Saturday, July 18, 2009



Thomas Stossel from Harvard is at it again. As Daniel Carlat has humorously described, Stossel is planning the inaugural meeting next week of a group to counter those he calls pharmascolds. The group is named ACRE – Association of Clinical Researchers and Educators. Here is its website: For months, Stossel has been warning of the dire negative consequences that will result from tightened conflict of interest policies, but he has not presented any persuasive examples of damage to “productive relationships between industry and physicians involved in clinical research and educational outreach.” At the same time, Dr. Stossel has conveniently overlooked the shenanigans of the bad actors whom Senator Grassley exposed. Dr. Stossel is a blowhard, as I have described here before.

But wait! ACRE has found something! A News item in the July 2009 issue of Nature Medicine (“Conflict of interest rules seen by some as too stringent”) quoted one of the participants in the upcoming ACRE conference. Avi Markowitz, chief of oncology at UT Medical Branch, Galveston, came up with this example: Patients taking a Sanofi Aventis chemotherapy product may experience peripheral neuropathy, which can cause unpleasant sensations in the hands and feet. ‘Sanofi Aventis had been providing Markowitz and his UTMB colleagues with free blankets and gloves for those patients. Last fall, however, the university adopted stricter rules banning industry freebies. Now, Markowitz can’t even accept the unbranded blankets and gloves that Sanofi Aventis has offered to provide.’ Reading between the lines, it is a good bet that these items originally were branded.

Whatever. And never mind that the patients receiving chemotherapy at UTMB are doubtless billed a hefty facility fee that must include comfort items like blankets and gloves. Since when does a chief of oncology need to beg for these basic patient care provisions from drug companies?

Is this all that ACRE can come up with? The ACRE homepage warned sternly of “restrictive conflict of interest policies that often sever productive relationships between industry and physicians involved in clinical research and educational outreach.” Does Thomas Stossel’s whining and catastrophizing through ACRE come down to piffling items like blankets and gloves for chemotherapy patients? That’s it? Where’s the beef?

At least ACRE has the good sense not to include on its program the smooth operators whom Senator Grassley outed – like Nemeroff at Emory, Schatzberg at Stanford, Kuklo at Walter Reed, Keller at Brown, Biederman at Harvard. Not even Stossel has been brazen enough to try to defend them.

The Nature Medicine News item does close on a helpful note: 'Stossel would like to see abuses involving financial conflicts of interest treated more like cases of scientific misconduct. Rather than forcing everyone to abide by prohibitive rules, he says administrators should focus on weeding out those who misbehave.' I say Amen to that, even if it is a day late and a dollar short.

We have arrived at our present state of discomfiture because the leaders of academic institutions and professional societies looked the other way for too long. They failed to do their job of reining in the ethical outliers. Grassley had to do it for them. As a result, the rest of us will be burdened with new regulations for years to come. Those who did speak up years ago were ignored or demonized. As the saying goes, every group gets the leadership it deserves. Those in academic medicine had better not count on Stossel and ACRE to lead them out of the wilderness.

Bernard Carroll.


Anonymous said...

Nice piece, but I am sorry to say, Danny Carlat is an idiot. Looking at his MAD Magazine handiwork regarding a serious issue tells me all I need to know about him. It's not that I am not troubled by all of the overlap between pharma and medicine at my school and elsewhere, but his self-righteous and now infantile approach has been given far too much credit. Has he never taken pharma funding? Would he accept pharma funding? He smacks of the same zealousness as all of those GOP politicians who pontificate about family values while screwing their girlfriends on the side.

Brittanicus said...

It is a shame that some Americans are so gullible, to the outlandish propaganda and lies spat in the newspapers, television and radio about Obama’s health care agenda. They have demonized the British, Canadian and other worthy plans. Hidden under a disguise cover, these radical entities are determined to keep the special interest organizations in absolute power. Comprising of the money-draining profitable insurance companies and their rich stockholders. They don't want any changes to the broken system of medical care, because it will hurt the status quo. I was born in England, in the county of Sussex and until the inception of the European Union and the European Parliament dictating to Britain. That they must accept millions of foreign workers, the nations medical system was exemplary. I never had to wonder if I would have to file bankruptcy, to pay my medical bills, or listen to the incessant ring of debt collectors on the phone.

On several occasions I ended up in the cottage hospital and their was never a cost applied to it, never a ream of paperwork. Incidentally, I choose my own doctor where I Lived. The longest I waited for surgery was three months, as it was not an emergency. No doctor, no hospital or specialist asking me for my Social Security number, drivers license or if I was covered by a predatory for-profit insurer. No premiums, no-cops and pre-existing condition clauses. Yes! Didn't have a private room, but who cares? Today the British Isles is being submerged under a barrage of legal and illegal immigrants, who have never paid into the system, have caused some rationing. Prior to the importation of foreign labor my trips to doctor, to hospital, the eye or a dentist was paid from my taxation. Unless we pass a national health care agenda, Americans will never know what it's like to breeze through their lives, without worrying about paying for health care? Tell your Senators and Congressman you want an alternative to the--GET RICH-- insurance companies, before a Universal health care is killed. 202-224-312 REMEMBER THE INVESTORS AND STOCKHOLDERS DON'T WANT THEIR PIECE OF THE $$$TRILLION$$$ DOLLAR PIE DISTURBED. EVEN SOME POLITICIANS HAVE THEIR DIRTY FINGERS IN THE PIE?

Anonymous said...

And this ad hominem attack means you don't like what, exactly? What makes him an "idiot?"

InformaticsMD said...

Looking at his MAD Magazine handiwork regarding a serious issue tells me all I need to know about him.

I a, not sure which "Mad Magazine" handiwork you refer to (perhaps his faked image of a "DSM V for Dummies" book?), but if you view use of humor as "infantile", as we say in medicine, you need to remove the plug from your a** and get a life.

Many enjoy a varied style, including use of humor, even where "serious" matters are concerned.

-- SS

Doug Bremner said...

The use of humour and satire gets the dander of people up all the more, as it exposes the foolishness and greed of some of our politicians and members of our profession, in a direct way that cannot be controverted. As the bard, said,
"methinks thou dost protest too much."

InformaticsMD said...

Anonymous came back with this:

"You don't know which "MAD Magazine thing" I am referring to? Well, likely that's because the "King of Transparency," Danny Carlat, is hiding behind an opaque curtain with regard to his foolish, sophomoric web site,, which he created and posted."

What followed was a Network Solutions lookup showing the "" domain is registered to Daniel Carlat.

This site is satirical, so my initial comment to anonymous applies.

Either that, or anonymous is attempting a quite amateurish discreditation attack. The site is Carlat's? To anonymous, I say, so what? Get a life.

(For your information, you may read about satire here).

-- SS