescribing patterns or research results. The practice “puts patients and tax dollars at risk,” said Lee Spiller, the policy director for the Texas branch of the Citizens Commission on Human Rights, a nonprofit mental health watchdog. “It taints the whole process. I’d hate to think donations were shaping state mental health policy in particular.”

The entire story is here.

The Best Treatment Of Anxiety May Not Involve The Drugs That Recent Literature Suggests

Medical News Today

A recent data analysis that was published in the British Medical Journal (BMJ) suggested that antidepressant drugs may offer the best treatment for generalized anxiety disorder. This new data analysis that is published in the recent issue of Psychotherapy and Psychosomatics suggests that BMJ is faulty and biased by conflict of interest.

Generalized anxiety disorder, the constant and fearful worry and fearful anticipation of events, is a common disturbance. A recent data analysis that was published in the British Medical Journal (BMJ) suggested that antidepressant drugs may offer the best treatment for generalized anxiety disorder. A new data analysis that is published in the recent issue of Psychotherapy and Psychosomatics suggests that BMJ is faulty and biased by conflict of interest.

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Although the study was allegedly independent, all authors had financial ties with Lundbeck and other pharmaceutical companies which manufactured the drugs that were included and discussed in the meta-analysis. The meta-analysis performed by Baldwin and colleagues is likely to yield misleading conclusions, particularly for the busy clinician who has no time to check its faulty procedures and the lack of appropriate clinical integration. The publication of this paper calls for a reassessment of journals' policies concerned with reviews, editorials and meta-analyses.

The entire article can be found here.