The Ties Between Pharma & Academic Med Centers
28 CommentsBy Ed Silverman // September 9th, 2008 // 4:26 pm
Want to know how much a drugmaker paid a doctor at an academic medical center? How about the amount of samples dropped off? Or the access given sales reps? Well, The Institute on Medicine as a Profession, or IMAP, has launched what it calls the first database of its kind to let everyone - you and me - review and compare conflict of interest policies among the nation’s 125 academic medical centers.
The data base will be a “one-stop resource to help users identify what academic institutions are doing or not doing to limit the influence of drug and device makers on medical practice and will offer users a toolkit on how to implement strong policies,” according to a statement. Take a look.
The site will focus on 12 key areas that some AMC’s are supposedly examining to regulate relationships with drug and device makers - gifts; meals; drug representative access; samples; purchasing committees; continuing medical education; consulting and honoraria; scholarships and travel; ghostwriting; speakers’ bureaus; enforcement; and implementation.
An analysis in last week’s Journal of the American Medical Association found that AMCs are increasingly adopting COI policies without any backlash from faculty or industry. At least 25 AMCs have embraced policies to regulate industry relationships, and faculty are overwhelmingly supporting those efforts, according to the paper, which was written by two IMAP officials.
IMAP is not rating or ranking AMCs, but does provide examples of “best practices” that feature model policies. IMAP, based at Columbia University’s College of Physicians and Surgeons, formed the database under the auspices of the Prescription Project, funded by the Pew Charitable Trusts. The site is also supported by a grant from the Attorney General Consumer and Prescriber Grant Program.
PharmacistMike
This seems like a good start with the varying size and services offered at academic medical centers, being able to compare programs is going to be difficult but at lease the issue is more out in the open.
Justice in Michigan
It’s a start. I only sampled a few AMCs, but I am struck (within that group) by the number who either have failed to respond or who have requested confidentiality.
Since some of these are state institutions, I’m not sure what “confidentiality” means in that context, unless there are contractual issues with companies.
Supremacy Claus
Hey Ed: You have repeated, threatening posts, targeting the pharmaceutical industry.
You have this ad, promoting an expensive meeting on coping with change.
http://www.iirusa.com/change/venue+pricing.xml
You failed to disclose your ties to management consultants in the sidebar. Your postings are designed to promote the consulting business. That hidden agenda to your biased, misleading, left wing ideologue blog eradicates your credibility. Your blog is pretextual. You discuss increasing good faith, just as you mislead and hide your Trojan Horse agenda.
I forced Dan Carlat to declare his conflict of interest, and his bias against competitors who provide a superior product to his continuing education product. He repaid me by banning me from his blog.
Honestly, the pretextual nature of your blog is dishonest.
Objective Consultant
Hey Supremacy,
I happen to know Ed and can tell you he does little to nothing for management consultants, or anyone else with an agenda. He is just as he appears to be on this blog - dead straight. Maddeningly, but it’s true. And yes, I wrote this as soon as I saw your post which is a little over the top. I don’t do the gushing ‘Ed, you’re wonderful’ stuff you see from some on here but you need to know the other side of this.
Ed Silverman
Dear Supremacy,
I don’t know what you mean by ‘pretextual.’
As to your accusation, I’m a journalist, as the ‘About Pharmalot’ page explains. The site is owned by The Star-Ledger of New Jersey, for which I’ve worked 13 years. The advertising is just that - advertising.
My only agenda is to post interesting stuff.
I don’t ban people, but have that right. For now, I will ask that grown-ups act like grown-ups. So I’m going to ask you and a few others whose remarks have spiraled into attacks to please tone it down.
The site should be like a lawn party where one can mingle among different groups holding different conversations. If someone throws a wine glass, however, the atmosphere is soured.
Let’s all stick to the topic at hand.
Thanks folks,
ed
Supremacy Claus
Hey, Ed: Have you ever seen the New York Times do a heavy hitting investigation of Saks Fifth Avenue? I never have, despite much turmoil there. I have never seen that left wing rag investigate its regular advertisers.
A lawn party of biased ideologues, relentlessly and unfairly attacking two productive industries with trivial gotcha is fair target for a mud fight. The left wants to attack with trivial gotchas, but does not want itself examined.
