An article in the JAMA (Journal of the American Medical Association) published yesterday, April 1, was widely reported on the radio and today in the NYTimes and other publications http://www.nytimes.com/2009/04/02/health/policy/02journal.html?_r=1&ref=health.
A group of physicians and physicians groups are advocating for the elimination of funding by pharmaceutical companies for medical research because of the flagrant conflicts of interest. The concern is that these restrictions "were essential if physician associations are to maintain their scientific integrity and the trust of their patients."
This trust is clearly eroding. I see more evidence of this every day in my practice.
More discussion at a previous blogpost http://ksparrowmd.blogspot.com/2009/04/corruption-between-drug-companies-and.html
For more information about my practice, please click here.
Thursday, April 2, 2009
Believing in Treatments That Don't Work
That is the title of author David H. Newman MD's piece today in the NYTimes. http://well.blogs.nytimes.com/2009/04/02/the-ideology-of-health-care/ On a medical acupuncturist's blog readers might conclude that the title refers to ineffective alternative medical treatments or supplements. But no. Dr. Newman is referring to many of the sacred tenets of medical practice that have been debunked but are still followed blindly.
He does a good job in pointing some of the biggest ideological practices in medicine, though there are many more than this. Beta-blockers for heart attacks, cough remedies for adults or children, antibiotics for ear infections, bronchitis, sinusitis or sore throats (cost $2billion/year), back surgeries (cost $20 billion): none have not been shown to be useful in carefully conducted medical studies.
He asks these questions of the medical community, "Can we abide by the evidence when it tells us that antibiotics don’t clear ear infections or help strep throats? Can we stop asking for, and writing, these prescriptions? Can we stop performing, and asking for, knee and back surgeries? Can we handle what the evidence reveals? Are we ready for the truth?"
At least there are those in the medical community asking the question.
(For more information about my website, please click here.)
He does a good job in pointing some of the biggest ideological practices in medicine, though there are many more than this. Beta-blockers for heart attacks, cough remedies for adults or children, antibiotics for ear infections, bronchitis, sinusitis or sore throats (cost $2billion/year), back surgeries (cost $20 billion): none have not been shown to be useful in carefully conducted medical studies.
He asks these questions of the medical community, "Can we abide by the evidence when it tells us that antibiotics don’t clear ear infections or help strep throats? Can we stop asking for, and writing, these prescriptions? Can we stop performing, and asking for, knee and back surgeries? Can we handle what the evidence reveals? Are we ready for the truth?"
At least there are those in the medical community asking the question.
(For more information about my website, please click here.)
Wednesday, April 1, 2009
Corruption between Drug Companies and Doctors
After I started my medical acupuncture practice 10 years ago, I was struck by something within my first year. I noticed that many of my patients were on antidepressants, and many of them had gained 30 pounds on them. Why were so many patients on anti-depressants? Why hadn't their doctors noticed the weight gain? It could hardly be a new, I had a tiny new practice and if I noticed this phenomenon, how could it not be apparent to established physicians? It was quite remarkable. The article reviewed here explains some of the biases in prescribing revealed by my small experience.
(for more information about my practice, please click here.)
This excellent review in the New York Review of Books(http://www.nybooks.com/articles/22237) discusses three new books a(see below) about the sordid corruption that has occurred in the production and dissemination of medical research. The review is written by an editor of the New England Journal of Medicine. Her conclusion echoes what I have been worried about for some time now--that you can't trust medical studies anymore. To quote the author, Marcia Angell, "It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidleines. I take no pleasure in this conclusion which I reached slowly and reluctantly over my two decades as an editor of The New England Journal Of Medicine."
Her review covers a number of topics.
Drug Companies make direct payments to physicians to tout their medicines at medical conferences and to patients. One Harvard physician had received $1.6 million between 2000 and 2007. The Chairman of the psychiatry department at Stanford controlled $6 million in stock of a pharmaceutical company that makes RU-486. He cofounded the company and was doing studies on using RU-486 for psychotic depression.
