Why some people distrust doctors
It was surprising to me the feds arrested a physician for promoting the off-label uses of a drug. Why?
Because so many do it. Most physicians I've worked with simply use drugs off-label when it's conventionally accepted as working. (For instance, Seroquel is FDA approved for bipolar disorder and schizophrenia, but is also used widely to reduce anxiety and agitation.)
Some doctors however, driven by greed, go too far. And for their endorsements and lectures, they're generously compensated by pharmaceutical companies that make those drugs. Drug companies haven't been immune from trouble related to promoting off-label uses of their drugs without good supporting evidence: Pfizer paid upwards of $400M in 2004 for promoting its anti-epilepsy drug for pain and bipolar disorder.
The AMA supports a doctor's unique right to prescribe medicines off-label, and to discuss off-label prescribing practices among themselves. But even its leaders would frown upon the kinds of claims the doctor in question was making.
In one seminar cited in the federal indictment, a session last August in Denver, Dr. Gleason told doctors that 'table salt is more dangerous' than Xyrem — a statement scoffed at by other experts on the drug.
That came from the July 22nd NY Times article "Indictment of Doctor Tests Drug Marketing Rules." And that wasn't the half of it.
The indictment also charges that Dr. Gleason committed fraud against insurance companies by advising doctors to leave blank an area on the Xyrem prescription form that asked for a disease diagnosis. Dr. Gleason acknowledges that he told doctors not to offer a diagnosis but says he never told them to lie if they were asked for one.
Some out there who heard about this story must be thinking -- if not already -- that if doctors can be swayed to prescribe something because of financial interests or anecdotal evidence instead of what's objectively beneficial, how can they trust that they're getting the best unbiased evidence-based care possible?
posted by Niraj "Raj" Patel @ 7/24/2006
4 comments
4 Comments:
Our Conflicted Medical Journals, a NY Times editorial addresses another issue on the growing distrust of medical experts: medical journals running studies likely biased because of authors' financial ties.
Two disturbing cases were described in detail by The Wall Street Journal in recent weeks. One involved The Journal of the American Medical Association, or JAMA; the other an obscure journal known as Neuropsychopharmacology, which is published by a leading professional society in the field.
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An even more egregious set of events occurred at Neuropsychopharmacology, which recently published a favorable assessment of a controversial new treatment for depression resistant to conventional therapies. Left unmentioned was that eight of the nine authors serve as consultants to the company that makes the device used in the therapy. The ninth works directly for the company. Just to make things particularly incestuous, the lead author of the study is the journal’s editor and a consultant to the company. He has been accused in the past of promoting therapies in which he had a financial stake.
It is hard to know whether to be more upset at the journal’s failure to disclose these ties or at its decision to let such interested parties serve as authors in the first place. Early drafts of the article were prepared by a professional writer hired by the company. With all those ingredients coalescing, it is no wonder that the new therapy was judged “a promising and well-tolerated intervention” for treatment-resistant depression.
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It seems imperative that more muscle be put into forcing disclosure and publication of conflicts of interest. If all leading journals agreed to punish authors who fail to reveal their conflicts by refusing to accept further manuscripts from them, a lot more authors would be inclined to fess up. Better yet, journals should try much harder to find authors free of conflicts. That is the best hope for retaining credibility with doctors and the public.
Finding a good doctor is like finding a good mechanic and it's up to the patient, aka The Consumer, to do the research. Not every wrench monkey is going to have your best interests in mind and neither is every doctor. It's that simple.
I hope you'll be one of the good guys.
Oh...and one more thing. The wonderful thing about science is that for every schmuck who is trying to skew evidence towards his or her bias, there are ten other schmucks trying to disprove his or her findings. Science regulates itself nicely, don't you think?
Jennine, thanks for writing. I aim to be one of the good guys, and I'd like to say I believe most docs & other healthcare professionals are among the good guys and gals too.
And I somewhat agree that the Darwinian environment in which scientific research is conducted does help weed out a lot of the poorly done studies & biased results. When companies withhold all the data, it is hard for the Darwinian priniciple to verify the "truthiness" (watching the Colbert Report) of a portion of scientific research.
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