Should nutritional supplements and sports drinks companies sponsor sport? A short review of the ethical concerns

By Simon M. Outram and Bob Stewart
J Med Ethics doi:10.1136/medethics-2014-102147

Abstract

This paper proposes that the sponsorship of sport by nutritional supplements and sport drinks companies should be re-examined in the light of ethical concerns about the closeness of this relationship. A short overview is provided of the sponsorship of sport, arguing that ethical concerns about its appropriateness remain despite the imposition of severe restrictions on tobacco sponsorship. Further, the paper examines the main concerns about supplement use and sports drinks with respect to efficacy, health and the risks of doping. Particular consideration is given to the health implications of these concerns. It is suggested that they, of themselves, do not warrant the restriction of sponsorship by companies producing supplements and sports drinks. Nevertheless, it is argued that sports sponsorship does warrant further ethical examination—above and beyond that afforded to other sponsors of sport—as sport sponsorship is integral to the perceived need for such products. In conclusion, it is argued that sport may have found itself lending unwarranted credibility to products which would otherwise not necessarily be seen as beneficial for participation in sports and exercise or as inherently healthy products.

The entire article is here.

How neuroscience is being used to spread quackery in business and education

By Matt Wall
The Conversation
Originally published August 26, 2014

Here is an excerpt:

Recent years have seen a huge growth in the public awareness of neuroscience. People have become more interested in new findings about the brain, and also find brain-based explanations quite compelling. This public interest has led enterprising individuals to try to apply neuroscientific ideas to more everyday situations.

This trend first began back in the late 1990s with “neuromarketing”. More recent developments involve the use neuroscience in the business world and in education. But, like homeopathy and phrenology many of these applications can be regarded as “cargo-cult neuroscience”.

The entire article is here.

Social media, big data and the next generation of e-health interventions

By Professor Helen Christensen
MAPS, Executive Director
Black Dog Institute and Professor of Mental Health, University of New South Wales

The Internet is a place where we, as psychologists, can quickly learn about new developments in our area, source research papers, publish research, connect with our colleagues and clients, undertake online training, manage accounts, and keep records. For those who use our services, we can also learn about useful apps or websites that offer online assessments, psychoeducation, self-help and supplementary therapies. However, as ordinary people in everyday life, we use the Internet far more frequently. We make social connections, keep in touch with our families, pay bills, upload our exercise data from our Jawbones and Fitbits, send out invitations, make appointments, read the news, text our family members, look at television programs we missed over the past week and even check the rain radar before we walk to work. Internet enabled activities are ubiquitous in Australia, as they are in almost all countries, and we can’t get enough of them.

The entire article is here.

Episode 11: Why Marketing is our Ethical Duty (and why Public Education is an ideal way to do it)

In this episode, John talks with Pauline Wallin, PhD, expert in marketing, public education, and media as well as a cofounder of The Practice Institute, where she helps clinicians build their practices.  It is important for psychologists to understand why marketing a psychological practice helps protect the public and raise awareness of how psychotherapy can improve people's lives.  Pauline makes the distinction between marketing and selling.  We also discuss four ethical ways to market psychological services via public education.

The end of this podcast, the listener will be able to:

1. Describe two ways that marketing your practice benefits the public.
2. List four ways to use public education to market your practice.
3. Describe two potential ethical pitfalls in marketing via public education, and how to avoid them.

Find this podcast on iTunes

For 1 APA-approved credit, click here.

Listen directly on this site here.



Resources

Dr. Pauline Wallin's website  @DoctorWallin

The Practice Institute  @PracticeHelp

APA Code of Conduct: Standard 5 - Advertising and Other Public Statements

National Institute of Health Information on Mental Health

American Psychological Association Media Referral Service

"Psychology Works" Facts Sheets - Canadian Psychological Association

Help a Reporter Out

The Self-Help Industry Helps Itself to Billions of Dollars

By Lindsay Myers
Brain Blogger
Originally published May 23, 2014

Self-improvement represents a $10 billion per year industry in the U.S. alone. In addition to high revenues, self-help also has a high recidivism rate, with the most likely purchaser of a self-help book being the same person who purchased one already in the last 18 months. This begs the question of how much good these self-help books and seminars are doing for consumers. If they are so effective at solving our problems, why do they usually result in a continuing stream of self-help purchases?

The entire story is here.

