Massachusetts Docs To Lawmakers: No Gift Ban
44 CommentsBy Ed Silverman // April 17th, 2008 // 8:26 pm
Last month, a bill was introduced in the legislature that would make the state the first to ban gifts to docs, which was described as a way to lower prescription drug costs. The bill would prevent reps from offering gifts and ban docs from accepting gifts of any kind. And the ban would extend to a doc’s staff and family members, although samples could be distributed, as long as the samples are for the exclusive use of patients.
Now, a couple of prominent docs are firing back. In an editorial in The Boston Herald, they write “For the Legislature even to deliberate passing a law imposing fines up to $5,000 and jail sentences up to two years on practicing physicians if they accept a pen, pad of paper or slice of pizza from a company representative reflects the success that critics hostile to commerce in general have had in capitalizing on profound misunderstandings of how these companies interface with medicine.
“The real intent of these critics goes far beyond food and trinkets, and its true purpose is to curtail strictly or even eliminate all contacts between physicians and private industry,” declare Tom Stossel of Brigham and Women’s Hospital, and Dennis Ausiello, chief of medicine at Massachusetts General Hospital. “We strongly oppose this agenda.”
They go on to explain that despite extensive training, docs can’t know the details of all products, especially new ones. So sales reps serve a useful purpose. The legislation, they argue, “aims at the misperception” gifts are used as bribes to “cajole” docs into prescribe meds inappropriately. But the evidence, the say, doesn’t support the view. Providing small gifts or meals, they argue, “hardly amounts to bribery or kickbacks.” And to hold down costs, they suggest more, not less, interaction with reps is needed.
“The state should be cautious about embarking on the radical course epitomized by the law under consideration. It threatens to dismantle a system that has served us well, and is deeply disrespectful of physicians and companies alike,” they conclude.
The editorial, by the way, failed to note that Stossel is on Merck’s advisory board and is a board member of ZymeQuest and Critical Biologics. His primary employer, Brigham and Women’s Hospital, has licensed intellectual property to these companies, which may result in milestone payments and royalties. He has also received speaking fees from Pfizer and Bristol-Myers Squibb. In the past, he served on Biogen and Dyax advisory boards. Ausiello, meanwhile, is on the advisory boards of Promedior, Proventys and Pulmatrix. And he is a director at Pfizer.
Hat tip to the WSJ Health blog
Former pharma Marketing Exec
These people are on the payroll as speakers/advisor’s But, they somehow come forward and make these claims and expect everyone will say, “Oh, what were we thinking?”
I do not think the issue is about pens paper and pizza slices. But while we are on the subject, it has always amused me that the medical field needs this kind of “cajoling”. I do know many good physicians who have been able to keep up to date on the latest and offer good services to their patients without so much as taking one small trinket form Pharma. I was always fascinated by this too.
Don’t they read the medical journals, isn’t it part of their job to keep themselves informed?
Hope the folks in the Senate see that this is a smoke screen and follow the lead of some other states and organizations and ban this stuff.
I will be keeping my eye on this one…
Laurie
“The editorial, by the way, failed to note that Stossel is on Merck’s advisory board and is a board member of ZymeQuest and Critical Biologics. His primary employer, Brigham and Women’s Hospital, has licensed intellectual property to these companies, which may result in milestone payments and royalties. He has also received speaking fees from Pfizer and Bristol-Myers Squibb. In the past, he served on Biogen and Dyax advisory boards. Ausiello, meanwhile, is on the advisory boards of Promedior, Proventys and Pulmatrix. And he is a director at Pfizer.”
I think this paragraph speaks for itself.
henry
In my opinion mass gen is big pharma- so this argument is not an argument!
Paul
I read this last year and found it again. Tells how organized and biased the critics are. These kinds of underhanded tactics make a mockery of adult, constructive and transparent discussion. Time to have an open debate from both sides.
Worth reading…
The tortuitous ties of the Prescription Project
As we noted The Prescription Project is ” an initiative of the Boston-based nonprofit healthcare advocacy group Community Catalyst, which made headlines a little over a year ago when it sued Pfizer over its marketing claims for Lipitor. The Prescription Project is being conducted in partnership with the Institute on Medicine as a Profession (IMAP) and is funded by a USD 6 million, two-year grant from The Pew Charitable Trusts and money from George Soros.
In addition, the group has assembled a prestigious advisory committee whose members include Cathy DeAngelis, the editor-in-chief of JAMA; Steven Nissen, the president of the American College of Cardiology; and Philip A Pizzo, the dean of the Stanford School of Medicine.”