You relentlessly list negative and what I consider trivial gotchas against doctors, drug companies. You never list their achievements and the essential services they provide. This site has bias by selection. This is the method of propaganda of the entire left wing, biased media. Every story on NPR, down to cooking items, has an anti-Bush angle. You tell yourself, this great story about kids doing volunteer work is almost over, no mention of Bush yet. Bing. It comes just before the end, without fail.
The blog’s slant happens to further the business of this specific advertiser, demanding $2000 a ticket for a two day conference. I thought meds were expensive at $10 a day. You post items implying corruption for failure to disclose conflict of interest.
I suggest you start disclosing yours, so the reader is not fooled. I am not suggesting you change your biased, anti-corporatist, anti-doctor propaganda garbage. I am not suggesting you be suppressed or intimidated by any lawsuit, investigation or Grassley style witch hunt. That is what the left does to its targets, and to all productive entities providing any competing authority to central government. I oppose such left wing oppression.
I am suggesting you take your own implied advice and disclose the revenue you get from advertising from consultants who benefit from the siege the left is maintaining on doctors and corporations. Be consistent. End the hypocrisy of your demand for transparency by being transparent yourself. Post all your income and the agendas of its sources on the web. Just like the posting of the receipt by a doctor of an all corrupting sandwich you and the left wing ideologues demand be posted on the web.
Also, the real beef here is about race. You and the left wing ideologues, such as that foul, lying, Blue Cross running dog, racist, Grassley, do not want brand name medications promoted. If they are promoted, dark skinned people on Medicaid may receive modern, superior treatments, just like you middle class whites.
But, hey, I am not like you. I believe in your freedom.
Salmon
Seems like Supremacy Clause and his handlers are getting scared.
I wonder what they could possibly have to be scared about?
Salmon
Supremacy Claus
As the lawyer and the left have taken out US shipping, the black family, the white family, manufacturing, education, church, crime victims, US based IPO’s and finance, they are going after drug companies, and are seeking to take over the $tril budget of health care for plunder.
After age 40, they will find an organ failing every few years. They will regret the defunding and plunder of the US drug industry by the left and lawyers. They will suffer needless agonies and the blockbuster drugs missing. The discovery budgets would have gone to fund the lavish lifestyles of lawyers and would have been redistributed to the parasitic constituencies of the left.
Patients should form direct action groups to go after the enemies of clinical care in self-help. To deter.
C. Pharma Researcher III
I have worked in the pharmaceutical industry for 20 years and have watched an industry undo itself. The problems that vex the industry are self created. Hired lobbyists obviously have a job to do, to protect the industry, but it makes little sense to attack the journalists etc when the problems were born within the industry itself. Let’s examine just a few issues.
(1) Suppression of Safety data & Drug Recalls. VIOXX was an example of a problem. The industry is built on a model that requires blockbuster mega-products to drive the financial engine. And because the entire model (as well as executive comp) hinges on that, people will do extraordinary things to keep some of these mega-products moving forward. If you have read everything you can about VIOXX you have to ask yourself, is that a real problem? is that something we need to be concerned about? Of course it it. You cannot blame the lawyers, or the media or even Congress for Merck’s failures to properly advise the FDA on CV risks. We see one safety scandal after another. And I witness it first hand every day, the companies simply want to focus all of their attention on efficacy data and messaging. As an industry, we are simply too reluctant to be transparent about safety data and it is a constant drag on reputation and trust.
(2) Financial Ties with Physicians. Much is written about this issue. And the defense is always that industry support for research and education are important and helpful. Well that’s sort of like looking at our environmental issues and saying “well ambulences save lives.” Sure there are aspects of that industry funding that are very valuable. The mere fact of relationships should not be in question. But it is the constant abuse of those relationships that again is a constant drag on reputation, integrity and trust.
Yes, physicians who are experts in certian areas should be able to work as clinical investigators and get paid for that work. That’s very valuable. And since pharma companies develop and sell medicines that can be dangerous etc it seems fair to assume that they will need to retain outside experts for occassional consulting on complex medical issues. And maybe (although I am not certain) it is fair for companies to hire physicians to work as promotional speakers to help promote a new product because the company on its own cannot reach all of the relevant audiences etc. And if that’s where the industry was we would not be seeing so much concern from medical centers, journals and the press. However, that’s not where we are.
