From the New York Times:

Dr. Manoj V. Waikar [is] among the top five [Eli Lilly drug rep] earners this year, received $74,850 for consulting and speaking at 51 events, according to Lilly’s on-line faculty registry.

… [D]octors [like Waikar are] essentially are giving canned speeches written by the drug companies; after all, … med schools would not allow students to present somebody else’s work. And so Stanford prohibits full faculty members from participating in drug company speakers’ bureaus. But unpaid adjunct instructors, like Dr. Waikar [Stanford lists him as still active, but his website has him teaching for them most recently seven years ago], are allowed to, as long as they are not using their Stanford titles.

… But Dr. Bernard Lo, the director of the medical ethics program at the medical school of the University of California, San Francisco, said that because drug companies controlled the content of such speeches, they should have their own employees give such talks. “Anyone who teaches medical students or residents should be bound by the same regulations,” Dr. Lo said. “Your own work has to be your own work.”

Stanford is reviewing its policy to determine if any clarifications or changes are needed, a spokesman for the medical school wrote in an e-mail message.

Forgive UD for doubting that as Waikar sells himself to Lilly he puts aside the Stanford connection. Names like Stanford represent precisely the aura of neutrality the company’s after.

UD‘s followed, on this blog, many embarrassing stories about adjunct medical school faculty, from Michael Jackson’s sperm depositor at UCLA all the way down to energizer bunnies like Waikar.

UD wonders why universities don’t give a shit about these clowns.

Pharma sings its version of Al Jolson’s Mammy. 

Background here.

**************

NAMI

Everything was lovely
When you were mine.
High-priced pills were rollin’
The day was fine.

Then I got investigated
And they wouldn’t let me hide
The multimillion dollar love
I hold for you inside.

Now I feel so sad.
I popped fourteen Celexas
But I still feel bad.
And here’s what I’m sayin’
As I watch my profits slide:

NAMI,
NAMI,
The sun shines east, the sun shines west,
I know where the sun shines best —

[SPOKEN]  NAMI…
My little NAMI …
My interests are tangled around NAMI…

NAMI,
My little NAMI
I spent a trillion bucks
Now I’m totally fucked
My NAMI.

******************

UD thanks a reader
for the New York
Times link.

… here, on a  Wharton School blog.  University Diaries follows lots of campus stories involving pharma-compromised professors and conflict of interest, and it’s easy to get lost in all the cases.  This article provides the big picture.

It is always moving to UD, a writer and literature professor, when historically silenced groups finally find a way to express themselves.

And so it is with America’s doctors, long muted behind ghostwriters in their scientific articles, and corporate scriptwriters in their public presentations. Suddenly this group has discovered its collective voice, its specific forms of speech, and the results are riveting.

At the University of Wisconsin, for instance, a professor of rheumatology, protesting a recent university ban on medical faculty giving promotional talks for drug companies, writes an email to his fellow medical school professors:

We must ACT NOW unless we want (the) administration telling us how to get our education, how we supplement our income and what our ‘ethics’ should be.

ACT UP! Our ‘ethics’ are under assault!

******************************

This particular doctor is interesting. He thinks performing surgery on people with chronic fatigue syndrone — itself a controversial diagnosis — is a great idea.

He’s particularly keen on this surgeon, whose license to practice medicine was recently suspended.

It’s so simple, as Tom Lehrer said in another context; so very simple.

If you want to get paid for plugging the newest, most expensive, least tested drugs on the market, lose the white coat, put on a suit, and start gilding the Lilly.

If you want to be a university professor at a medical school, a person who pursues and represents legitimate research, you’re going to have to sacrifice the $30,000 you make each year by reading aloud from Eli Lilly powerpoints.

Eric Campbell, who researches the medical speaker’s bureau scam, and whose words provide this post with its headline, calls the lucrative practice of professors doing pharma’s bidding “a complete violation of the hallmark of academia: independence. … [Don’t be a drug salesman] under the shroud of academia.’’

The Carlat Psychiatry Blog alerted me to the article in the Boston Globe that quotes Campbell and others (including Daniel Carlat himself) on pill promo circuits and the doctors who love them. Carlat points out that although salesmen may claim their presentations are independent of the drug companies paying them, they’re clearly following orders. In response to one doctor who protests that he chooses the order of the slides he presents, Carlat writes:

The fact that [this drug company speaker may choose] the order of his Lilly-boosting slides hardly constitutes compliance with [his hospital’s] policy that the “lecture’s content, including slides and written materials, are determined by the clinician.’’ [The presenter] might argue that he follows the letter of the rules because he, in fact, determines which among a menu of Lilly slides he uses in his presentation. But this is a hollow argument, because he didn’t write the menu.