Part of this campaign includes class action lawsuits initiated by the Prescription Action Litigation Project which in turn is comprised of Trial Lawyers Inc (large trial firms that seek huge monetary damages by suing corporations) and their public advocacy front, Public Citizen and various state organizations.
For instance, one mainstay of the PALP is the law firm Hagens Berman Sobol Shapiro (HBSS) which has been going after Pfizer for what is alleges are “false marketing claims by pharmaceutical giant, Pfizer. We are investigating claims made for its cardiovascular disease drug Lipitor, that encouraged doctors to prescribe the drug for patients when it was not necessary or healthy to do so.” The firm is claiming that Pfizer encouraged doctors to prescribe the cholesterol drug for hypertension, chronic kidney disease, and many other unapproved illnesses besides the prevention of cardiovascular disease. …
Hagens, Berman is famous for suing Starbucks for unbridled competition and being slapped with a $10 million penalty for violating their “.. duty of loyalty to three small water bottlers that in 2003 were close to settling a claim with Nestle Waters North America, the owner of Poland Spring Water Co.” “Seattle law firm told to pay $10.8 million”, Seattle Post-Intelligencer, Mar.24; Lattman, Mar. 24).
Public Citizen and the U.S. Public Interest Research Group (PIRG) works closely with Hagens Berman and other tort firms through Community Catalyst and TPP and other conduits to attack off label prescribing via fishing expeditions, testimony and now legislation at the state level to force doctors to either disclose or disgorge any money obtained from drug or biotech firms for any purpose.
This is not an effort to ‘clean up’ medicine. This is a witch hunt, a Stalinist effort to purge medicine of any relationship between academia, private industry and clinicians. And it is an effort to presume that off-label prescribing is both hurtful and possibly criminal behavior. Let’s be clear: the goal is to create another opportunity for shaking down the drug industry and physicians. All you need are RiskMaps that prohibits and limits off-label prescribing and you have a whole new source of revenue for tort lawyers…..
Sort of like shorting currencies and buying them up. No wonder Soros is involved.
Posted by Robert Goldberg on March 27, 2007 7:20 PM | Permalink
Corrupt Harvard Doctor
Corrupt Harvard Doctor
Doctors in the Partners.org Harvard medical system are some of the most heavily biased by drug industry involvement. Doctors do not realize this and think that the Harvard label is something that immediately commands respect. Let’s start with the Massachusetts Medical Society that is the parent of the NEJM. It is funded more than 50% at least directly by the drug companies. The journal is one big advertisement literally, and in many cases more deviously by ghost-written industry-sponsored trials. There is no way that this addiction and malignant corruption can ever be fixed internally by the New England mafia of doctors.
Melody
Do we really need entitlements for doctors? Funny thing–entitlements; they are “good things” when one is wealthy and DESERVES them; they are ‘evil things’ if one is poor and NEEDS them.
Ariel
As a person with an incurable disease and also a participant in a clinical trial, I have had to learn more about this industry than I ever wanted to.
I find the doctors claim that “critics hostile to commerce” don’t understand how the pharmaceutical companies interface with medicine to be absolutely ludicrous and quite the opposite. I think the critics of this system have a very good understanding, indeed, about the interface of pharmaceutical companies with physicians. It’s called greed, pure and simple. Not to mention the total lack of ethics by creating diseases that then require yet another drug. All of this has been going on since the 1920s when doctors turned to the Public Relations industry to help drum up business. (See “Trust Us, We’re Experts: How Industry Manipulates Science and Gambles with Your Future” by Sheldon Rampton and John Stauber). And it has become even more prevalent as the healthcare system in the U.S. became a market/profit-based system.
I agree with the post by Corrupt Harvard Doctor for the most part; i.e., for some reason we - patients and doctors alike - give what has become too much trust to those associated with a so-called reputable institution. On the other hand, one Harvard doctor, John Abramson, has written an excellent and candid book that exposes the machinations of the health care industry - clinical trials, etc. - “Overdosed America: The Broken Promise of American Medicine.” Even doctors who are sincerely trying to help their patients are being mislead by the data both published AND withheld by the pharmaceutical companies. And the medical journals themselves are part of the problem.
James
Dear Ed,
I’ve noticed in many of these stories, you mention the business relationships kept by those who make pro-pharma statements. Yet, I’ve not seen any research into folks who don’t come out as pro pharma.
Case in point, the April 11 story “A Key Vytorin Memo Was Misleading And Inaccurate”. You mention Jim Stein, “a University of Wisconsin cardiology professor and one of the outside experts.” Did you do any research into business connections he or his employer may have?