We have physicians who are paid large sums of money to run seeding trials.
We have consulting meeting after consulting meeting and nice hotels not because we really need the consulting but because we need to foster strong relationships with “Key opinion leaders.”
And we engage hundreds and some times thousands of physicians who act as promotional speakers at dinners for our products. Sometimes these physicans can earn hundreds of thousands of dollars on speaking tours where they show up at a dinner give a promotional talk about a product and fly to the next dinner.
Every product team at every major company has courted and built relationships with Opinion Leaders with a complex web of substantial financial ties. And the reality is that Ed and the rest of the pharma media aren’t hitting hard, indeed they often miss the point. The media and even congress focus too much attention on the small potatos, the pens, pads and lunches. The reality is that Key Opinion Leaders are courted with enormous sums of money via a series of complex financial arranges. A key opinion leader may serve as a lead investigator for a product, his university depart may receive substantial support for the clinical trial, he might then be retain as a consultant at 3 or 4 advisory boards to review messaging etc, he might receive financial support for drafting and editing the manuscript and he might serve as a promotional speaker at 20, 30 or 40 promotional dinner events. And a serious KOL might be doing that for 4 or 5 different products with 4 or 5 different companies. He or she could easily be making enormous sums of money (in the millions) on these relationships.
Again some of that is important and helpful. But there is great abuse in the system. And it is abuse on both sides — in pharma and among physicians. And the more people understand about that, the more concerned they are. And I am on the inside and I think they should be concerned.
The Key Opinion Leaders who are courted with great sums of money are the same people who are drafting Practice Guidelines that will help guide diagnosis and treatment at hospitals and clinics across the country. Those same KOLs are advising the FDA at Advisory Committees on drug approvals and safety risks. As patients and consumers we have an interest to ensure that the leaders in the practice of medicine retain enough independence to make balanced treatment decisions. And I think that is being called into question in one forum after another.
You see one attempt at transparency after another. But what you don’t see is the industry jumping on board any of them. Because everyone knows that the numbers are too large with a number of key Opinion Leaders and at the end of the day the financial ties that have been built cannot in full be defended. Again, these practices are industry created. I do not see these attacks as unfair. I wish the industry as a whole would take the opportunity to scale back some of this activity before people actually figure out a way to achieve transparency. I wish Congress did not need to consider legislating it. But what I see is the exact opposite. As pipelines dry up and patent expiries come on, what I see are companies getting more and more desparate and aggressive. Financial ties with key practitioners are only growing. Regulation and enforcement have not acted to curb these practices. The web of financials ties is to complex to even figure out. The only genuine solution is increased transparency and public scrutiny. I am sad to see that play out. But if the industry and healthcare in america are going to be better in 5 or 10 years, then it has to play out.
There are other points. I look forward to writing about DTC ads! But for the time being I will put this stake in the ground. My request would be that Ed drive harder, go deeper, take it to the next level. We need more people not just talking about the latest Vytorin scandal but actually discussing what it all means and where the best solutions might be developing. We need to find a better way (as an industry) to learn from our mistakes and better position ourselves for success over the long term (not just the next 6 months).
Regards.
Ed Silverman
Dear Supremacy,
I will repeat something I have written here before, since I’m not sure when you began visiting the site - pharma is undergoing a great deal of change and challenge, which causes tension.
As a journalist, I follow the tension. And there are many ways to tell tales of tension - through battles over patents, pricing, safety, litigation, legislation, marketing, executive changes, stock prices, and clinical trial results, among other things.
A wide variety of such developments - both positive and negative - are reported here if you were to go back through the archives of the past 20 months. It would appear you missed some things in making your assumptions.
I’m not sure what other assumptions you make when you accuse me of conflicts. Can you be specific? The advertising is placed by The Star-Ledger and a sister company, and they book the revenue, so it is up to them to disclose how much they charge for any ad. The newspaper pays me a salary. I don’t hold stock in the companies I write about or have any business relationships with them.
