LATE LAST month I attended the 7th International Osteoporosis Symposium in Washington, D.C. I thought I'd learn a lot that I could then pass on to other older women in the Berkshires, many as little conscious of osteoporosis as I had been, and I hoped to get clearer what to do about my own diagnosis, and the urgently prescribed medication for it, which I have refused for a year now.
The event was basically a five-day non-stop education — some might call it a fancy sales job, or even indoctrination — by MDs for MDs (also physical therapists and other health professionals). From 8 a.m. to 9 p.m., talks and panels, lots of exciting information, in grand hotel ballrooms. All meals provided — dinners especially nice, supplied by the drug companies — plus nifty perks like a handsome tote bag emblazoned with 'Lilly' (maker of Forteo, scariest of the drugs), and a beautiful pen inscribed 'Fosamax,' the blockbuster seller. A very different world from the pretzels and chips and cheap white wine of my own decades of university English literature meetings.
After I came home I thought for a while that things seemed clearer. Just about everyone who spoke or whom I spoke to seemed of one mind: this is a really bad disease, undertreated, it desperately needs to be publicized, diagnosed (give a DEXA scan to every woman over 65), and medicated, or it will wreak devastation.
So my first draft of this article read like the NIH ad in the recent Sunday Times Magazine devoted to older women. I crammed it full of data, carefully defining the disease (bone thinning, especially after menopause), listed risk factors (like family history and smoking), noted how men get it too but later and to a lesser degree, urged kale and yogurt, heavy vitamin D3, exercise overseen by a really skilled physical therapist....
I couldn't however share the leadership MDs' enthusiasm for the drugs as good, safe, effective; nor their repeated deploring of 'non-compliance' (naughty patients who drop their meds). The scolding of the 'non-compliant' seemed to have priority at the symposium over the exciting talks by research scientists, and no speaker dealt with why so many people go off these drugs or are reluctant, like me, to take them in the first place.
The tone was always upbeat, a kind of beating the drum, and the line between the drug companies and the MDs uncomfortably unclear. True, the dinner panels are called "industry sponsored satellite sessions" — but the same leadership MDs who are major speakers during the day, and whose names keep appearing on the important research in the major medical journals, are the same ones on the evening 'satellite' sessions that subtly but unmistakably sell the drug — Forteo, Actonel, Fosamax — sponsoring the session.
Before I left for Washington, I stumbled upon an on-line story in Slate about two Sheffield University (England) researchers conducting clinical trials of Actonel (second in sales to Fosamax) for Proctor & Gamble for $250,000. But P&G took away the final data, denied them access, wanted to ghostwrite the conclusions for publication under their signatures. [See our most recent post here.]
One of the scientists, Aubrey Blumsohn, refused and insisted on seeing the data first, only to find that 40 percent had been removed. This a year after medical journal editors 'warned that growing industry interference with academic research (from study design to data analysis and publication) was threatening the objectivity and trustworthiness of medical research.'
Barbara Quart concluded,
So in my own looking for some truth I could rest my decision on, I discovered that even the truths I thought I already had are probably not trustworthy. Compromised doctors. Compromised data. Flying blind indeed.
I am angry that this richest of American industries uses its vast wealth far less for research to make better, less dangerous drugs, than to buy off doctors; to plaster misleading ads everywhere; to dispatch armies of salesmen and lobbyists; and to manipulate and thus destroy the meaning of scientific research results.
Because I spend most of my professional life as a research-oriented academic general internist, the meetings I attended were mostly small, serious, academic, and non-glitzy. I never had an opportunity to attend one of the big meetings with a big exhibit hall. So I think I understand Ms Quart's mixture of wonder and outrage when she first attended a big, heavily commercially sponsored meeting.
Her reaction reminds us that physicians, medical research, academic medicine, physicians' societies, and medical journals have all gotten too entangled with the companies that sell drugs and devices, regardless of how good their products may be.
But if physicians don't give up the "nifty perks," and appearances in the "satellite sessions" that "subtly but unmistakably sell the drug," etc, etc, an outraged public will and should take harsh measures to make sure we do give them up.
ADDENDUM (4 June, 2oo7) - See Aubrey Blumsohn's response on his Scientific Misconduct Blog.