Does the University of Wisconsin School of Medicine receive donations from any organizations critical of pharma? Has anyone in the school written articles critical of pharma? What are the business relationships of the Atherosclerosis Imaging Research Program, of which he is the Director?
I ask because I would not be surprised if many organizations and individuals have some connections to anti-pharma groups. Moreover, I would not be surprised if they have received money from pro-pharma groups.
“Follow the money” is a phrase that has been so overused as to become hackneyed, but in some cases, it doesn’t prove bias. Obviously, you leave it to us to draw our conclusions, but equal attention to the connections of those not supportive of pharma would at least diminish perceptions of bias.
Disgusted
Not a surprise that the Harvard-based docs don’t want the limits. They draw hundreds of dollars an hour and thousands of dollars a day from Big Pharma companies as advisors. Then they conduct trials for millions. It’s the same story elsewhere, but Harvard is the worst. reach the faculty at harvard and make millions from drug companies on the side. Don’t let these guys fool you - they don’t want anyone messing with their side jobs!
Prescription Project » Blog Archive » RxP Weekly Reader — Heartbreak Hill Edition
[...] Pharmalot and the HealthBlog are really good about pointing out relevant ties to industry that may color the opinion columns and letters of pharma’s more prolific defenders like Stossel, which is good, because it seems the original publisher of those pieces rarely get disclosure of his industry ties right on the first try…. [...]
Alan
Ed, are you going to respond to James post? I am surprised to see no response. I second his request.
HorusCat
Do we really need entitlements for doctors? Funny thing–entitlements; they are “good things” when one is wealthy and DESERVES them; they are ‘evil things’ if one is poor and NEEDS them
Melody, I will gladly donate all of my entitlements (pens, sticky notes, the occasional something-I-have-no-idea-what-this-is-for-and-no-way-am-I-giving-it-to-a-doctor, etc.) to the homeless persons of your choice. It’s called marketing and it happens in EVERY SINGLE INDUSTRY on this planet. You own a small business, I believe. Do you market, or do customers find you by osmosis?
Former, there are far, far more physicians out there who do not take the time to keep up on things than there are doctors who do. And even if a doctor could read every PI of every drug he uses, do you really think he will retain all that information? And what about situations like I encountered today, where a doc had a patient who couldn’t afford a $500 co-pay. I have told this doc (love him, he is one of my favorites, and yes, I take him Starbucks every time I see him, because then I get a capp, too) every other week for six months that we have a program where patients get the drug for a $50 co-pay for a year. I reminded him of this and he looked at me like I had just told him he won the lottery. Got on the phone, called his nurse in the other office (not in my territory, and she is new or she would have known about the program, because we aren’t stupid, we know the nurses keep track of stuff like that) and made arrangements to drive 2 hours out of my territory to meet her, explain the program, give her the forms, and make sure the patient gets signed up. Then, having had this experience, I will go into every single one of my offices over the course of a month and re-educate the nurses about the program and how to enroll a patient in it. Show me a journal that will do that for a doctor and a patient.
Then, on Monday, had a neuro describe a really tragic case to me, 19 year old brain dead for no apparent reason. He had possibly taken some methadone, but not enough to kill him. His EKG was a little funny, but otherwise, they were flummoxed. I pointed out that methadone causes arrthymia problems and in patients with a family history of arrthymia, could very well lead to cardiac arrest. I know this arcane piece of information because I used to sell a drug that affects the EKG, and so learned the name of every medication under the sun that affects EKG. Well, the doc telling the story knew this, but two of the other docs didn’t. I just smiled.
HorusCat
Ariel,
You have an incurable disease. Did pharma invent it?
Ed Silverman
Hi Alan, and James,
Sorry. I forgot to do so. Had a very scattered day. And to answer the question - yes, I do. A recent example - earlier this week, when the JAMA paper about Merck’s ghostwriting came out, I made a point of noting the four researchers have all served as expert witnesses to plaintiff’s lawyers who have sued drugmakers. And I mentioned that in the second paragraph, just so it would be clear that such a connection exists.
In general, I do poke around for connections, although I’m not sure why you cite Jim Stein from the University of Wisconsin, James. He doesn’t hold himself out as a pharma critic. He happened to take exception to the sudden appearance of minutes from a meeting that, he felt, incorrectly portrayed the remarks and conclusions made by himself and his colleagues.
As far as a ‘perception of bias,’ well, I believe the overall issue at hand is the extent to which the industry is accused of unfairly trying to influence prescribing habits, consumer demand and legislation. This is, largely, in the context of controversy and concern over safety and pricing. I agree that connections should be disclosed and understood for all who are engaged in debate, but this is why I regularly point to connections when they exist.