In any event, most publications and sites have advertising, so presumably one can always wonder if there is a conflict, but I can only say that credibility would be damaged if such a conflict were real and were to surface. And credibility is hard to restore, which is to say that no one ad is worth that price. I hold this view as the person responsible for the content, whether I were to own the site myself or not.
If you have specific facts you wish to present, please do so. Meanwhile, I have to get back to work. So I’ll leave you with one parting thought - I’m happy to have your participation on the site and always appreciate dialogue about the topics at hand. But if you’re unhappy with my reply and choose to harbor suspicions, you have the option of not returning.
And if you choose to continue to participate, I’ll respectfully remind you - and others who have communicated with you on this site - to please avoid unpleasant language and personal attacks against other visitors here.
ed
Doug Bremner MD
Supremacy’s rants against Ed are clearly delusional and bullying. Ed provides a service by allowing readers to comment in real time, which allows for real discussions to take place, unlike other sites I have written on like the huffpost where comments have to be approved and it can take days for them to show up, killing the free exchange of ideas. This is a priviledge that should not be abused by anonymous posters. Supremacy seems to boast about getting banned from the Carlat site, maybe he is lobbying to get banned here as well. Speaking as a doctor and an academic I don’t feel that Ed is “against” me. The relationship between pharma and academics is important and newsworthy, and should be covered by pharmalot.
Nancy Fruge
Staying on message…
University of Texas Southwestern Medical Center’s conflict of interest policies are “Coming soon” to the IMAP COI Policy Database!
Cheers to Rothman and Chimonas et al for the Toolkits linked to the IMAP COI Policy Database Web page - a treasure trove of recommendations for bridling conflicts of interest between physicians and drug companies.
harpy
Supremacy Claus is a troll who has been making the rounds of the pharma blogs in its quixotic mission to save pharma from the disclosure of its misdeeds. If you don’t like what you read here, SC, I’m sure you’re more than welcome to hop on over to DrugWonks or the Drug and Device Law Blog and see what they’re reporting. You won’t, however, because you seem to be more interested in suppressing freedom of the press through obnoxious, vituperative attacks than doing something constructive.
Lisa Van S
Supremacy is providing a wonderful insight to exposing the Pharmaceutical Industry, and their beliefs that the individual consumer/consumers are racists and vile individuals. Those in Industry who are truly caring individuals must cringe everytime he opens up his “Potty Mouth”.
no bias
As soon as Merck knew there were CV risks with their product, they DID inform the FDA. The risk was CLEARLY stated in the product information. The notion that Merck covered this up is make believe. people who don’t like the industry want people to believe that drug companies will do anything for profit. they’re wrong. and they don’t know what the hell they are talking about. There was no clear sign of CV risk when the drug was launched and as soon as any risk was exposed it was communicated. there is no cover up or blame. just stupid people with an agenda.
Doug Bremner MD
“No bias”, that’s actually not true. There was evidence in the trials going back to 2000, but Merck spokespersons turned themselves into pretzels trying to deny it.
Justice in Michigan
“no bias” is simply wrong on the facts. This is not the place to review the particulars. But Merck was not appropriately forthcoming and marketed to docs deceptively, minimizing or camoflaging risks, as two FDA warning letters attest and so do Ed Skolnick’s emails (about what was known/strongly suspected).
Felony fraud? Not from what I’ve seen. Playing _with_ regulations rather than _by_ them? Absolutely.
anon
IMAP is based out of columbia university organisation. Perhaps IMAP should look into columbia’s COI’s. It is practically a one stop shop for medical device and drug companies. For example a columbia affiliated org. cardiovascular research foundation (through which medical device makers pay interventionalists based at columbia’s medical center to promote their products) has been recently targeted by congress.
Is this another smokescreen?
Supremacy Claus
Ed: You warn me about civility. Others call me foul mouthed names. You say nothing.
Doctor’s income is 10% from drug companies services. More typical is under 1% because drug companies are so cheap, the doctor loses money participating in their events. The doctor could make twice as much seeing more patients during that time, and without travel. That 10% is not enough to influence clinical decisions that will make the doctor’s life miserable, if the patient does not do well.
