Tuesday, April 15, 2008

"Singed by the Blogsphere," Academic Doctors Give Up Conflicts of Interest

Everyone now and then we get to comment on good news.

In the New York Times today, Gina Kolata's article was entitled, "Citing Ethics, Some Doctors are Rejecting Industry Pay." The main points were:

With little fanfare, a small number of prominent academic scientists have made a decision that was until recently all but unheard of. They decided to stop accepting payments from food, drug and medical device companies.

No longer will they be paid for speaking at meetings or for sitting on advisory boards. They may still work with companies. It is important, they say, for knowledgeable scientists to help companies draw up and interpret studies. But the work will be pro bono.

The scientists say their decisions were private and made with mixed emotions. In at least one case, the choice resulted in significant financial sacrifice. While the investigators say they do not want to appear superior to their colleagues, they also express relief. At last, they say, when they offer a heartfelt and scientifically reasoned opinion, no one will silently put an asterisk next to their name.

They are part of a group responding to accusations of ethical conflicts inherent in these arrangements, and their decisions repudiate decades of industry influence, says Dr. Jerome P. Kassirer, a professor at the Tufts School of Medicine, who has written a book on conflicts of interest.

Five years ago, 'nobody paid any attention to taking money from industry,' he said, adding: 'They just took it. In some instances, I think people thought they were suckers if they didn’t.'

Now, Dr. Kassirer said, he keeps finding experts who are rejecting the money.

'I don’t think there’s any question that the atmosphere has changed,' Dr. Kassirer said.

He attributes the change to publicity about conflicts and what can be almost a public shaming when researchers’ conflicts are published. 'Finally, it’s gotten to people,' Dr. Kassirer said.

The article only discussed three academicians who have renounced conflict. Yet all three are prominent, so I would like to hope this represents a trend.

The article also told how the people involved began to worry how the conflicts were affecting their thoughts and actions.

Kelly D. Brownell, director of the Rudd Center for Food Policy and Obesity at Yale, made a similar decision. His was to protect his integrity when he began to wonder whether his industry associations were subtly affecting his objectivity. 'The money offers started happening about 20 years ago, at the point that I became a visible person in the field,' Dr. Brownell said.

First it was drug companies developing obesity drugs. Then it was food companies. Eventually, Dr. Brownell said, he began to worry. Were his associations unconsciously affecting his objectivity? He said the money could be substantial. He was offered, for example, $50,000 to be on an advisory board.

'It is easy to offer subtle statements that would favor a drug,' Dr. Brownell said. 'You do it for two reasons. You’ve got a money stream coming in, and you get to like the people who work for the companies. You feel like you’re on a team.'

In many of our previous posts about conflicts of interest, we have quoted people with conflicts indignantly protesting that their financial ties could not possibly have affected their scientific or clinical objectivity. They all believed they were invulnerable to such influence. But common sense, psychological evidence, and the case above suggest that financial entanglements with commercial health care firms cannot help but affect one's thinking.

Also there was this in the NY Times article,

Dr. [Eric P] Winer [Director of the Breast Oncology Center at the Dana-Farber Cancer Institute at Harvard] said. 'I just said enough is enough. And in truth, it has made my life simpler. I no longer debate can I take this, can I not take this. It is simpler when I talk to reporters. It is simpler when I give lectures.'

This is reminiscent of the quote by Joe Collier from the British Medical Journal that I have been fond of using,[Collier J. The price of independence. Br Med J 2006; 332: 1447-9. Link here and related post here.]

People who have conflicts of interest often find giving clear advice (or opinions) particularly difficult.

Finally, one case described in the NY Times article had particular resonance.

Dr. Peter Libby, chief of cardiovascular medicine at Harvard’s Brigham and Women’s Hospital, said that when he first began receiving offers from drug companies, in the early 1980s, they seemed like a natural reflection of his burgeoning reputation.

'When you start emerging as an opinion leader or as a researcher who has knowledge and expertise, the pharmaceutical industry takes an interest in either having you consult to help them with their research or to speak,' he said.

Dr. Libby wanted to assist. Like many scientists, he feels that it is important for researchers to consult with drug companies to help develop therapies and set up studies. He never owned stock in companies that he consulted for. He always disclosed the fact that he consulted and spoke for companies. And, he added, he thought that he was protected from accusations of favoring any particular company’s products because he consulted for so many.

'I lived safely in that comfort zone for many years,' Dr. Libby said.

Then he was hit with a moment of truth. He had spent four years working without pay to help create a public television series, 'The Mysterious Human Heart.' The project was, he thought, a worthy effort to educate the public about what heart disease was and how to prevent it. He was proud and pleased when the series was broadcast in October.

But to his dismay, bloggers immediately attacked him and the other medical experts who appeared on the programs for having consulted for manufacturers of pharmaceuticals and medical devices, Dr. Libby said, adding: 'They said we were biased. What I thought was four years of public service was impugned.'

'That was a wake-up call for me. I was singed in the blogosphere.'

This year, he made his decision. He would continue speaking at forums sponsored by the pharmaceutical industry and would continue consulting for companies. But he would no longer accept payment.

Since then, Dr. Libby said, company executives and lawyers have asked whether they offended him. Does he have some secret agenda?

His motives are straightforward, he replies. 'I want to speak out about the beliefs I am passionate about regarding prevention and medical advances that I think can reduce disease and save lives,' he said. 'It is not worth it to be under suspicion.'

The blogs that did the singeing were Health Care Renewal (see our post here) and PharmaLot (see Ed Silverman's post here). The PBS show was funded by AstraZeneca and Medtronic. Dr Libby and another physician were content advisors. The show did not disclose that Dr Libby had consulted and served on a speakers' bureau for AstraZeneca, and the other advisor had consulted for Medtronic. I wrote then,

Thus the show's content was influenced by people with significant personal financial relationships with AstraZeneca and Medtronic.

Again, as noted above, there is nothing to suggest that the show's content directly promoted particular products. But by increasing awareness and concern about cardiovascular disease, and emphasizing its treatability, the show could still have served a marketing purpose for companies that make drugs and devices used to treat cardiovascular disease.

Furthermore, although the show did apparently disclose its funding from Medtronic and AstraZeneca, it did not disclose the funding received by some of its medical advisors from the same company.

I suggested,

physicians and researchers who are in a position to influence how the media discusses medicine and health care should, at a minimum, fully and completely disclose any financial arrangements they have with organizations with vested interests affected by such media discussions.

I am very glad that Dr Libby was listening. In my humble opinion, I think he and the two other physicians discussed in Ms Kolata's article made wise decisions to forgo further financial relationships with commercial health care firms. Congratulations to them all. I hope that more physicians and health care academics would also do away with their asterisks.

1 comment:

Anonymous said...

Forgoing financial relationships with commercial healthcare firms or industry is not equivalent to lack of conflicts of interests, credibility or objectivity. One of those three, for instance, doesn't need industry funds, he runs his own "nonprofit" organization and is implanted with a vast network of NGOs and foundations that impart just as much conflicts of interest and powerful political interests, but have the false patina of altruism. I found his statements disingenuous at best.