The industry, though, is the issue. Interestingly, some drugmakers (and device makers, too) are gradually responding to the realization that transparency - a favorite buzzword now - is in their interest. Read the post today about Zimmer Holdings. Or a recent one about AstraZeneca. I would favor disclosure efforts from everyone involved, as you would, and will be happy to write about them. If you find a connection I fail to uncover, please let me know.
I should add that allegations of conflicts occur in various contexts. If you’ve kept up with the unusual Provenge saga - which I have written about extensively on this site - you may recall allegations of undisclosed financial conflicts of interest against two oncologists who sat on an FDA panel last year and voted against approving the Provenge prostate cancer vaccine. They then quietly wrote the FDA to urge the vaccine not be approved.
It’s a long story; please go back and read some of the posts for all the details. I write this for everyone’s benefit, because I know James regularly reads this site. But one key issue in this tale is how the FDA handles such allegations. It was hardly an anti-pharma situation, though, because the many people who want Provenge approved - cancer patients, not just investors - are largely supportive of the manufacturer.
So you see, the conflicts of interest issue - or undisclosed financial ties - cuts different ways. And has been covered on this site. So please keep an open mind and read as much as you can on Pharmalot. You may find a great deal to chew on.
I hope this helps,
ed
Atlex
James and Alan,
I’ll step in to defend Ed a bit. I’ve been pushing him to look for the less than obvious COIs and he’s been acknowledging them more and more often. For instance, many (maybe most) negative reports on mental health medications are written by psychologists, who have a strong vested interest in nondrug treatments. The COI is both philosophical and financial. In a recent interview with one of these authors, Ed specifically asked the writer to address this issue.
Atlex
Former pharma Marketing Exec
HC,
You keep forgetting that I was a rep too and, I might add, the top of my class, just like you.
Let me tell you, the docs out there are keeping up, the only reason they are engaging you in many cases is to amuse themselves and use you for something. Maybe you’ll go back to HQ and say, My Doc Smith is quite good at such and such, he really seems to be a good KOL in this area, maybe we can have him to a speaker tour for us?
Stop and think HC, do you think your doc made it through the competition of Med school then residency, then practice by NOT keeping up to date? Frankly, most docs know, they just want to hear what you have to say.
Sorry, I am not buying that they really need to hear from sales reps - its a scratch my back, I’ll scratch yours game…
truthman30
HorusCat
Ariel,
You have an incurable disease. Did pharma invent it?
That’s really charming HC…
It is disconcerting (but not suprising) to see such an example of disdanin and sarcasm from the industry in regards to patients health..
Lisa Van S
Atlex,
Negative reports of Mental health drugs “for children” came directly from MHRA (U.K.’s FDA) our FDA, and The Industry themselves via their own clinical trial data.
Children are not adults and should never be treated as such.
Atlex
Lisa, did I once mention children in the above posting? Not every statement made by everyone on this blog is about children.
HorusCat
Former,
It would be easier to hear what you have to say if you didn’t frame it in condescension. I have a PhD in neuropharmacology…somehow I don’t think I “amuse” my doctors.
Much of what I have to share with my physicians can’t be found on-line. For instance, let’s say I sell Enemamax. The PI says to dose it starting low and going slow. That fits with what docs are taught in med school, so that’s what they do. Six months later, what reps hear from their docs is, “Your drug doesn’t work, and my patients are all growing a third eye.” This causes much consternation, because the studies show efficacy and no sign of third eyes. A little confab with the DMT, and voila! The dosing in the PI is determined by the dose-finding trials and the FDA. The actual clinical trials (published, by the way) dose the drug completely differently–fast and high, not low and slow. Fortunately for us, the trials are legal to use, so we point out to doctors how Enemamax is dosed in the trials. Doctors try it that way and lo and behold, Enemamax works and no third eyes! How is it that these doctors whom you seem to think are so much smarter than I didn’t read the trials (which we were passing out from the beginning BTW and were available on line) and figure out the dosing difference for themselves? Oh, and BTW, Enemamax has to be taken on an empty stomach…which doctors forget on a regular basis, to this day.
I used a little satire, but Enemamax is a real drug that I sold, with the details changed. Exactly how did such a situation occur if a doctor is only amusing himself with me? Doctors are exactly like the rest of us: they have their job and they want to do a great job, but they also have families and outside interests. More and more, docs are working fewer hours and spending more time with their families. When one of my neurologists gets done putting in a 10-hour day, she/he is going to go home and go to their kids’ T-ball game and then watch CSI with their spouse, not get on the internet and browse PubMed. I, on the other hand, have empty time during the course of my work day when I can go to the library or read journals. Plus I am a nerd and like to spend time on the internet and reading about weird diseases.