Here’s an analogy. If my son comes home and says that for lunch he ate a cheeseburger and french fries, I might express my dispeasure and ask him to make healthier choices in the future. “But there was nothing else on the menu,” he might respond. “Where did you go for lunch?” “McDonalds!” If you choose to go to McDonald’s for lunch, your “choice” of food is severely limited. Similarly, if [this doctor] chooses to go to Lilly for his medical information, every slide on the menu will be Lilly-friendly, meaning that his defense that he “chooses” what to teach is meaningless. His only choice was to become a promotional speaker, and he checked his academic independence at the door.

The former head of the National Institutes of Health explains it nicely and concisely.

His comment appears in a long article (subscription) about UD‘s acquaintance, Paul Thacker, described as Charles Grassley’s “bulldog” in the fight against the dangerous corruption of academic science.

“Paul’s good,” said the senator, sitting across from Thacker. “If you’re going to be successful in these investigations, you gotta have people like Paul.”

The article notes that scientists grown accustomed, as Zerhouni says, to lying about the money they stand to make from their own research results don’t like Paul Thacker one bit. Too bad.

… What a filthy business. And it’s not going to change.

Details.

Because it’s not going to change — I mean, the journals aren’t going to do anything about it, just as universities aren’t going to do anything about conflict of interest — we need to think about ways of protecting ourselves from the many bogus, corporate-run studies that inspire doctors to prescribe dangerous drugs.

Remember that the assault comes from more than these sources. In bogus, corporate-run Continuing Education events, in direct payments in exchange for prescription, in the training of a drug sales force made up of medical school professors, in countless ways, we’re cultivating a generation of compromised practitioners who hurt us and our children with the meds that enrich the practitioners.

Don’t forget the crucial adjunct to these practices: Constant frightening television advertisements.

What can we do?

********************************

Beats me. They’ve got all the money. And they’re fucking geniuses.

… from Eric Alterman, in The Nation:

[If Harvard] allows its faculty to be corrupted by greed and payola, then society suffers as well.

… In 2008 Harvard earned an F from the American Medical Student Association for its lax conflict-of-interest standards on accepting Big Pharma cash…

[New York Times reporter Duff Wilson] tells me that “we [still] haven’t got to the bottom of the amount of influence drug companies and other special interests have on medical education or continuing medical education. As we reported, Harvard Medical’s dean wants to increase, not decrease, the school’s connections with industry.”

… of a big corruption investigation, the Sapir Prize is a drop in the bucket.

But the tale of this Israeli literary award tells us something about conflict of interest in general, and the disgust it inspires. And the damage it does.

UD‘s already covered this totally corrupt prize, reserved for writers who have friends, relatives, and business partners among the judges. Amid the press’s revelation of clear COI involving the winner and one of the finalists, organizers — operators? — of the Sapir decided to suspend it altogether this year.

Actually, they tried to do the whole thing over again, but most writers – among the finalists, and among the general population of Israeli writers – don’t seem to think it’s worth their time to compete for a rigged prize.

Plus, the original winner and four finalists were promised prize money.

…When the fund canceled the original award on July 2, it promised to appoint a new panel of judges to choose a new winner. However, the five finalists then refused to resubmit their candidacies in protest, and “there were quite a few other authors who also said they would not compete,” the terse, five-line announcement said.

… [T]he five finalists had planned to take joint legal action to secure compensation. But attorney Mibi Mozer, who originally represented all five of them, said disagreements among them made joint action impossible. Instead, “each of the authors will take whatever action he deems necessary.” …

… “There was no literary consideration of any value in favor of a second round,” [said one finalist]. “This was a proper decision … after a string of bad, stupid decisions. But that doesn’t absolve them from resolving the issue of the prize. Mifal Hapayis shouldn’t wait for our lawyers…”

So, you know, that’s a mess. A “fiasco,” Ha’aretz calls it.

This memorable quotation from Springtime for Hitler serves nicely to introduce Harvard’s latest attempt to shut up its critics. UD‘s friend Bill sends her this link to a New York Times article. Excerpts:

Harvard Medical School is backing off a new student policy that would have restricted interaction with the news media after students complained it would chill their ability to talk about current issues in medicine, school officials said Tuesday.

