… delivers a wonderful commentary on tonight’s Marketplace program. Subject: Why doesn’t the American Economics Association have a code of ethics? Especially given all the undisclosed corporate conflicts of interest among economists who advise the government?

An excerpt:

Long before the current financial crisis burst upon us, Harvard economist Andrei Shleifer was taken to court to face accusations of advancing his own financial interests while receiving support from U.S. taxpayers to advise Russians on the best way to develop a stock market.

Both Professor Shleifer and Harvard University agreed to settle the case with no admission of wrongdoing, but paid hefty financial penalties. The case quickly disappeared from sight.

But what could undermine our professional prestige more than suspicion of unethical behavior?

You remember Shleifer. Did Harvard ever come down hard on him!

Harvard University, Shleifer and the Justice department reached an agreement under which the university paid $26.5 million to settle the five-year-old lawsuit. Shleifer was also responsible for paying $2 million dollars worth of damages…

[Shleifer] remains on Harvard’s faculty. However, according to the Boston Globe, he has been stripped of his honorary title of Whipple V. N. Jones Professor of Economics.

Ouch! He doesn’t get to be Mr Whipple anymore!

… this one from Canada. As with Allen Frances, so with just-retired University of Laval medical school professor Fernand Turcotte:

… Fernand Turcotte had not been retired long from his job in the faculty of medicine at the University of Laval when he came to an unsettling conclusion.

“I realized that the things I had been teaching my students for 35 years were not true,” says the silver-haired former Quebec City professor.

“What I thought were the contributions of my specialty to the health and well-being of humanity in fact served to further poison people’s lives.”

Turcotte’s getting at something Donald Light has argued. Light says that (I’m quoting an Inside Higher Education piece I wrote about this last year)

the market for prescription drugs – in the United States and throughout the world – has become a lemon market, indeed “the largest and most dangerous market in lemons in modern society.”

Turcotte puts it this way:

[T]he medical industry is suffering from an “ethical bankruptcy,” in which well-meaning doctors don’t have the time to synthesize all the information coming at them from pharmaceutical companies.

Studies suggest a doctor would have to spend roughly 600 hours per month reading academic journal articles just to stay up to date with the latest findings.

“The average doctor feels guilty about falling behind on his reading, and this creates a fear of incompetence,” Turcotte says. “This makes them more welcoming of whatever suggestions, no matter how ridiculous, that come from consensus conferences.”

He charges that many of these conferences, where medical consensuses are formed, are tainted by conflicts of interest.

In some cases, papers presented at these conferences – and related articles published in leading medical journals – were found to have been written by ghostwriters paid for by pharmaceutical companies.

It all adds up to major over-prescription of needlessly expensive drugs.

Turcotte’s afraid Canada is going to look like us soon. Which would be pretty gross. He’s translating Nortin Hadler’s Worried Sick: A Prescription for Health in an Overtreated America, into French as fast as he can.

… Carl Elliott, about the University of Minnesota and conflict of interest.

We’ve had one scandal after another [involving payments to U doctors by drug and device companies]. It’s depressing; nothing really has happened. At other institutions, a panel is usually appointed to look into something. Here, the PR response is, “We don’t think we’ve done anything wrong.” I have some hope things will change with the new president coming in [at the U]. But who knows?

… warns Canadians what they’re in for:

Big Pharma is also lobbying hard for the abolition of current Canadian regulations prohibiting direct-to-consumer advertising of prescription drugs. Experience from the United States and New Zealand — so far the only two countries to permit DTC advertising — demonstrates these ads are a highly successful tool for the industry to persuade people to “ask your doctor” for the latest and most expensive products. Tens or even hundreds of millions of dollars are spent on campaigns for drugs. Industry calls this “public education” but it’s an education which invariably exaggerates benefits and downplays harms. If/when DTC drug advertising is approved in Canada, the costs to our health-care system will escalate dramatically. At the same time, deaths from prescription pharmaceuticals will become even more common, as will a range of serious side effects.

… in response to the university’s denial of a request from its bioethics faculty.

The University of Minnesota’s drug trial problems broaden.

… bans all drug ads. Reasons here.

In 2000, the University of Florida named Professor Dov Borovsky a Research Foundation Professor, his work on insect control making him among “the best of the best” on that faculty. He’s clearly admired, and well-compensated.

Borovsky has responded to UF’s largesse with conflict of interest and theft. He’s been arrested on grand larceny and fraud charges:

Borovsky took three separate trips to Malaysia that he reported were on behalf of the university, but were actually in connection with his work as a paid consultant, scientific adviser and shareholder in the Malaysian-based company EntoGenex International.

He got the university to pay for his airfare, although EntoGenex had already paid for it. He also denied a business interest in the company.

More leakage.

The New England Journal of Medicine and 13 other research publications may force scientists submitting studies to disclose payments from hedge funds in the wake of insider-trading probes involving a drug-maker and technology companies… Existing rules on payments by drugmakers and device companies don’t cover arrangements with investors…

Until recently, Professor Yves Benhamou was toddling along giving CME lectures, publishing his research, and, allegedly, selling insider information to Human Genome Sciences (he’s been arrested). So we’ve got a third area of disclosure opening up.

Haven’t the journals forgotten about researchers whose articles have been ghostwritten by industry? That’s four.