All in all, I think you underestimate me and overestimate the average doctor.
HorusCat
truthman,
I apologize for my sarcasm, but I find it ironic that someone who says they have an incurable disease and has been in trials accuses the industry of “creating” diseases. Which is it? It’s like the overactive bladder thing…I only hear men saying it is “invented.” I (wish I could bold that) have peed my pants while running for the toilet, just from THINKING about having to urinate, so I don’t think pharma invented it. (I am holding out for surgery though…)
HorusCat
Former,
My dad is a urologist, one brother-in-law is a pulmonologist and another is IM. My best friend is a neurologist. They all tell me they value their reps, and none of them treats me in as patronizing a manner as you do. In fact, the pulmonologist, who does critical care, often asks me questions about the psychotropics, since he isn’t familiar with them, but does occasionally have use for them.
I am not naive. I am not friends with all of my doctors, and of course it is a back-scratching relationship. But since only six of my 150 physicians is a speaker for me, I don’t think they are holding their breath waiting to make the big bucks as a KOL. Most of them, as I pointed out above, have actual lives and don’t want to spend their evenings out, even if it means making $750. They don’t exactly need the money.
pg
It is vaguely possible that Ariel’s disease was in a way ‘created’ (or caused) by pharma as a result of a clinical trial - he/she doesn’t say, but the first line of the post was:
As a person with an incurable disease and also a participant in a clinical trial, I have had to learn more about this industry than I ever wanted to.
Trials can do that and the 2006 TGN1412 clinical trial disaster brought that to the attention of world media.
Whether that is the case, or Ariel has at some point been a volunteer in a trial (probably thinking, as blood donors do, that it would help to save lives) and at some point has developed an unrelated terminal illness is irrelevant to Ariel’s criticism of pharma.
Suffering a terminal illness does not take away a person’s right, or mental capacity, to think, to research evidence or to give a view. I don’t see anything ironic about it at all, neither, unfortunately, do I see it particularly unusual that a representative protecting against criticism of a drug industry would use an admission of terminal illness as an ‘easy’ response.
ATG
The only criticisms of psych drugs I’ve read were actually by psychiatrists. Mental health drugs… guffaw. Military intelligence.
pg
Keep reading. Its very rare to find a psychiatrist that criticizes psych drugs. They know how criticising drug makers (by criticizing fraud and flaws in the ’science’ of approving psych drugs) has a tendency to lead to an abrupt cessation of credibility and career. There’s a lot of criticism that isn’t made by psychiatrists, you’ll find it.
Former pharma Marketing Exec
HC,
Then for the sake of all of us, start acting like you have the intelligence you claim.
Maybe try focusing your thoughts a bit more and I might actually read through your posts.
pg
According to an industry representative, doctors “don’t exactly need the money”.
I wonder why then, that a “bill” that would “prevent reps from offering gifts and ban docs from accepting gifts of any kind” has caused such a stir by doctors in opposition to the bill.
Surely the removal of the freedom to accept what only apparently amount to cheap and cheerful items such as a free “pen, pad of paper or slice of pizza” isn’t worth such a fuss and such opposition by physicians who find reps serve such a ‘useful purpose’ in providing information that will effect the lives and health of others?
Are those couple of PROMINENT physicians so strapped for cash they can’t buy their own pen/paper/pizza and continue to give their usual cheerful welcome to those ‘useful’ drug reps??
pg
If “prominent physicians” can’t afford a pen, they sure need $750.
Or if ‘useful information’ of a drug rep in only worth the few cents a pen costs, then the usefulness of a drug rep’s information sure isn’t that useful.
HorusCat
pg,
Actually, I don’t think the doctors particularly care about the pens (unless it is the occasional really good one), it’s the staff that like them, and the patients. Nor do the doctors use the sticky notes; again, it’s the staff. The doctors appreciate the pizza because the staff appreciate it. Anyway, you are picking at details and missing the point, which is that doctors don’t want legislators controlling them.
Former,
As you admit you don’t read my posts, I don’t think I have to put any stock in what you say.
pg
I suspect that patients actually pay for the free lunches (and free pens etc) given to doctors while struggling (in many cases) to pay for overpriced medication from which pharma make enough profits to supply ‘free gifts’ to doctors?
pg
“The National Physicians Alliance’s “Unbranded Doctor Campaign” is unmasking the Pharmaceutical Industry’s bogus claim that its marketing efforts are just educational ventures for physicians. By signing up physicians to renounce gifts, lecture fees, and “education” from companies, the Alliance is championing objectivity, integrity, and professionalism.