These are just two examples of a rampant practice of of MD's being paid at conferences or to "ghost study" medications. ("Ghost study" refers to a study set up by the drug company and the physician puts his/her name on the study to lend credence.) Estimates are that tens of billions of dollars are spent per year on this type of promotion. To wit, the drug companies have gained enormous sway over how doctors evaluate and prescribe medications.
Drug Companies now are intimately involved in the clinical studies which before 1980 were the sole purview of academic institutions. Not surprisingly most of the studies published are favorable for their products and are clearly NOT unbiased scientific studies. It has been shocking to hear testimony of drug companies admitting that they buried any negative studies because they would be "commercially unacceptable." There was a hair-raising story of the giant GlaxoSmithKline burying evidence that Paxil was ineffective and even harmful to children as an example.
Many popular drugs on the market may be no better than placebo. It has been difficult to find out because of the buried negative studies, but a Freedom of Information Act request obtained FDA reviews of every placcebo-controlled clinical trial for the initial approval of the six most widely used antidepressants approved between 1987 and 1999. (Prozac, Paxil, Zoloft,Clexa, Serzone, and Effexor.) They found that on average, placebos were 80 percent as effectivs as the drugs i.e. clinically ineffective. But because the negative results were buried, the public and the prescribing doctors believed that these were potent antidepressants. The studies are skewed also, by comparing them to another drug but at different dosing levels, or to a placebo and not a existing drug, or in young people instead of old so that side effects won't show up.
Practice Guidelines have been corrupted since the medical experts writing them have been shown to have conflicts of interest. It was revealed that the National Cholesterol Education Program in 2004 called for sharply lowering the levels of "bad" cholesterol, it was revealed that eight of the nine members had financial ties to the makers of cholesterol-lowering drugs. 95 of 170 contributors to the most recent edition of the American Psychiatric Associations DSM(manual of psychiatric diagnoses) had financial ties to drug companies.
Drug companies have now become shameless in efforts to expand the markets for their drugs. Instead of promoting their drugs, they now promote diseases to fit their drugs. They rename common conditions with technical or ominous sounding names to cast a larger net for their wares. (Heartburn is now GERD, PMS is now "premenstrual dysphoric disorder," shyness is "social anxiety disorder." Anyone remotely familiar with medical practice as patient or physician cannot help but be struck by the myriad of uses of Neurontin. An anti-epileptic drug now used for pretty much anything-bipolar,PTSD,insomnia, restless leg, hot flashes,migraines, any and all pain. (I've never seen it work yet. Doesn't mean it hasn't...) The new condition to watch for is "pre-diabetes."
The author blames the medical community more than the drug companies, in that physicians first responsibility should be to patients. Her suggested reforms include getting all subsidies from drug companies out of medical clinical trials. Any researchers performing studies should accept no payments from drug companies and should not let the companies have any control whatsoever over the design and implementation of the studies.
It is about time that medical research studies became "scientific" again and not just a marketing ploy.
When I was at a UCSF conference on Issues in Women's Health last December, one of the presenters admitted that she was so impressed with a colleague of hers who was studying breath control and hot flashes because there certainly was no money for that...
The books under discussion were "Side Effects: A Prosecutor, a Whistleblower, and a Bestselling Antidepressant on Trial" by Alison Bass
"Our Daily Meds:How the Parmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs" by Melody Petersen
"Shyness:How Normal Behavior Became a Sickness" by Christopher Lane
(for more information about my practice, please click here.)
This excellent review in the New York Review of Books(http://www.nybooks.com/articles/22237) discusses three new books a(see below) about the sordid corruption that has occurred in the production and dissemination of medical research. The review is written by an editor of the New England Journal of Medicine. Her conclusion echoes what I have been worried about for some time now--that you can't trust medical studies anymore. To quote the author, Marcia Angell, "It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidleines. I take no pleasure in this conclusion which I reached slowly and reluctantly over my two decades as an editor of The New England Journal Of Medicine."