Episode 10: Social Media for Psychologists

In this episode, John talks with Dr. David Palmiter about the basics of social media.  They discuss why it is important for psychologists to understand social media as their patients are likely using various forms of social media.  Psychologists also need to know what social media is before they participate. They discuss their use of social media as part of professional development.  Psychologists need to know at least the basics about social media to practice psychotherapy effectively.

At the end of this podcast, the listener will be able to:

1. Explain the concept of social media.
2. List two reasons every psychologist should be on Twitter.
3. Define the concept of branding.

Please read David Palmiter's article: To Tweet or Not to Tweet for an understanding of Twitter.

Find this podcast on iTunes

Click here to purchase 1 APA-approved credit for this podcast

Listen directly here.




David Palmiter, PhD sites and contact information

Helping Parents.net

Hectic Parents Blog

Follow Dave on Twitter @HelpingParents

Resources

Palmiter, David. (2012). Positive Ethics Applied to Public Education Through Traditional Media and the Internet. In the APA Handbook of Ethics in Psychology, Volume 2: Practice, Teaching and Research.  Edited by Knapp, Gottlieb, Handelsman, and VandeCreek. Washington DC: The American Psychological Association.

10 Ways That Blogging Transformed My Private Practice
Julie Hanks

1 in 4 Americans now consults Google before booking an appointment with a doctor
Mark Sullivan

Social media: how does it really affect our mental health and well-being?
Medical News Today

Robi Ludwig: Fox News ‘homosexual impulses’ guest: My words were ‘twisted’

A Few Predictions on the Sunshine Act

By Genevieve Pham-Kanter
The Lab @ Edmond J. Safra Center for Ethics - Harvard


The Sunshine Act–for those of you who did not meticulously read all 11,000 sections of Bill HR 3590–is that part of last year's health care reform law that requires pharmaceutical and medical device manufacturers to report payments that they make to doctors for consulting services, speaking, meals, research grants, and other gifts of monetary value.

These payments have long been cause for concern because of their potential to influence the prescribing and research practices of payment recipients (for background, see this Institute of Medicine report). Surely requiring the disclosure of these potentially distorting payments would be a good thing; what more needs to be said?

The entire story 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.

Research shines light on the dark side of ethics

By Judy Ashton
Phys.org
Originally published March 25, 2013

Here is an excerpt:

"Fundamentally, the research shows that we are programmed to treat in-group members differently than out-group members, possibly as an evolutionary legacy of survival in the ancestral environment," says UC marketing professor James Kellaris, the James S. Womack/Gemini Professor of Signage in the Carl H. Lindner College of Business. "We tend to go easy on fellow in-group members and harder on strangers, due to complications of loyalty."

The entire story is here.

Here is the abstract to the research.

ABSTRACT

Once a matter of safety and survival, loyalty is a moral principle deeply rooted in human evolution—one that may wield a profound influence on ethical judgment and conceptions of just punishment. Consumers live in a complex Web of loyalty obligations woven through affiliations with marketers, fellow consumers, and other groups. This article examines how such affiliations shape consumers’ judgments of ethically controversial marketing conduct and preferences for punishment. In general, the more unethical an act is judged to be, the more severe the preferred punishment. However, the findings show that although consumers judge a controversial marketing act as more unethical when an in-group member targets the consumer's in-group (vs. out-group), a more lenient punishment is preferred (Study 1). Additionally, the extent to which one embraces loyalty as a moral value appears to mediate the relationship between group affiliations and preferred punishment (Study 2). This is a bias participants deny having, but believe others exhibit. This research finds evidence of loyalty to the principle of loyalty itself. A person will view an out-group member transgressing a member from that same out-group with disdain similar to that accorded an in-group member who transgresses the in-group, because the innate badness of the act is compounded by the stigma of disloyalty.

That article is here, behind a paywall, and hopefully accessible through your university library.

Institutional Corruption and Pharmaceutical Policy

Institutional Corruption and Pharmaceutical Policy
An Edmond J. Safra Center Symposium
(forthcoming)
Journal of Law, Medicine and Ethics 
Vol. 14, No. 3 (2013)

The goals of pharmaceutical policy and medical practice are often undermined due to institutional corruption — that is, widespread or systemic practices, usually legal, that undermine an institution’s objectives or integrity. The pharmaceutical industry’s own purposes are often undermined. In addition, pharmaceutical industry funding of election campaigns and lobbying skews the legislative process that sets pharmaceutical policy. Moreover, certain practices have corrupted medical research, the production of medical knowledge, the practice of medicine, drug safety, and the Food and Drug Administration’s oversight of pharmaceutical marketing.