You stop your relentless bashing of doctors and drug companies, you lose your advertisers. Your advertisers are here for doctgor and drug company bashing. These are consultants dependent on these attacks on clinical for their high fees. Your ads end, you lose your entire job. Your conflict of interest is 100%, not 10% as with the doctor. Your blog is a Trojan Horse for the consulting business dependent on attack on clinical care.
You are so swimming in it, you have zero awareness you are in a sewer of left wing bias, to make a living, to keep your job.
I am going to guess you are under 40. I await your 40th birthday. You will pay big time for your misguided attacks on the people that will save your life over and over, and will make life worth living between the long parade of organ failures. You will remember my curse.
If you are not knowingly corrupt, you are being played. This campaign is by insurance companies with $tril in reserves to deprive dark skinned people on Medicaid of expensive, superior brand name medication. They have Grassley and chumps on the left serve as water boys. If docs start writing for generics, your blog and the entire hubbub disappears.
Ed Silverman
Dear Supremacy,
This is my last note to you, because I think you’re making assumptions without any direct knowledge.
For instance, have you analyzed the advertising on this site over the past few months to determine how much of it was placed by companies targeting consumers compared with other target audiences and which companies placed those ads? How many were consulting firms? I would like to see a breakdown. If you’re unable to provide a breakdown, I’ll make it easy - there were very few consulting firms advertising on the site.
I understand your points, but I respectfully disagree. You’re entitled to your view, but you unnecessarily surround them with a bit too much invective. And for that reason, I’m now moving on. Feel free to write back as much as you like, but I’m afraid I have nothing more to say.
ed
Supremacy Claus
Ed: As the states are passing regulations requiring the reporting on the internet of a sandwich provided to a doctor, I suggest your employer list all Pharmalot advertisers, their fees, and their agendas.
As the public may judge the influence of a sandwich on clinical decisions, shouldn’t the public get to judge the influence of 100% dependence for your entire salary on advertisers profiting from the attack nature of the blog?
Lead the way toward transparency. If you feel, this demand is oppressive, picayune and ridiculous, why is the regulation mandating the reporting a sandwich less so? If you feel the demand chills Free Press rights, where no harm has been shown, why is the equally Supreme Court protected validity of clinical decisions any less chilled by the demands of the left wing attack ideologues?
laurie
” If you feel, this demand is oppressive, picayune and ridiculous, why is the regulation mandating the reporting a sandwich less so?”
Because last time I checked Ed wasn’t prescribing drugs or treating patients. He’s a reporter…..doing what reporters do.
Old argument, SC ,that has been trotted out here before when someone doesn’t get the support they want in their opinions.
Lisa Van S
Salmon,
Maybe sepremacy is actually Peter Pitts!
Supremacy Claus
Hey, Ed: Female mental patients are groupies of yours. All seem off meds. Do you ever run into them in person at leftie meetings?
They should be easy, and wild. If you want to really increase your readership, try blogging encounters with med free left wing blog groupies.
Start a premium service. I would pay to read it. That would open another world of potential advertisers. You should, of course, name them, their fees, and their agendas. For transparency.
Lisa Van S
Supremacy,
You do wonders for Industrys’ image.
atlex
Lisa et al,
SC no more represents the pharma industry as some of the occasional nuts who post irrational rants against the industry. (Please note that I am not trying to bash the regular anti-industry posters, many of whom have legitimate issues and rational opinions–though I disagree with most). Why pay attention to SC; just ignore him and (maybe)he’ll go away.
By the way, I doubt that its Peter Pitts; he usually has cogent opinions–like them or not. He also isn’t afraid to use his real name.
Atlex
Lisa Van S
Atlex,
I dont believe its Peter Pitts and I agree with your opinion of him.
Im not anti industry, Many of my friends and family need their medications to survive. I have a real problem with children being overmedicated, and children in the foster care program being abused, and adolescent teens who have been victims of rape and incest being told that they need Psychtropic drugs for their chemical imbalance. What they deserve is the perpetrator being prosecuted and to provide them w/adequate counseling/therapy.
I will take your advice and ignore SC..
Supremacy Claus
Lisa: Too late. You are an addict.