You’ll take my job in sales when you pry it from my cold dead hands.

In a recent interview, Christopher Hitchens explains that he almost never watches television, because the spectacle it presents, hour after hour, show after show, is so repellent:

“It’s… the Barry Manilow effect, when you see Barry Manilow and you think, ‘There are people who want to hear this, and they want more of it.’ Clearly there’s something I’ve missed.”

UD has struggled with a variant of the Barry Manilow Effect through all the years of her coverage, on this blog, of academic psychiatry at some of America’s most esteemed (Stanford, Harvard, Minnesota, Brown) universities. Although she recognizes the importance of the subject of campus medical research for any blog calling itself University Diaries, UD is always tempted to avert her eyes from the steaming piles of Conflict of Interest, irresponsibly recruited subjects, non-operating oversight boards, and ineptly designed studies that litter this activity.

And not only are there people who want to sponsor this work – people at the National Institutes of Health – but NIH is taxpayer funded; so, whether or not we like the tune these researchers are singing, we’re compelled by the government to hear more of it.

Which really makes us dupes, doesn’t it? We pay for bad studies that might put dangerous drugs on the market, and then we’re damaged by said drugs… said very expensive drugs…

Hard to think of a more thorough fucking-over than that.

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UD‘s thinking about this because of yet another sordid revelation from the academy…

… a first-rate summary of the mind-blowing fraud that is the American drug industry.

She features, in the article, a few of its main academic enablers.

Slowly, slowly, slowly, American and Canadian universities begin to react to the scandal of drug companies corrupting their institutions.

Stanford’s industry-compromised professors are today’s big news; but smaller, just as important stories – like this one from the University of Toronto – give UD just the tiniest bit of hope that in the struggle between pharma and ethical people, ethical people can win the occasional tussle.

A Toronto med student in a pain management course featuring a pharma-paid guest lecturer – who gave free copies of a pharma-written book to the students – reported this circumstance to two UT med school professors. The son of one of these professors died not long ago of an accidental OxyContin overdose, and the professor wasn’t happy to see that OxyContin’s manufacturer was essentially the author of the book.

In the book, notes another UT professor:

“[O]xycodone … is listed as a moderate-potency opioid, when I think everybody agrees it’s a very strong opioid, up to twice as strong as morphine.”

While it’s appropriate to prescribe oxycodone for severe acute pain or cancer pain …the book suggests that physicians can prescribe the drug for chronic non-cancer pain with relative safety for the patient.

… “When you prescribe to people with chronic non-cancer pain, it’s very difficult to do that safely,” he said, noting that the book pays little attention to issues of addiction and deaths from overdose.

“The book in several places makes reference to a claim that the rates of addiction if opioids are used for chronic non-cancer pain are very low. And they’re not nearly as low as is claimed in the book.”

In fact, a study by [this professor] and colleagues published last year showed prescription rates for opioids — including OxyContin, a long-acting form of oxycodone — soared in Ontario over the last two decades, as did the number of deaths linked to the narcotic.

What’s of greatest concern, of course, is how such information imparted to medical students as part of their curriculum will affect prescribing practices once they become doctors…

UT has announced that the course will be revamped, but who knows? An obvious huckster and his wares happened to get noticed by one student ; that student was enterprising enough to contact the right professors about it, etc. See how unusual it is for anyone to do anything about this? How risky? (Why isn’t the medical student named?) How much in denial the university remains? (The guy in charge of the pain program says there wasn’t any real conflict of interest.)

One of the UT professors who complained to the administration puts it very bluntly.

“It is in the interests of the drug company to have physicians prescribing as many opioid medications to as many patients as possible.”

… at the American Economic Association. Also on lack of disclosure, conflict of interest – the stuff Stanford University’s You CAN Have It All! medical staff is dealing with at the moment.

The New York Times recently noted the AEA’s amoral ways.

You can argue that things like ethics codes don’t make no nevermind one way or the other; but somehow their absence, when every other professional organization has something along these lines, feels like a statement in itself.

Asked about this, UD‘s acquaintance James Galbraith (economist; brother of Peter) says:

You can’t have an ethical code unless ethical people design it. No sign of that sensibility at the AEA. I think what should happen is the formation of small societies with codes joined by subscription. Then people could distinguish between economists who avoid or disclose conflicts, and those who do not.

… of non-compliance.

… [M]ore than a dozen of the school’s doctors were paid speakers in apparent violation of [Stanford’s conflict of interest] policy.

… Dr. Alan Yeung, vice chairman of Stanford’s department of medicine and chief of cardiovascular medicine, who was paid $53,000 from Eli Lilly & Co. since 2009. In an e-mail, Yeung said he quit speaking for the company this fall.

“I take full responsibility for this error,” he said. “Even though I felt that these activities are worthwhile educational endeavors, the perceived monetary conflict may be too great.”

Child psychiatrist Hans Steiner was paid $109,000 by Lilly to deliver talks about a drug for attention deficit hyperactivity disorder. In an e-mail, Steiner said he spoke in “very rural and other impoverished settings which only have limited access to experts like me.”…

Those poor schlubs! You would deny them experts like me!

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The Stanford University Motto:

Adipiscitor pecuniam medicam cum ex digitis mortuis nostris revulseris.

(You’ll get our drug money when you pry it from our cold dead fingers.)