As a result, practitioners may think they are using reliable information to engage in sound medical practice while actually relying on misleading information and therefore prescribe drugs that are unnecessary or harmful to patients, or more costly than equivalent medications. At the same time, patients and the public may believe that patient advocacy organizations effectively represent their interests while these organizations actually neglect their interests.

The entire journal is here.

The articles are organized into five topics: (1) systemic problems, (2) medical research, (3) medical knowledge and practice, (4) marketing, and (5) patient advocacy organizations.

Physicians Under the Influence: Social Psychology and Industry Marketing Strategies

By Sunita Sah and Adriane Fugh-Berman
April 30, 2013

Journal of Law, Medicine and Ethics, Volume 14, No. 3, August 2013,
Forthcoming Edmond J. Safra Working Papers, Forthcoming

Abstract

Pharmaceutical and medical device companies apply social psychology to influence physicians’ prescribing behavior and decision-making. Physicians fail to recognize their vulnerability to commercial influences; due to self-serving bias, rationalization, and cognitive dissonance. Professionalism offers little protection; even the most conscious and genuine commitment to ethical behavior cannot eliminate unintentional, subconscious bias. Six principles of influence — reciprocation, commitment, social proof, liking, authority, and scarcity — are key to the industry’s routine marketing strategies, which rely on the illusion that the industry is a generous avuncular partner to physicians. In order to resist industry influence, physicians must accept that they are vulnerable to subconscious bias, and have both the motivation and means to resist industry influence. A culture in which accepting industry gifts engenders shame, rather than gratitude, will reduce conflicts of interest. If greater academic prestige accrues to distant, rather than close relationships with industry, a new social norm may emerge that promotes patient care and scientific integrity. In addition to educating faculty and students about the social psychology underlying sophisticated, but potentially manipulative marketing and about how to resist it, academic medical institutions should develop strong organizational policies to counteract the medical profession’s improper dependence on industry.

The entire paper is here.

Pfizer Settles a Drug Marketing Case for $491 Million

By KATIE THOMAS
The New York Times
Published: July 30, 2013

The drug maker Pfizer agreed to pay $491 million to settle criminal and civil charges over the illegal marketing of the kidney-transplant drug Rapamune, the Justice Department announced on Tuesday.

The settlement is the latest in a string of big-money cases involving the sales practices of major pharmaceutical companies; four years ago, Pfizer paid $2.3 billion for improperly marketing several drugs. The recent case centers on the practices of Wyeth Pharmaceuticals, which Pfizer acquired in 2009.

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.

What Brand Is Your Therapist?

by Lori Gottlieb
The New York Times
Originally published November 23, 2012

Here is an excerpt:


What nobody taught me in grad school was that psychotherapy, a practice that had sustained itself for more than a century, is losing its customers. If this came as a shock to me, the American Psychological Association tried to send out warnings in a 2010 paper titled, “Where Has all the Psychotherapy Gone?” According to the author, 30 percent fewer patients received psychological interventions in 2008 than they did 11 years earlier; since the 1990s, managed care has increasingly limited visits and reimbursements for talk therapy but not for drug treatment; and in 2005 alone, pharmaceutical companies spent $4.2 billion on direct-to-consumer advertising and $7.2 billion on promotion to physicians, nearly twice what they spent on research and development.

According to the A.P.A., therapists had to start paying attention to what the marketplace demanded or we risked our livelihoods. It wasn’t long before I learned that an entirely new specialized industry had cropped up: branding consultants for therapists.

I couldn’t imagine hiring a branding consultant to lure people to the couch. Psychotherapy is perhaps one of the few commercial businesses that doesn’t see itself as one, that views financial gain as unseemly when connected to the delicate work of emotional insight. Moreover, the field is predicated on strict concepts of authenticity, privacy and therapist-patient boundaries. Branding was the antithesis of what we did.

The entire article is here.

Abbott Settles Marketing Lawsuit

By Michael S. Schmidt and Katie Thomas
The New York Times - Business Day
Originally published May 7, 2012

The pharmaceutical company Abbott Laboratories said on Monday that it had reached an agreement with the federal and nearly all state governments to pay $1.6 billion in connection with its illegal marketing of the anti-seizure drug Depakote.