–Jerome Kassirer, MD
former Editor-in-Chief, New England Journal of Medicine”
http://www.unbrandeddoctor.org
pg
On the other side of the coin, there seem to be physicians who spend at least some of their time earning money from advising anyone interested in how to become a drug representative who will benefit from:
“exclusive company sponsored trips all over the world, has the best health care coverage offered in corporate America (including free prescription medications), benefits from a lucrative 401(K) and pension plan, receives an abundance of bonus dollars, drives a fashionable company car fueled by a company gas card, has a flexible schedule, and 15-30 days of paid vacation. If you desire a more fulfilling, rewarding career then a pharmaceutical sales position is for you.” http://www.accomplishconsultinggroup.com
I can’t see those physicians joining an Alliance that champions objectivity, integrity and professionalism.
Lisa Van S
Atlex,
You posted:” For instance, many (maybe most) negative reports on mental health medications are written by psychologists, who have a strong vested interest in non drug treatment”
Well the same can be said that Industry and their apologists have a vested interest in distorting the safety and efficay of antidepressants in children and adolescents.
You also say: Lisa, did I once mention children in the above posting? Not every statement made by everyone on this blog is about Children.
I disagree, when NJ pays out more than 76 Million Dollars for antipsychotics for infants, toddlers, children and adolescents. Does NJ truly have so many mentally ill children, no,… its Industry promoting for profit.
Lisa Van S
Atlex,
Johnson & Johnson makes it about children.
Risperdal Legos: Building Blocks for care:
http://www.pharmalot.com/2007/05/risperdal_legos_building_block_1/
pg
According to ‘Quackwatch’, psychologists and their associations have been making a concerted effort to be ‘allowed’ to prescribe psychopharmacological medications for several years and been attempting to set up training programs for psychopharmacology.
Stephen Barrett (a psychiatrist/ex psychiatrist - not sure which) is against this happening because he believes that the type of training and length of time it takes psychiatrists to become psychiatrists is what enables psychiatrists to know when to prescribe, what the side effects are, what drug interactions there are, what action to take when this kind of thing happens to a patient…apparently.
ATG
pg– I know of non-psychiatrist reform authors, have read articles and chapters by many, but the works I’ve read are mainly by authors like Peter Breggin, Grace Jackson, David (on the fence) Healy, Joanna Moncrieff, etc.. Point being, some of the most notable critics of psych drugs are… psychiatrists.
I’m trying to figure out what the “philosophical COI” is in the case of people who could make a s***-load by drugging the monkeys out of every kid and adult in their practices but, oddly, don’t. Writing books? Speakers’ fees? None touch what could be gained– from drug kickbacks, publishing, speakers’ fees, ghostwriting, etc.– from promoting the drugs.
But we know of a local pediatrician who was busted by his wife for sleeping with his (male, as it happens) drug rep. Now, is that a philosophical or financial COI?
AA
HC,
As an FYI, when someone says they have an incurable disease, you don’t jump on the rest of their post no matter how much you disagree with it. Not to be condescending but if I remember correctly, you said you thought you might be on the autistic spectrum. As a result, you might not realize that this is one of those unwritten rules that people on the spectrum can have problems with.
AA
truthman30
The few psychiatrists who speak out against the psychiatric drug regime and pharmaceutical drug cartels are usually vilified and mocked because all regimes need complete devotion, blind belief and unquestionable loyalty ..
The ones that break ranks(usually due to a crisis of conscience) are seen as a danger to the ideology..
Psychiatry is nothing more than a cult of lies built on a snake pit of myths..
Psychiatry would not survive as a profession without drugs, it is not a science , it is a fraud…
Anyone who doubts that psychiatry is a bastard, slave and whore to the pharmaceutical industry should read this letter
http://www.critpsynet.freeuk.com/Mosher.htm
Renowned Psychiatrist Loren R. Mosher Resigns
from the American Psychiatric Association in Disgust
Renowned Psychiatrist Loren R. Mosher Resigns
from the American Psychiatric Association in Disgust
This is a copy of a letter by Dr. Mosher resigning from the American Psychiatric Association. Note that Dr. Mosher was a pioneer in establishing programs of psychosocial community care in the field of psychiatry (e.g., Soteria House,); his many publications in that regard have been very influential (e.g.: Mosher, L., & Burti, L. (1989). “Community mental health: Principles and Practice”. New York: Norton.).
