Corrupt Practices vs Corruption–Conflicts of Interest

Marcia Angell during and after her tenure as editor of the New England Journal of Medicine has decried pharmaceutical industry practices. Her recent review of three books in the NY Review of books has gotten the attention of industry.

The books were Side Effects: A Prosecutor, a Whistleblower and a Best Selling Antidepressant on trial by Alison Bass, Our Daily Meds: How the Pharmaceutical Companies Transformed themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs by Melody Petersen, and Shyness: How Normal Behavior became a Sickness by Christopher Lee.

In the article Angell highlighted the practice of having researchers on payrolls of companies whose products they were evaluating. She called the practice corrupt and urged:

“But there is clearly also a need for the medical profession to wean itself from industry money almost entirely. Although industry-academic collaboration can make important scientific contributions, it is usually in carrying out basic research, not clinical trials, and even here, it is arguable whether it necessitates the personal enrichment of investigators. Members of medical school faculties who conduct clinical trials should not accept any payments from drug companies except research support, and that support should have no strings attached, including control by drug companies over the design, interpretation, and publication of research results.”

Dr. Alvin Shatzberg and his University (Stanford) took issue with calling conflicts of interest a corrupt practice and had an exchange of correspondence with Dr. Angell in the February 26, 2009 issue of NY Review of Books. The major point of Dr. Shatzberg and the University appears to be:

“The exchange of money or other items of value between the medical community and medically related industries should be transparent and limited to payment for legitimate services.”

“As Angell notes, the provision of money and other valuables by pharmaceutical companies to medical schools, medical societies, and individual physicians has been widely accepted for many years. Some of the effects, such as the development of effective new treatments, have been positive. It is good that society and the profession are finally paying attention to the consequences that are negative. But standards-of diagnosis, research, and behavior-change over time. It is unfair to suggest physicians are “corrupt” for activities that were virtually universal when they occurred.”

Dr. Angell replied:

“My article was about the conflicts of interest that permeate medicine, not failures to disclose them. And nowhere did I state or imply that they were unlawful, as Schatzberg’s lawyer charges. My point was that pervasive conflicts of interest corrupt the medical profession, not in a criminal sense, but in the sense of undermining the impartiality that is essential both to medical research and clinical practice.”

Medicynical note: It’s necessary to read the original article to fully appreciate the issues. Medicine in my professional lifetime has compromised itself. Our profession no longer can be relied upon to put the patient’s interest first. We’ve monetarized the system and the choices made have corrupted it.

I’ve always felt that disclosure of a conflict of interest did not help. For example, what does it mean when the author of an article reveals he/she is being paid by and/or has a financial interest in the company whose drug, procedure, or medical device the doctor is evaluating. How much should we rely on the conclusions of an obviously biased source? The practice at best opens the door to doubt and at worst corrupts and irreversibly contaminates them.

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