Sunday, May 17, 2015

BLOGSCAN - New England Journal of Medicine Scoffs at "Pharmascolds"

The venerable New England Journal of Medicine has now published an editorial,(1) and two commentaries(2-3), with one more promised, hailing physician industry "partnership," as per NEJM editor Jeffrey Drazen,(1) and deploring the "pharmascolds,"(3) who might question the glorious innovations that could arise when industry pays academic and practicing physicians.   

In a tweet, Dr Harlan Krumholz said he was "shocked" that a NEJM commentary would "give credence to the 'pharmascold' narrative.  

So far, the only more detailed questions about this new direction for the Journal came in a guest blog by Dr Susan Molchan in the HealthNewsReview blog, which responded only to the editorial(1) and the first commentary(2).  Dr Molchan wrote, 

Dr. Rosenbaum makes a nice try at reinterpreting financial conflicts between physicians and pharma, but however one twists and turns it, the dots still reconnect into dollar signs. She asks, “Have stories about industry greed so permeated our collective consciousness that we have forgotten that industry and physicians often share a mission — to fight disease?” Is Dr. Rosenbaum’s consciousness so clouded as to think that pharmaceutical companies don’t exist first and foremost to make money? That their primary responsibility is not to their shareholders?  It’s true that a means to this end is fighting disease, (including new “diseases,” tailored to one’s drug), but this should not be confused or conflated with the primary mission of (hopefully most) physicians.

I and many others suggest that the 'stories about industry greed' have not permeated enough, and that this problem has polluted much of medical research and medical practice, to the point where trust of the medical research enterprise has been eroded....

The airtime the NEJM is giving this issue, including publishing three - count them - strongly opinionated but hardly journalistic commentaries by their ostensible"national correspondent," suggest a major push against the "pharmascolds."  Again, note this this inflammatory and ad hominem term was used in a supposedly serious article on "Medicine and Society."  I strongly doubt we have heard the last of this.  Stay tuned. 

ADDENDUM (20 May, 2015) - See also comments by Mickey on the 1BoringOldMan blog.  

1.  Drazen JM.  Revisiting the commercial-academic interface.  N Eng J Med 2015; ; 372:1853-1854.  Link here.
2.  Rosenbaum L.  Reconnecting the dots - reinterpreting industry-physician relations.  N Eng J Med 2015;  372:1860-1864.  Link here
3.  Rosenbaum L. Understanding bias - the case for careful study.  N Engl J Med 2015;  372:1959-1963.  Link here


Steve Lucas said...

This only shows that almost any organization can be bought. The appeal to authority; the NEJM says there is no problem, is obvious. Attack the messenger is obvious in using the derogatory term “pharmascolds.” Ignoring the massive amount of material published listing the fines, consent agreements, and other court findings simply ignores the facts.

This is a goal of pharma when institutional corruption reaches the point that it is supported by major publications, it has won a victory it cannot put a price on, but can exploit.

We have reached a point in much of academia where white is black, black is white, and academic rigor has give way to financial gain and relative ethics.

Steve Lucas

Anonymous said...

Not sure where this is coming from at NEJM and why now--pressure from advertisors, purchasers of their reprints? Waiting for Marcia Angell to jump in and Arnold Relman must be spinning . . . Looking forward to seeing you at Pharmed Out Roy
Dr. Susan Molchan

Unknown said...

I have a different perspective. In May, 2011 I published a piece in Nature Medicine about conflicts of interest that arise not from extramural remuneration but from being a faculty member at a medical school. I argued that medical schools today are just as concerned about generating revenue as industry: they promote their products just as energetically and with fewer constraints. I don't see why taking money from a drug company is fundamentally different than being paid as a medical school faculty member. (I am a medical school faculty member, and I'm not paid by a drug company.) For medical school faculty to be so upset about drug companies while ignoring the financial incentives their own institutions provide seems like noticing the splinter in someone else's eye and ignoring the log in your own.

Roy M. Poses MD said...

Dr Movsesian,

I surely agree that a physician employed by a hospital/ hospital system/ academic medical center may be subject to external pressures due to employment that may have similar effects to the conflicts of interest generated when practicing or academic physicians are paid part-time by drug companies and other for-profit corporations.

Hospitals/ hospital systems/ AMCs may themselves be for-profit. Even when they are nominally non-profit, their leadership may be "generic managers," may put revenue ahead of physicians' values, and may be actively mission-hostile.

We have posted about the plight of the corporate physician here:

about generic managers here:

about mission-hostile management here:

That said, however, I see the pressures imposed by revenue hungry employers, generic managers, and mission hostile leaders as additional to the influences of conflicts of interest due to financial relationships with drug/ device/ biotechnology companies or other commercial firms.

My guess is that medical school faculty are just about as concerned about the pressures caused by their own bosses as those causes by financial relationships with "outside" corporations, that is, not as concerned as they should be, in my humble opinion.

Steve Lucas said...

A few years ago a doctor blogger noted the concept of givers and takers. Givers were such things as cardiology and drug research. Takers were IM and medical schools. This simplistic concept of income versus expense was driving the decisions of this academic institution.

We see the results of this process in the Dan Markingson case covered here, and at other blogs and journals.

Troubling was there was never any admission of culpability on the part of the administrators and action was only taken years after the fact due to public pressure. The drive to maintain drug research income appears to be so great that a life was sacrificed in order to maintain a study’s protocols.

Equally troubling is that most academic medical centers were established for the express purpose of providing a medical education to meet the demands of the communities served by the institutions. We have so perverted this concept that now the core reason for the existence of these institutions is at risk as many of these very institutions would gladly drop their educational programs in favor of only doing income producing activities.

There is a cognitive disconnect in medicine today that needs to be resolved and using simplistic tools such as givers and takers does not address the complexity of the issue.

Steve Lucas

Contact said...

I surely agree that a physician employed by a hospital/ hospital system/ academic medical center may be subject to external pressures due to employment that may have similar effects to the conflicts of interest generated when practicing or academic physicians are paid part-time by drug companies and other for-profit corporations.