The Hypocritic Oath

In his excellent weekly post Economic Principals (http://www.economicprincipals.com/issues/2012.01.08/1328.html)
David Warsh wrote last week about the American Economic Association’s decision
to require that all publications come with disclosures.  Specifically, the executive committee has recommended that all those wanting to publish in any of the seven journals ofthe association must disclose;

  1. “Interested parties from whom they have received over $10,000 during the past three years, including consulting fees, retainers, grants, as well as in-kind support, such as access to data.”
  2. Unpaid positions, both non-profit and for-profit.
  3. The same information for authors’ partners and close relatives.
  4. Parties with the right of prior review.

These guys (and gal) mean business.  Noting the increase in papers produced with
something less than pure motives, and data, the committee is seeking to restore some credibility to the dismal science.  For this they are to be commended.

Would that a similar action could find its way into other areas.  Warsh’s column triggered in my all too leaky memory an article from last summer’s The American Scholar by Harriet Washington, Flacking for Big Pharma (http://theamericanscholar.org/flacking-for-big-pharma/).

Many of us notice that our doctors write prescriptions on pads carrying a pharmaceutical company’s name and logo while using a pen displaying the same.  They
may drink coffee from a mug representing another company, and stash their
papers in a bag supplied from another.  Harmless? Perhaps.  The nose of
the camel under the tent?  Positively.

Yet, as Washington noted, these cheap giveaways are disappearing as “Big Pharma,” the name given to the largest of the pharmaceutical companies, has set its sights on bigger game—the medical journals.  Starting small with an ad placed here or there, Big Pharma has, for the past 30 years, been increasing its budget and its demands on the medical journals that we regard as reliable sources of information, if not for ourselves directly, then for our doctors.

How (fill in the word here: disheartening, disingenuous, enraging) then, to find that, not only have the advertising dollars from pharmaceutical companies become the major source of journal funding (97to 99%, according to Washington), but that the journals, in some cases, now allow the companies into the editorial process.  Some companies will advertise only if the issue also mentions its products favorably.  Other companies furnish their own copy, prepared in-house, to make sure the message is delivered properly.  They also offer finished papers, prepared by medical professionals in their employ, detailing the (always) excellent results of some new clinical trial.  This gives rise to a whole new definition of “peer-reviewed.”  Why walk a mile for a camel when one is already in the tent?

Oh, doctors can still get a pen or coffee mug.  It’s just that now they pick it up in Hawaii
or the Caribbean, where they attend “educational” meetings in between golf games and dinners.  Even better, some physicians are sent to be the speakers at these events, in order to lend an air of respectability.

In short, as the old saying goes, “the only difference between men and boys is the cost of their toys.”  Whether doctors have demanded more, or the pharmaceutical companies offered more is a chicken and egg question that doesn’t matter.  Six billion dollars is spent annually in this game, and they are playing with our health.  Where to point the finger of blame?  Why shouldn’t the drug companies push their weight around?  After all, they were invited to play in Washington and look how that turned out; a federal prescription drug program where prices could not be negotiated and legislation that they helped write themselves.  It seemed almost logical to continue on with the journals.

The problem is where this leads.  Also last summer, The New York Times ran a piece Useless Studies, Real Harm by Carl Elliott (http://www.nytimes.com/2011/07/29/opinion/useless-pharmaceutical-studies-real-harm.html) which discussed “seeding trials,” a misleading name that is part of the marketing process for new drugs.  Doctors are invited to join and sometimes paid for recruiting subjects.  The drugs being tested already have F.D.A. approval and are legal, but this all stays under the radar unless people die.  And they do.  Vioxx and Neurontin are just two of the drugs with deaths and other adverse results.  These are real people dying or suffering.  The system in place for this part of the process is, at best, not equipped to do the job and, at worst, corrupt.  A comparison with the rating agencies being paid by the bond issuers comes to mind.  Take a moment to remember how well that turned out.

So where does this leave the rest of us?  Where do we go for reliable information?  The web, we have come to realize, is long on quantity and short on quality, as there is no filter on what is done to information before we can see it.  There may be articles that tell the truth, but who’s to say that the pharmaceutical companies aren’t churning out self-serving favorable pieces and paying some techie to make sure that these are at the top of the Google hits while the truth gets buried on page 37?

I am all for free speech and generally against censorship.  I realize that an opinion
different from mine, even abhorrent to me, has its place in our society.  But I also believe that if you come to the market with an agenda, we should be informed about it.  If one is paid to produce a confirmation of pre-determined results, and it does not correspond to reality, then perhaps the author should reexamine the data to see if it passes the smell test, because once the smell is there, it is very difficult to have it removed.  Long after the money is spent, the scent on one’s reputation remains.  The Supreme Court has ruled that corporations are people.  If only they would act like it, maybe medical science would not become another dismal science.

1.16.12

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