As a follow-up to this post — about a group of Australian scientists so dismayed by alternative medicine having crept into the university curriculum that they have formed a pressure group to fight the trend — there’s this heartwarming father-and-son tale.
Dad runs a cult-of-personality clinic (watch the film) which will cure you of incurable cancer if you’ll just listen to the Leader. Sonny’s CEO of a big vitamin concern that uses Dad’s research to back up its product claims. The big vitamin concern dismisses conflict of interest charges with the following argument: “The mere fact of both having the same surname was the ultimate disclosure in itself.” Game, set, and match.
Meanwhile, there’s an ongoing court case in which Australia’s regulatory Therapeutic Goods Administration has ordered the vitamin concern to stop making claims about their stuff’s effectiveness having been “clinically proven,” onaccounta it ain’t – despite Dad’s best efforts – been.
Wayne Blackmon, a psychiatrist and lawyer who teaches at George Washington University Law School, said he commonly sees patients taking more than one antipsychotic, which raises the risk of side effects. Blackmon regards them as the “drugs du jour,” too often prescribed for “problems of living. Somehow doctors have gotten it into their heads that this is an acceptable use.” Physicians, he said, have a financial incentive to prescribe drugs, widely regarded as a much quicker fix than a time-intensive evaluation and nondrug treatments such as behavior therapy, which might not be covered by insurance.
There’s lots more here, including some choice remarks from UD‘s friend Allen Frances.
… to some extent at most American medical schools, UD says they should turn their attention to corporate ghostwriting of articles and books for university researchers.
AMSA’s simple expediency of publishing COI rankings for each school has shamed many institutions into taking more seriously not merely specific practices like free drug samples and the constant trolling of campus by pharma sales people, but also disclosure in general, as in how much pharma money this or that professor pockets.
The widespread scandal involving professors claiming publications in the scientific literature which have in fact been written, in whole or in part, by ghostwriting firms paid by pharmaceutical companies, is much talked about. But professional organizations and editorial boards – both almost completely dependent on revenue from drug firms – will never do anything about it. Universities don’t care. Only independent groups like AMSA can get anywhere on this one.
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We can expect resistance to all of these changes. UD anticipates a new organization emerging called PharmFee.
UD‘s buddy Carl Elliott is one of the few writers eloquent and informed and tenacious enough to worry any and all corrupt corners of the American scientific establishment – inside and outside of universities.
William Heisel, at Reporting on Health, notes that Slate magazine has pulled a recent piece Carl wrote for them because one of the people mentioned in the piece hired a lawyer to write a letter threatening a defamation suit.
Today, Slate retracted a well-researched commentary by Dr. Carl Elliott about the ethical controversy surrounding Celltex Therapeutics, a company marketing unlicensed stem cell injections, and the American Journal of Bioethics (AJOB).
Celltex recently hired the editor of AJOB, Glenn McGee, and other bioethicists have charged that McGee has been running the journal while working for Celltex. Following the criticism, McGee announced today that he has quit Celltex.
The company works in a medical and ethical gray area, harvesting adult stem cells from fat and injecting them into other parts of the body without solid evidence that the procedures work. Bioethicist Leigh Turner at the University of Minnesota has suggested that the company’s work looks exactly like something that would prompt action by the U.S. Food & Drug Administration.
Heisel’s post contains links to all of the relevant documents, articles, and letters. He points out that a libel suit, given McGee’s public profile, would be almost impossible to win; but, as this case demonstrates, the threat is sometimes enough to chill speech.
Yes, medical “practice is informed by biased evidence summarized for us by people who have financial relationships with companies set to profit from alterations to our practice.” Yes indeed, industry-funded ghostwriters write articles promoting industry’s drugs and then place the articles in high-profile research journals where they’re read by unwary practitioners who duly prescribe them. Yes. But here’s one thing I’ll tell you for damn sure: If most of your journal’s advertising budget comes from industry, you’re not exactly going to resist the situation. You’re going to make yourself as comfy as you can in your favorite comfy chair and then you’re going to pour yourself an excellent scotch and then you’re going to accept the situation.
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See, it’s just like this Australian guy with his anti-depressant du jour, Valdoxan, which he’s touting in The Lancet. He has financial links to Servier, Valdoxan’s manufacturer. His paper’s been torn apart by scientists the world over, with one of them noting that “publication of this flawed paper will undoubtedly validate marketing of Valdoxan, and we are curious to see how many paid Valdoxan advertisements will be published in Elsevier journals.”
With anti-depressants as with sausages — You really don’t want to see how they’re made.
… and now they’re coming for the Ritalin!
These American staples, the backbone of our thriving pharma-economy, are under assault by scientists who claim they don’t work for most people and that they can do terrible harm.
What’s next? Our babies’ antipsychotics??
Not very seemly, this image of the APA laughing mercenarily at our misery.
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UD thanks Dirk.
… has had a long, storied, lucrative relationship with the Johnson and Johnson corporation, makers of Risperdal, an absolutely adorable anti-psychotic for the millions of American children who, thanks largely to Biederman’s research, have been diagnosed bipolar.
What’s adorable about Risperdal is how it’s marketed. What child can resist free legos? Risperdal puts legos stamped with the word RISPERDAL in pediatricians offices! If the sight of a three-year old playing with toys advertising her induction into a world of really powerful anti-psychotic medicine doesn’t make you go AWWWW, maybe there’s something wrong with you.