______________________________________________
Loren R. Mosher M. D.
2616 Angell Ave
San Diego, CA 92122
December 4 1998
Rodrigo Munoz, M.D., President
American Psychiatric Association
1400 94 Street N. W.
Washington, D.C. 20005
Dear Rod;
After nearly three decades as a member it is with a mixture of pleasure and disappointment that I submit this letter of resignation from the American Psychiatric Association. The major reason for this action is my belief that I am actually resigning from the American Psychopharmacological Association. Luckily, the organization’s true identity requires no change in the acronym.
Unfortunately, APA reflects, and reinforces, in word and deed, our drug dependent society. Yet, it helps wage war on drugs. Dual Diagnosis clients are a major problem for the field but not because of the good drugs we prescribe. Bad ones are those that are obtained mostly without a prescription. A Marxist would observe that being a good capitalist organization, APA likes only those drugs from which it can derive a profit - directly or indirectly.
This is not a group for me. At this point in history, in my view, psychiatry has been almost completely bought out by the drug companies. The APA could not continue without the pharmaceutical company support of meetings, symposia, workshops, journal advertising, grand rounds luncheons, unrestricted educational grants etc. etc. Psychiatrists have become the minions of drug company promotions. APA, of course, maintains that its independence and autonomy are not compromised in this enmeshed situation.
Anyone with the least bit of common sense attending the annual meeting would observe how the drug company exhibits and industry sponsored symposia draw crowds with their various enticements while the serious scientific sessions are barely attended. Psychiatric training reflects their influence as well; i.e., the most important part of a resident curriculum is the art and quasi-science of dealing drugs, i.e., prescription writing.
These psychopharmacological limitations on our abilities to be complete physicians also limit our intellectual horizons. No longer do we seek to understand whole persons in their social contexts rather we are there to realign our patients’ neurotransmitters. The problem is that it is very difficult to have a relationship with a neurotransmitter whatever its configuration.
So, our guild organization provides a rationale, by its neurobiological tunnel vision, for keeping our distance from the molecule conglomerates we have come to define as patients. We condone and promote the widespread overuse and misuse of toxic chemicals that we know have serious long term effects: tardive dyskinesia, tardive dementia and serious withdrawal syndromes. So, do I want to be a drug company patsy who treats molecules with their formulary? No, thank you very much. It saddens me that after 35 years as a psychiatrist I look forward to being dissociated from such an organization. In no way does it represent my interests. It is not within my capacities to buy into the current biomedical-reductionistic model heralded by the psychiatric leadership as once again marrying us to somatic medicine. This is a matter of fashion, politics and, like the pharmaceutical house connection, money.
In addition, APA has entered into an unholy alliance with NAMI (I don’t remember the members being asked if they supported such an organization) such that the two organizations have adopted similar public belief systems about the nature of madness. While professing itself the champion of their clients the APA is supporting non-clients, the parents, in their wishes to be in control, via legally enforced dependency, of their mad/bad offspring. NAMI, with tacit APA approval, has set out a pro-neuroleptic drug and easy commitment-institutionalization agenda that violates the civil rights of their offspring. For the most part we stand by and allow this fascistic agenda to move forward. Their psychiatric god, Dr. E. Fuller Torrey, is allowed to diagnose and recommend treatment to those in the NAMI organization with whom he disagrees. Clearly, a violation of medical ethics. Does APA protest? Of course not, because he is speaking what APA agrees with but can’t explicitly espouse. He is allowed to be a foil; after all he is no longer a member of APA. (Slick work APA!)
The shortsightedness of this marriage of convenience between APA, NAMI and the drug companies (who gleefully support both groups because of their shared pro-drug stance) is an abomination. I want no part of a psychiatry of oppression and social control.
Biologically based brain diseases are convenient for families and practitioners alike. It is no fault insurance against personal responsibility. We are just helplessly caught up in a swirl of brain pathology for which no one, except DNA, is responsible. Now, to begin with, anything that has an anatomically defined specific brain pathology becomes the province of neurology (syphilis is an excellent example). So, to be consistent with this “brain disease” view all the major psychiatric disorders would become the territory of our neurologic colleagues. Without having surveyed them
I believe they would eschew responsibility for these problematic individuals. However, consistency would demand our giving over “biologic brain diseases” to them. The fact that there is no evidence confirming the brain disease attribution is, at this point, irrelevant. What we are dealing with here is fashion, politics and money. This level of intellectual/scientific dishonesty is just too egregious for me to continue to support by my membership.