The settlement comes as the Justice Department and the states have increased scrutiny of the sales and marketing practices of pharmaceutical companies, particularly in cases in which they market drugs for uses that are not approved by the Food and Drug Administration.

(cut)

Doctors may prescribe drugs for any purpose, but pharmaceutical companies are prohibited from promoting drugs for conditions that are not approved by the agency.

The entire story is here.

J.&J. Fined $1.2 Billion in Drug Case

By Katie Thomas
The New York Times
Originally published April 11, 2012

A judge in Arkansas ordered Johnson & Johnson and a subsidiary to pay more than $1.2 billion in fines on Wednesday, a day after a jury found that the companies had minimized or concealed the dangers associated with an antipsychotic drug.

The fine, which experts said ranked among the largest on record for a state fraud case involving a drug company, is the most recent in a string of legal losses for Johnson & Johnson related to its marketing of the drug, Risperdal.

In January, Texas settled a similar case with the subsidiary, Janssen Pharmaceuticals, for $158 million. Last year, a South Carolina judge levied civil penalties of $327 million against Janssen, and in 2010, a Louisiana jury awarded nearly $258 million in damages.

The entire story is here.

Here is a prior story about Johnson and Johnson with Risperdal.

How the FDA forgot the evidence: the case of donepezil 23 mg

By Lisa M Schwartz & Steven Woloshin
British Journal of Medicine
Published March 22, 2012

What is the difference between 20 and 23? If you said three, you are off by millions—of dollars in sales, that is—at least from the perspective of Eisai, the manufacturer of donepezil (marketed as Aricept by Pfizer).

A little context helps make the maths clearer. Donepezil, the biggest player in the lucrative market for Alzheimer’s disease treatments, was a blockbuster, with over $2bn in annual sales in the United States alone. But the drug, first approved in 1996, had reached the end of the road: the patent expired in November 2010. Investors call this “going over the cliff,” an anxious reference to plummeting sales as market share is lost to generic competitors. Necessity, however, is the mother of invention. Just four months before the expiry of the patent, the US Food and Drug Administration (FDA) approved a new dose for moderate to severe Alzheimer’s disease: donepezil 23 mg. Is 23 an odd number? Not really, when you consider that you cannot get to 23 mg using the 5 mg and 10 mg doses that were going generic. The “new” 23 mg product would be patent protected for three more years.

Now it was time for the marketing to begin. In addition to their sales force, the manufacturers deployed dedicated teams of “Aricept 23 mg clinical nurse educators” to reach prescribers. They focused particularly on “priority targets”—neurologists and high volume facilities for the long term care of people with Alzheimer’s disease—to promote the idea that “there are no ‘stable’ AD [Alzheimer’s disease] patients—therefore aggressive treatment is required.

The entire story is here.

Thanks to Ken Pope for the information.

Glaxo to Pay $3 Billion to Settle U.S. Cases on Sales, Marketing

By Phil Serafino and Makiko Kitamura

Bloomberg News

GlaxoSmithKline Plc (GSK) agreed to pay $3 billion to resolve U.S. criminal and civil investigations into whether the U.K. company marketed drugs for unapproved uses and other matters, its biggest legal settlement.

Negotiations over the terms will be completed next year, the London-based company said in a statement today. The cost is covered by existing legal provisions and will be paid from the company’s cash resources, Glaxo said.

The potential settlement brings Glaxo closer to putting years of legal probes behind it. The company set aside 2.2 billion pounds ($3.5 billion) in the fourth quarter last year in anticipation of reaching an agreement on the cases. Glaxo said it will have about 1 billion pounds of its 2.9 billion pounds in total legal provisions remaining after today’s settlement is completed, and it hasn’t decided what to do with the money.

“This news essentially draws a line under a 10-year legal saga,” Gbola Amusa, an analyst at UBS AG in London who recommends buying Glaxo shares, said in an e-mail. “This removes significant uncertainty on ongoing legal issues.”

There rest of the story can be found here.

Why Therapist Directories Are A Waste Of Time

by Mike Langolis
Gamer Therapist
Psychotherapy Meets Web 2.0

This post is for all of you who have been considering or actively using listings in therapist directories.  I frequently get asked from consultees which directories they should list in.  I also frequently see colleagues debating on bulletin boards and listservs the merits and demerits of individual directories.  So I figure it’s time to offer you my perspective.  Please bear in mind that I am sharing my experience and opinions here, and if you’ve had a different one, hopefully you’ll mention it on the comments.  If you own a directory service, I hope you’ll disclose that as well.

