Friday, June 01, 2007

A Reporter's Close Encounter with a Big Medical Meeting

I stumbled across an interesting article in a relatively obscure media source (the Berkshire Eagle, located in the beautiful Berkshire mountains of Massachusetts, USA). The reporter, Barbara Quart, experienced something of a personal odyssey after attending a medical research convention,

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.


Anonymous said...

Barbara Quart, in her first visit to a medical convention discovered: "The emperor had no cloths."

I feel the bigger issue is: Have doctors become such a part of the sell, sell, sell, atmosphere that they embrace this business model? This being only one of a a number of legitimate medical issues that, while needing attention, are not the sole medical concerns of the population at large.

As patients we are constantly bombarded by the need for testing and medicating these "silent" killers. The higher the profit, and lower the perceived risk of drug therapies, the higher the noise level. Statins come to mind. BMI calculations are very big as we see diet drugs, only available through you doctor, being advertised. The list goes on.

Doctors need to come to grips with the selling nature of these conferences. When a doctor participates they will take away an altered perspective of the drugs available, and the need to medicate. This is the purpose, and if they were not successful, pharma would not sponsor the gatherings.

Steve Lucas

Anonymous said...


Regarding Ms. Quart's observations, can you say "MLM"? Our present-day pharmaceutical industry has evolved into nothing more than a huge multi-level marketing manager--no data, no proof, just glitzy marketing.

It seems a bunch of willing doctors, researchers, medical schools and charities are willing--even eager--to sell themselves for an opportunity to be positioned slightly beneath the top of the pyramid; they get "paid" for signing up--and then accumulate wealth by preying on others who want to join the grand pyramid, as well as an army of unwary consumers.

Doctors wonder why their reputations are tarnished? Wonder no more. Those who enlist in a pyramid scheme paint all their brethren with the broad brush called 'flim-flam.'


Anonymous said...

Interesting post by the disclosure by this doctor. And for those of you who don't know, the big pharma companies treat thier sales force in a similiar way, with the perks and abnormal excitement in obvious attempts to resist your temptation to analyize the situation occuring such a time frame. Some do choose to apply such a corporate mask, yet it's far from realistic.