Her review covers a number of topics.
Drug Companies make direct payments to physicians to tout their medicines at medical conferences and to patients. One Harvard physician had received $1.6 million between 2000 and 2007. The Chairman of the psychiatry department at Stanford controlled $6 million in stock of a pharmaceutical company that makes RU-486. He cofounded the company and was doing studies on using RU-486 for psychotic depression.
These are just two examples of a rampant practice of of MD's being paid at conferences or to "ghost study" medications. ("Ghost study" refers to a study set up by the drug company and the physician puts his/her name on the study to lend credence.) Estimates are that tens of billions of dollars are spent per year on this type of promotion. To wit, the drug companies have gained enormous sway over how doctors evaluate and prescribe medications.
Drug Companies now are intimately involved in the clinical studies which before 1980 were the sole purview of academic institutions. Not surprisingly most of the studies published are favorable for their products and are clearly NOT unbiased scientific studies. It has been shocking to hear testimony of drug companies admitting that they buried any negative studies because they would be "commercially unacceptable." There was a hair-raising story of the giant GlaxoSmithKline burying evidence that Paxil was ineffective and even harmful to children as an example.
Many popular drugs on the market may be no better than placebo. It has been difficult to find out because of the buried negative studies, but a Freedom of Information Act request obtained FDA reviews of every placcebo-controlled clinical trial for the initial approval of the six most widely used antidepressants approved between 1987 and 1999. (Prozac, Paxil, Zoloft,Clexa, Serzone, and Effexor.) They found that on average, placebos were 80 percent as effectivs as the drugs i.e. clinically ineffective. But because the negative results were buried, the public and the prescribing doctors believed that these were potent antidepressants. The studies are skewed also, by comparing them to another drug but at different dosing levels, or to a placebo and not a existing drug, or in young people instead of old so that side effects won't show up.
Practice Guidelines have been corrupted since the medical experts writing them have been shown to have conflicts of interest. It was revealed that the National Cholesterol Education Program in 2004 called for sharply lowering the levels of "bad" cholesterol, it was revealed that eight of the nine members had financial ties to the makers of cholesterol-lowering drugs. 95 of 170 contributors to the most recent edition of the American Psychiatric Associations DSM(manual of psychiatric diagnoses) had financial ties to drug companies.
Drug companies have now become shameless in efforts to expand the markets for their drugs. Instead of promoting their drugs, they now promote diseases to fit their drugs. They rename common conditions with technical or ominous sounding names to cast a larger net for their wares. (Heartburn is now GERD, PMS is now "premenstrual dysphoric disorder," shyness is "social anxiety disorder." Anyone remotely familiar with medical practice as patient or physician cannot help but be struck by the myriad of uses of Neurontin. An anti-epileptic drug now used for pretty much anything-bipolar,PTSD,insomnia, restless leg, hot flashes,migraines, any and all pain. (I've never seen it work yet. Doesn't mean it hasn't...) The new condition to watch for is "pre-diabetes."
The author blames the medical community more than the drug companies, in that physicians first responsibility should be to patients. Her suggested reforms include getting all subsidies from drug companies out of medical clinical trials. Any researchers performing studies should accept no payments from drug companies and should not let the companies have any control whatsoever over the design and implementation of the studies.
It is about time that medical research studies became "scientific" again and not just a marketing ploy.
When I was at a UCSF conference on Issues in Women's Health last December, one of the presenters admitted that she was so impressed with a colleague of hers who was studying breath control and hot flashes because there certainly was no money for that...
The books under discussion were "Side Effects: A Prosecutor, a Whistleblower, and a Bestselling Antidepressant on Trial" by Alison Bass
"Our Daily Meds:How the Parmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs" by Melody Petersen
"Shyness:How Normal Behavior Became a Sickness" by Christopher Lane
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