When I started building my practice, I had a lot of time to spend filling out various online directories.  I literally spent hours filling out profiles that promised to make me visible to potential patients.  To be fair it gave me the opportunity to hone my bio and elevator speech, but other than that I now think that I was wasting my time.  But let’s talk a little about why directories may be a waste of your time, because I think it points to a larger misconception about marketing your practice online.

Billboard in a bottle.

Many therapists still approach the internet as if it was a giant Yellow Pages.  We often create static content, the equivalent of a business card, cover letter and resume, and then slap it up on a website, or a directory.  Then we sit back and wait for the phone to ring.  It’s like we imagine that we created a giant billboard and threw it into the world wide web.  But in reality, it’s more like a message in a bottle, thrown in a vast ocean.  We imagine that that will get us recognized.  It usually doesn’t, and here’s why.

If you google “find a therapist” you will literally find dozens of website directories guaranteed to help patients find the right provider.  If you’re ambitious you could spend hours and days finding all of them and entering your information.  Many of them are free, some charge money, and a few don’t let you know whether they will charge or not until you’ve entered all of your information.  One of the main problems with directories is exactly that there are so many of them.

One thing I’ve learned from starting up social networks for other companies is that you always need a critical mass of members as quickly as possible.  If you launch a site you have a few days to a week to achieve this in most cases.  Otherwise potential members will log in to your site, look around and see little activity, and leave.  So low enrollment of providers in a directory will drive little traffic to it.

On the other hand, if you take a directory like Psychology Today’s you will see that they did achieve a critical mass, and have more traffic.  But the problem here is that this is because every therapist and her maiden aunt is now listed there.  So the problem becomes how to set yourself apart from the rest.  If you are determined to spend time on listing yourself in a directory, I’d suggest that you pay for the PT one and try to distinguish yourself as best you can.  In fact, the Psychology Today site is the only directory I even try to keep current and pay for anymore.

The entire blog post can be found here.

Useless Studies, Real Harm

By Carl Elliot

The New York Times

www.nytimes.com

LAST month, the Archives of Internal Medicine published a scathing reassessment of a 12-year-old research study of Neurontin, a seizure drug made by Pfizer. The study, which had included more than 2,700 subjects and was carried out by Parke-Davis (now part of Pfizer), was notable for how poorly it was conducted. The investigators were inexperienced and untrained, and the design of the study was so flawed it generated few if any useful conclusions. Even more alarming, 11 patients in the study died and 73 more experienced “serious adverse events.” Yet there have been few headlines, no demands for sanctions or apologies, no national bioethics commissions pledging to investigate. Why not?

One reason is that the study was not quite what it seemed. It looked like a clinical trial, but as litigation documents have shown, it was actually a marketing device known as a “seeding trial.” The purpose of seeding trials is not to advance research but to make doctors familiar with a new drug.

In a typical seeding trial, a pharmaceutical company will identify several hundred doctors and invite them to take part in a research study. Often the doctors are paid for each subject they recruit. As the trial proceeds, the doctors gradually get to know the drug, making them more likely to prescribe it later.

In an age of for-profit clinical research, this is the new face of scandal. Pharmaceutical companies promote their drugs with pseudo-studies that have little if any scientific merit, and patients naïvely sign up, unaware of the ways in which they are being used. Nobody really knows how often companies conduct such trials, but they appear with alarming regularity in pharmaceutical marketing documents. In the marketing plan for the antidepressant Lexapro for the 2004 fiscal year, Forest Laboratories described 102 Phase IV trials — the classification under which seeding trials fall — in a section labeled “Marketing Tactics.”

Oversight bodies like the Food and Drug Administration generally don’t view seeding trials as research scandals: seeding trials are not illegal, and the drugs in question have already received F.D.A. approval. But even after particularly egregious seeding trials have been exposed, the F.D.A. has not issued sanctions. Take the notorious Advantage study, a seeding trial of the pain reliever Vioxx conducted by Merck. According to a 2008 report in the Annals of Internal Medicine, litigation documents show that the Advantage study was conceived and managed by Merck’s marketing department. Three subjects died in the Advantage trial; five more subjects experienced heart attacks. Oversight bodies should treat the Advantage study as a violation of research ethics.

The entire story can be read here.