is “evidence-based medicine” affected by industry payoffs?

DO INDUSTRY PAYOFFS AFFECT THE INTEGRITY OF EVIDENCE-BASED MEDICINE?

Physicians and researchers must exercise judgment in complex situations that are fraught with uncertainty. Colleagues, patients, students, and the public need to trust that these judgments are not compromised by physicians’ or researchers’ financial ties to pharmaceutical, medical device, and biotechnology companies. Ties with industry are common in medicine. Some have produced important benefits, particularly through research collaborations that improve individual and public health. At the same time, widespread relationships with industry have created significant risks that individual and institutional financial interests may unduly influence professionals’ judgments about the primary interests or goals of medicine. Such conflicts of interest threaten the integrity of scientific investigations, the objectivity of medical education, and the quality of patient care. They may also jeopardize public trust in medicine.  From 2009’s Conflict of Interest in Medical Research, Education, and Practice, which was put together by the Institute of Medicine (US) Committee on Conflict of Interest in Medical Research, Education, and Practice.

“Can we really believe that clinical researchers are more immune to self-interest than other people?”  Dr. Marcia Angell, past editor of The New England Journal of Medicine, from 2000’s Is Academic Medicine for Sale?

“Is academic medicine for sale? These days, everything is for sale.”  Catherine Diamond, M.D., M.P.H. University of California Medical Center, Irvine, CA, from a letter to the editor (NEJM) in response to Dr. Angell’s article.

“For the past twenty years I’ve been hollering about the fact that we cannot trust a great deal of the research coming out of our scientific medical community.  Much of this is due to the fact that the relationship between doctors, the medical research community, our medical schools, and the government agencies that are supposed to regulate all of this, can be described as nothing less than ‘incestuous’.”  Dr. Russell Schierling from SPINNING THE RESEARCH.

On Tuesday, the CMS (Centers for Medicare and Medicaid Services), under new “Sunshine” clause directives via the Affordable Care Act, finally released their long-awaited list of which doctors and hospitals are collecting monies from the pharmaceutical and medical device industries. It appears that half of all US physicians (546,000) and a large number of teaching hospitals (1,360) have received 4.4 million payments totaling nearly $3,500,000,000.  And this was just for the final five months of the year.  Extrapolate these figures and it means that these industries are paying at least eight billion dollars a year to promote their products through physicians.   Some of the ways that the government has said that doctors are being unduly influenced include….

  • FREE MEALS:  Although these are sometimes eaten at restaurants, often times they are catered in to the office for the entire staff.  I know a person who works in a cancer treatment center who says that every single lunch is catered by industry (HERE).
  • SPEAKING FEES:  This covers a lot of ground.  It may be a large seminar, but more likely than not, it’s a smaller get together in the back room of a local pub, in which a physician gets paid to deliver a sales pitch to local docs.  However, be aware that any number of doctors are making millions of dollars in this fashion (HERE).
  • CLINICAL RESEARCH:  It has always fascinated me that in America, the drug companies not only get to do their own research, but essentially (with a little help from the FDA — see previous link to see how this works) get to approve these same drugs.  It’s a nice little deal.  They hire employees to do studies in buildings on college campuses of medical schools that actually bear the name of their own company (MIT’s brand new Pfizer Research Center is a prime example of this common phenomenon), and then turn around and hire people as “consultants,” who were just last year working for the FDA (again, see previous link).
  • CONSULTING FEES:  This is probably the most tricky of all of them.  What does a “consultant” really do?  Maybe nothing.  Calling someone a ‘consultant’ and paying them big bucks to show up a couple of times a year for corporate meetings is an all-too-common sham (one last time, see previous link on Donald Rumsfleld).  Politicians do it all the time.  So do the Medical Device and Pharmaceutical Industries.

So; back to the question at hand — the question I asked in this post’s title.  Do industry payouts affect the integrity of evidence-based medicine?  Rather than answering this question directly, allow me to do so by asking another.  Does anyone remember what a Conflict of Interest is?  A popular online legal dictionary says this of COI’s. “The presence of a conflict of interest is independent of the occurrence of impropriety.”  Stop and re-read that last sentence if you did not grasp its significance. A COI does not necessarily mean that anything devious has happened.  It simply means that the potential for deviousness to happen is present.  That’s why the rule of thumb is to avoid even the appearance of such conflicts.  This is why you don’t spend significant amounts of time alone with your neighbor’s wife.  Even if nothing is going on; at the very least it looks bad. 

Don’t kid yourself.  Big Corporations are never altruistic for the sake of being altruistic.  They can’t be.  They have share-holders to keep happy.  Every single thing they do and every move they make is predicated on making money and increasing market share.  The bigger the corporation, the more money it takes to keep the wheels turning.  The real question we need to be asking in light of this story is can we trust them?  Can we trust “The Industries” mentioned (Big Pharma and medical device makers) to play nice?  Are you kidding me?  HERE are a few of my posts on Evidence-Based Medicine, revealing why it will never be the bell tower of truth that DR. GORSKI and others believe it to be.  But these links don’t even begin to tell the whole story — not even the tip of the tip of the tip of the iceberg.  This problem of COI in the medical industry is so prevalent that it’s basically winked at — that is until someone gets caught.  Then, by golly, they need to pay!   This is always stated in the most indignant tone possible, with a politician slamming their fist on the table in mock disgust.

And by the way, all of you politicians who are sitting around patting each other on the back because you helped pass the ACA; just for the record, we don’t trust you either.  For the most part, you’ve proved to us that you’re a bunch of self-serving schmucks as well.  You all talk about COI with such disdain, yet you always seem to be in the VIP room surrounded by lobbyists.  If you were truly serious about Conflicts of Interest, you would start by tackling similar issues in your own house like lobbying, political contributions, and PAC’s. 

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