Tuesday, May 29, 2007

Journalistic Malpractice, or Pharmaceutical Malpractice?

In today's Wall Street Journal, Scott Gottlieb of the American Enterprise Institute has a piece entitled "Journalistic Malpractice" that accuses medical journals such as the NEJM of an ideological agenda and demonization of the pharmaceutical industry. The piece can be read in its entirety at the AEI website at this link.

The "money quote" is this:

At what cost do political machinations of the medical journals come? When editors pursue a political agenda, it's public health that pays a price ... There is a problem when some journals let antipathy for business interests and left-leaning views interfere with the medical decisions that they make, bending standards or stepping outside their mandate, using their prestige and influence in ways that distort medical facts in the aim of influencing political outcomes.

I have written a letter to the editor to the WSJ in reply. As its chances for publication are slim (the WSJ published my letter to the editor regarding electronic medical information privacy in Dec. 2006 and will be unlikely to take another one so soon), I have reproduced my response below:
May 29, 2007

Re: "Journalistic Malpractice" (WSJ, Tue May 29, 2007, p. A15)

Dear WSJ,

In “Journalistic Malpractice” (WSJ, Tue May 29, 2007, p. A15), Scott Gottlieb writes that medical journals such as the NEJM are pursuing a political agenda of left-leaning views and seems to imply some journals are demonizing the pharmaceutical industry.

I think he’s missed the root cause of the attacks on the pharmaceutical industry almost entirely.

The root cause is not primarily the result of an ideological or anti-capitalist agenda; after all, both the left and the right and everyone in between get ill, and stand to benefit from pharmaceutical innovation.

The cause of the attacks from venerable journals such as the NEJM is not ideology, but mistrust . The pharmaceutical industry has taken societal trust - a must for any industry to be successful - and blown it out of the water. In fact, the public mistrust of the pharmaceutical industry has been well-earned.

As many print and web-based writers including the Foundation for Integrity and Responsibility in Medicine (FIRM) have increasingly and repeatedly pointed out in websites such as FIRM's Healthcare Renewal ( http://hcrenewal.blogspot.com ), where I occasionally write on medical informatics-related topics, pharma has regularized some highly questionable practices.

It is an industry that hires ghost writers to “pave the road” for new or existing drugs with what amounts to scientific spin doctoring. It bribes clinicians with gifts and perks. It advertises its wares shamelessly, as if it were selling lingerie. It presents data “with the best foot put forward” until forced not to, and has done this in some exceptionally socially-tender areas, such as antidepressants in children regarding suicidal ideation. It is an industry that hires MBA-credentialed senior executives who never took care of a patient in their lives (one of the largest pharma's CEOs was actually general counsel at McDonald’s and was president of the company’s smaller brand, Boston Market), leading to clinician and patient disgust and distrust. Its websites promise employees wonderful careers helping people, and then the industry lays off thousands of such professionals in a heartbeat due to a slight tick in stock market valuations. It is an industry where R&D may be controlled by non-medical personnel who often have more power to control internal information flow and availability than senior scientific leadership. (I've seen IT departments effectively running R&D through rationing of critical drug discovery tools.)

In effect, pharma is an industry that socially acts like a bull in a china shop. My only surprise is that the medical journals are not even more hostile than they already are -- and that may have to do with "money issues" as in the preceding paragraph.

Put bluntly, the pharmaceutical industry has lost the public trust. It is said that self-improvement cannot come before one has insight into one’s faults.

Blaming medical journals for journalistic malpractice while the pharmaceutical industry commits social, medical and scientific malpractice is mistaking a symptom for its causative and far more society-damaging disease.

-- SS

Addendum: I am informed of the following via "Integrity in Science Watch - May 29, 2007" (link) in its "Cheers and Jeers" section:

Jeer: To the Wall Street Journal for failing to tell readers of an op-ed by Scott Gottlieb, former FDA deputy commissioner now at the American Enterprise Institute, that AEI takes financial contributions from the drug industry and former Merck chief executive Raymond V. Gilmartin sits on its board. The op-ed accused the New England Journal of Medicine of "journalistic malpractice" in publishing a study that suggested the diabetes drug Avandia, made by GlaxoSmithKline, increased the risk of heart attacks.

I am a Medical Informaticist who got laid off by Merck under Gilmartin's watch during the "Equinox" mass layoff of 4,400 people in Nov. 2003 (they name the layoffs...) This was after helping fill a huge gap in flow of scientific articles to Merck scientists from a constant 100K/year from 1989 to 2000, to over 1,000,000 per year by 2004, and ending rationing of essential drug research informatics tools due to (non-scientist) IT personnel's control of the budget. I accomplished those feats through aggressive challenging of the "IT-department-controls-research" status quo, probably making me a prime layoff target.

I received a special benefit: I gained experience in how to lay off people, because as a manager I was made to take the layoff training in the days before they laid us off. Good industry social graces indeed.

With regard to my post above and the "Cheers and Jeers" item, I say this:

"I rest my case."

-- SS


Anonymous said...

Having Gottlieb chastise another's "ideological agenda" is so ridiculous that I am almost impressed by the audacity. I suppose "profit" is not technically an ideology, but the agenda is clear. The Gottliebs and Troys are doing a great job standing up for their clients and their clients' agenda, and I am glad that the NEJM is standing up for theirs.

insider said...

Great post.

Anonymous said...

I cannot link to Gottlieb's original article. Did AEI pull the plug on this?

That would be wise -- because for a minute there, it looked like AEI were trying to both practise medicine without a license and without permitting informed consent to the public.

Anonymous said...

To the original response that Gottlieb misses the point: I think you're missing his point. The fact of the matter is that NEJM is responsible for publishing reliable scientific evidence, not pollitical positioning. The NEJM has done nothing but take a very good drug away from physicians.

InformaticsMD said...

Anonymous said...To the original response that Gottlieb misses the point: I think you're missing his point.

I'm not missing his point at all, in fact, I'm acknowleging the NEJM study may or may not be valid (In actuality I'm not a fan of metastudies.)

What I am doing is adding an additional point that gives what I believe is one of the explanations why NEJM and others have become increasingly hostile towards pharma.

My post yesterday "Drug Makers Finance Nurses as On-Site, Chart-Reviewing Drug Reps" is yet another example of how pharma shoots itself in the foot with regard to social trust.

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