Biederman’s Harvard-legitimized work for J&J no doubt made it easier for that company to get states like Texas to approve it for Medicaid coverage. Only now the state’s all pissed and it’s suing to beat the band because “The state contends it paid 45 times more for Risperdal than comparable drugs after accepting the company’s claims that it was superior to rival medications.” (Let’s not even talk about J&J ad reps kissing doctors’ asses to get them to prescribe it in unapproved ways.) On what research (assuming the state of Texas is able – and willing – to read research) did Texas base its conclusion that its citizens should subsidize Risperdal?
So – bottom line here is that J&J will lose the case and will be made to pay an absolutely derisory sum in damages – a few hundred million, the cost of doing business, no one gives a shit.
… hit close to home for UD last year, with one of her colleagues in the econ dept (here’s the post about him) (and here’s the original article about the conflict of interest) failing to note that a paper of his offering “a strong argument for shrinking the role of the Federal Housing Administration in insuring mortgages… was at least partially underwritten by the private mortgage insurance giant Genworth Financial Inc., which stands to benefit from a pull back in the market by FHA.”
Turns out this sort of thing is all in a day’s work for a lot of economists, who, like some scientific researchers at universities (led in the enterprise, until recently, by Charles Nemeroff and Joseph Biederman), don’t see why it’s anyone’s effing business which corporation or interest group pays for (and maybe ghostwrites) their research.
The American Economic Association has now adopted a few COI rules.
The remarkable American Psychiatric Association (until recently ruled by Alan Schatzberg) makes money two ways:
1.) Publishing, and regularly revising with an eye toward broadening the categories under which people can be considered mentally disordered, the Diagnostic and Statistical Manual of Mental Disorders.
2.) Making the people who work for the APA devising these broader categories sign confidentiality agreements so that the APA can without hindrance from the scientific community enlarge the number of Americans who must buy psychotropic drugs.
Now, as Allen Frances notes, the APA has gone a step further, loosing its lawyers to stalk bloggers who use the letters DSM in their blog’s name. It’s all part of protecting psychiatry’s, and pharma’s, enormous investment in retaining ownership of the who’s mentally disordered franchise.
UD‘s buddy Carl Elliott puts the ongoing, er, difficulties of a University of Wisconsin professor in perspective.
You must remember this: A Zdeblick is just a Zdeblick. A Medtronic is just a Medtronic. The fundamental things apply.
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And ask yourself: Why should this guy, a fully-functioning arm of the Medtronic corporation, bother with the whole “chairman,” “professor,” “university” thing anyway?
Look at it from Medtronic‘s point of view and you’ll immediately understand. They’re after the prestige and scientific legitimacy most people continue to associate with universities. As long as the University of Wisconsin continues to agree to play its assigned role – generator of an atmosphere of intellectual integrity – Medtronic will insist that its man remain on its faculty.
The anti-DSM movement finds its poet. This guy can really write.
Psychiatrists get paid for treating mental illness. There is a strong motivation for them to look at things they used to attribute to chronic personality, or just life, and see them as psychiatric illness. If you have an unstable personality disorder I am afraid psychiatry has little to offer, but if we call you bipolar or cyclothymic we treat you with antidepressants and mood stabilizers, and get paid to do so.
… An apparently scientific argument is said to be “not even wrong” if it is based on assumptions that cannot possibly be falsified or used to predict anything. I am afraid after nearly 20 years in the belly of the beast of psychiatry I come to no other logical conclusion than that for the most part the DSM and the psychiatry behind it are “not even wrong.” … Because of this purely descriptive, medicalized approach untied to verifiable pathology, if I as a doctor want to see bipolar disorder as irritability and daily mood swings (as many do), than that to me is being “bipolar.” I can also look at it as a byproduct of a very challenging environment superimposed on temperament, but I cannot prove that it is or is not “bipolar disorder.” I can only prove that I choose to interpret some symptoms as diagnostic of that particular label. When the definition of the construct cannot escape subjective description or self report we cannot escape the arguments by certain groups with competing interests that we are either “under” or “over” diagnosing disorders. Whether we are or are not depends on what kind of world you want to live in and how you want to conceptualize what people tell you.
University psychiatrists who unwarily hand out diagnoses and pills to students, or who, as researchers sometimes compromised by industry affiliations, lend academic legitimacy to pseudo-science, have much to answer for.
Conflict of interest, which is all over the Penn State fiasco, is…
Oh, I dunno. Coin of the realm. Everywhere. Universities try to deal with it by constantly tweaking their COI language in yearly faculty declaration forms, etc. Sterner rhetoric. More paragraphs to read before you sign. But there’s nothing they can do. COI. It’s a way of life.
So frinstance take this guy in England. He advises the government on health issues, and is very influential, but he’s always making the papers because of his generous pharma friends.
Questions over Professor Strang’s links come just months after he was criticised for failing to disclose ties to drug companies when applying for a government project.
… It is the second time in a year that Professor Strang’s pharmaceutical links have been questioned. In July, The Independent revealed how Professor Strang had failed to disclose links with drug companies that sell tranquilisers such as Valium before conducting a DH review into the same drugs. His report is guiding government policy in this area.
These things are pretty easy to write, and given the incredibly lucrative medicalization of normalcy at the heart of the newest edition of the Diagnostic and Statistical Manual of Mental Disorders, we’ll see more and more of this literary genre.
Or maybe less and less. It can be hard to write clearly when you’re on anti-psychotics.
Mental health clinicians should consider signing this petition. It explains why taking the fifth, if you will, would be a terrible error.