… Nate Favini, a Harvard medical student and chairman of the Student Council Advisory Board, said in an e-mail message Tuesday: “Instead of limiting students, we should encourage bold thinking and allow them to advocate for the reforms that our health care system so badly needs.”

[The dean of students] did not deny that the policy was prompted in part by student remarks earlier this year about the influence of pharmaceutical companies on medical education.

… David Tian and Kirsten Austad, activist medical students at Harvard, said in an e-mail message Tuesday, “It is hard to imagine that this new policy is not somehow related to the past advocacy efforts of students. The reason we spoke out against conflicts of interest was to promote patient welfare as the primary concern of medicine, in the face of institutional practices that can harm patient care.”…

Half empty, half full kind of thing… Empty people protecting Joseph Biederman’s privileges… But, on the other hand, young people full of moral ferocity…

Usually the empty people win. Maybe this time they won’t.

… Marketing fraud cases against pharmaceutical companies have become almost routine, with almost every major drug maker having been accused of giving kickbacks to doctors or shortchanging the Medicaid program on prices. Prosecutors said that they had become so alarmed by the growing criminality in the industry that they had begun increasing fines into the billions of dollars and would soon start charging doctors individually as well.

… [Secretary of Health and Human Services Kathleen] Sebelius’s decision to make the Pfizer announcement in a news conference in Washington suggests that the political environment for the pharmaceutical industry has become more treacherous…

If they start doing perp
walks out of the med
school down the street
from UD‘s office,

she’ll take pictures
and post them.

… await the updated DSM-V, with new mental disorders just for us, a voice of caution arises among the psychiatrists:

The first draft [of the DSM-V] is crucial because only the Task Force working as a whole can discipline and reconcile the often inconsistent outputs produced by the different Workgroups. It is a very reliable rule of thumb that Workgroups are always more willing to make changes than is desirable. Experts in any given area tend to have their pet ideas and to worry more about missed cases than about creating potential false positives. By ruthlessly applying the necessary rule of empirical documentation, the Task Force must provide a useful check on Workgroup enthusiasm.

Allow UD to clarify.

The Workgroups include people riding lots of horses very hard: Mr Internet Addiction. Ms Intermittent Explosive Disorder. Their careers and fortunes are riding on these things… False positives, you say? I dare you to falsify any psychiatric diagnosis. Can’t be done, and certainly not by some confused patient sitting in a psychiatrist’s office. What’s the poor fool going to say? I really doubt there’s good research backing up your claim that I need anti-psychotics because I’m shy. No, once the designation’s in the manual, we’re out of the starting gate…

Problems can result even from improvements in the wording of criteria sets. For example, the better written and more easily remembered DSM-IV criteria set for ADHD may have resulted in its overuse—especially by primary care doctors and the general public.

However perilous it is to change existing criteria sets, the risks are much greater still whenever the system adds totally new diagnoses that are at best lightly tested. The potential for false positive epidemics and forensic conundrums are much harder to predict for anything novel. New disorders are best kept in the appendix until they have achieved wide acceptance in the field. The DSM system should always follow, not lead, research and practice. It can never be paradigm shifting on its own weight.

Same crap. So the new ADHD language has netted more clients than the old. Problem?

So we’re creating new epidemics. And?

Publishing profits are the only possible driver of a fixed and implacable 2012 publication deadline, and this is obviously not acceptable.

The man’s paranoid.

A former chief financial officer at Hadassah is claiming that she had an affair with Bernard Madoff.

Sheryl Weinstein reportedly makes the claim in her book “Madoff’s Other Secret: Love, Money, Bernie, and Me,” which is set to be published Aug. 25 by St. Martin’s Press.

… The Jewish women’s organization has said that it invested $40 million with Madoff from 1988 to 1997.

… Weinstein served on the Hadassah committee that decided to invest with Madoff…

… in the Minneapolis Star-Tribune from the president of hopelessly conflicted University of Minnesota. He had to say something; the newspaper’s been all over the many ongoing conflict of interest scandals in the UM medical school.

What he’s produced, though, is too lacking in content for SOS to take hold of anything from it for discussion purposes. The piece makes no reference to particular COI cases — a basic requirement under the circumstances.

If you’re in the mood for meaningless reassurance and groundless self-congratulation, go to it.

“Seventy-eight percent [of Americans polled] believed that accepting gifts from the pharmaceutical industry influences their doctors’ prescribing habits.”

Know why it’s so many?

Because accepting gifts from the pharmaceutical industry influences doctors’ prescribing habits.

The Washington Post anticipates the establishment of a public database that will let patients look up their doctors’ industry ties.