Conflicts of Interest

March 21, 2007

DollarThe debate about the ethically questionable relationship between physicians and the pharmaceutical industry opened up again this morning on the front page of the New York Times. Although the article is heavy on interview and anecdote and a little short on evidence, it is difficult to avoid casting a critical eye on this relationship. The impetus for the article is the new laws in a handful of states requiring drug makers to disclose all payments made to doctors. These laws have made public previously hidden relationships that many doctors have had with the pharmaceutical industry and the article highlights a number of physicians who engage in such relationships. The article opens with a discussion about Dr. Allan Collins the president of the National Kidney Foundation who has received significant criticism over the amount of money he has received from Amgen, the makers of Erythropoietin and Darbopoietin. Multiple doctors and former employees from the pharmaceutical industry are interviewed and quoted extensively regarding the potential bias found in not only in lectures given to doctors but even in the guidelines written to guide decision making. The slant of the piece is clear especially in light of the sections titled Unknown to Most Patients and A Silent Quid Pro Quo. Nevertheless, it is difficult to argue that the influence that the pharmaceutical industry holds over all of us is not problematic. There’s a certain skepticism that flows through many of us when we hear the terms such as pre-hypertension and pre-diabetes likely coined by a pharmaceutical industry hoping to increase the numbers of patients taking prescription drugs. For those physicians interested in the topic there is an excellent website that clearly shares the perspective expressed in the NY Times article: www.nofreelunch.org.

-Sean Cavanaugh, MD Associate Program Director NYU Internal Medicine Residency Program

References:

New York Times Article

Pharmaceutical Company Payments to Physicians: Early Experiences With Disclosure Laws in Vermont and Minnesota Ross.J et. al. JAMA. 2007;297:1216-1223.

Image Courtesy of Wikimedia Commons

One Response to Conflicts of Interest

  1. Bruce Cronstein on April 6, 2007 at 12:23 pm

    I would agree with you that that was an interesting article, more for its distortions than for the expose. The individual who came in for the greatest criticism for having taken $1.9 million from Amgen was the recipient of a research grant for nearly all of that. That the grant came in his name (to a “shell” foundation for externally funded research at a state university) was clearly used to tar him. It is almost like being taken to task for being associated with the US government because you can trace a large sum of money coming in my name to NYU (to pay for my research).
    The New York Times has taken a very strong political and editorial position in the area of medical conflict of interest and seems to take great delight in sliming people. The single best example of this approach was in their discussion of the FDA panel reviewing Vioxx and Coxibs. They often note (and repeated in this article as well) that in the vote taken on whether to take Vioxx off the market that 10/17 votes cast to keep the drug on the market were cast by individuals who had taken money from the pharmaceutical industry. What was not mentioned was that these individuals were all practicing rheumatologists or clinicians who cared for patients with arthritis and that the other 7 individuals who voted with them were clinicians as well. This ultimately prompted a charge by one of the epidemiologists on the panel that caring for patients constitutes a conflict of interest in judging drug safety (Furberg).
    Although I would agree that the pharmaceutical industry’s primary goal is to make money and that they can and do influence our medical decisions you should recognize that we live in a sea of advertising most of which we ignore. Moreover, you should also realize that increasingly the decision as to which drug you prescribe for any patient is being made by the formulary person at the third party payor for your patient.

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