I view with no surprise that psychiatric training is being systemically disavowed by American medical school graduates. This must give us cause for concern about the state of today’s psychiatry. It must mean, at least in part, that they view psychiatry as being very limited and unchallenging. To me it seems clear that we are headed toward a situation in which, except for academics, most psychiatric practitioners will have no real relationships, so vital to the healing process, with the disturbed and disturbing persons they treat. Their sole role will be that of prescription writers, ciphers in the guise of being “helpers”.
Finally, why must the APA pretend to know more than it does? DSM IV is the fabrication upon which psychiatry seeks acceptance by medicine in general. Insiders know it is more a political than scientific document. To its credit it says so, although its brief apologia is rarely noted. DSM IV has become a bible and a money making best seller - its major failings notwithstanding. It confines and defines practice, some take it seriously, others more realistically. It is the way to get paid. Diagnostic reliability is easy to attain for research projects. The issue is what do the categories tell us? Do they in fact accurately represent the person with a problem? They don’t, and can’t, because there are no external validating criteria for psychiatric diagnoses. There is neither a blood test nor specific anatomic lesions for any major psychiatric disorder. So, where are we? APA as an organization has implicitly (sometimes explicitly as well) bought into a theoretical hoax. Is psychiatry a hoax, as practiced today?
What do I recommend to the organization upon leaving after experiencing three decades of its history?
1.. To begin with, let us be ourselves. Stop taking on unholy alliances without the members’ permission.
2.. Get real about science, politics and money. Label each for what it is - that is, be honest.
3.. Get out of bed with NAMI and the drug companies. APA should align itself, if one believes its rhetoric, with the true consumer groups, i. e., the ex-patients, psychiatric survivors etc.
4.. Talk to the membership; I can’t be alone in my views.
We seem to have forgotten a basic principle: the need to be patient/client/consumer satisfaction oriented. I always remember Manfred Bleuler’s wisdom: “Loren, you must never forget that you are your patient’s employee.” In the end they will determine whether or not psychiatry survives in the service marketplace.
Sincerely,
Loren R. Mosher M. D.
pg
“I’m trying to figure out what the “philosophical COI” is in the case of people who could make a s***-load by drugging the monkeys out of every kid and adult in their practices but, oddly, don’t. Writing books? Speakers’ fees? None touch what could be gained– from drug kickbacks, publishing, speakers’ fees, ghostwriting, etc.– from promoting the drugs.”
ATG - thanks btw for enlarging on the earlier comment, it was the lack of ‘notable’ that made it unclear.
Re the comment copied into this one, is it possible - at least in some cases - that you’re looking for a philosophical COI that may not exist - that some people genuinely care about their profession, or get back to remembering why they first wanted to go into that profession - and are willing to make ’sacrifices’ rather than engage in unethical practices which sacrifice their patients’ well being?
The Conflicted Again Defend Conflicts of Interest | pharmaceutical
[...] to be too snide, but I wonder to whom the “us” above refers. As discussed in posts by Ed Silverman on PharmaLot, and on the WSJ Health Blog, the two authors of the op-ed, Dr Thomas Stossel and Dr Dennis [...]
The Conflicted Again Defend Conflicts of Interest | Womenhealth
[...] to be too snide, but I wonder to whom the “us” above refers. As discussed in posts by Ed Silverman on PharmaLot, and on the WSJ Health Blog, the two authors of the op-ed, Dr Thomas Stossel and Dr Dennis [...]
stargirl
Maybe I am naive, but can’t drug reps “educate” doctors about their products without pens and pizza? I saw that the CEO of Eli Lilly, John Lechleit, was arguing before the Mass. Senate that it was sad how one of the groups that might be harmed by this new ban on all gifts to doctors from drug companies was the poor and struggling medical practices in low-income areas that make good use of free products from big pharma.
I was like, wow, he must be so philanthropic… why not give an anonymous donation of pens and pads to these poor doctors and medical institutions? That sounds condescending, but if he was sincerely interested in these low income medical practices, then I am sincere in my suggestion.
HorusCat
AA,
Sorry, the “I have ‘x’” or “I have been through ‘y’,” therefore you cannnot dispute anything I say argument doesn’t fly with me; and it doesn’t have anything to do with being on the spectrum. Cindy Sheehan tried that with the war. If you enter the fray, you are fair game. You don’t get to snipe, then claim immunity. Ultimately, we all have an incurable disease–it is just killing some of us more slowly than others.
Besides, anyone can say anything on the net. That could have been a 25 y.o., healthy-as-a-horse picture of health posting that comment.
Either way, if you can’t take the heat, stay out of the kitchen.
stargirl
I mean blank pens and pads with no brand names on them…