Everything Conceivable

Liza Mundy talks about the fertility business on "Fresh Air."

Medtronic discloses

"Following years of pressure, medical device maker Medtronic Inc. will begin disclosing how much money it gives physicians in various consulting and other payments, though the reporting threshold is far less than currently proposed legislation." MPR reports.

The "other" other white meat

Because that's where the money is

The highest paid employee at Columbia University? A dermatologist, at $4,332,759 a year. At Cornell? A fertility specialist, at $3,149,376. Maybe this is why doctors are getting out of the disease business and into the enhancement business. Read more in the Times.

Minnesota Daily editors refuse to yield

The Minnesota Daily, responding to Frank Cerra's editorial, stands by its call for Dean Powell to recuse herself from the conflict-of-interest task force, pointing out that her relationship with PepsiAmericas gives her a financial stake in the outcome. Read more here.

Pfizer will disclose payments

Pfizer, like Eli Lilly, will begin disclosing the payments it makes to physicians. Read more here.

Art imitating life?

Was John Le Carre's book, The Constant Gardener, based on Pfizer's Trovan clinical trial in Nigeria? Jim Edwards looks at the evidence.

Pay for Performance

Critiquing the  'business of medicine' seems part history, comedy and tragedy, with the latter drama usually involving some compromise in the doctor-patient relationship. The latest attempt to encourage 'pay-for performance' as a potential antidote for the ills wrought by 'fee-for-service' seems like a tragedy waiting to happen.

Since when do doctors need incentives? Isn't the term 'patient advocate' a redundancy? Is the gerbil wheel an apt metaphor or is this more of a convoluted habitrail for patients and doctors to lose each other in?

Guinea pigs up north

Anne Silversides reports on the Canadian guinea-pigging scene in the CMAJ.

Medtronic's "Reclaim"

Minnesota Public Radio announced yesterday that Medtronic has received FDA approval for a new OCD treatment. The treatment, so to speak, consists of a small device that is implanted under the skin which delivers a steady series of electrical pulses to one's brain, intended to "block abnormal brain signals".

Offshore Outsourcing of Drug Trials on the Rise

An article published today in the New England Journal of Medicine raises ethical concerns of undue influence and potential exploitation of offshore workers. Although there appears to be no argument that such testing is on the rise, critics of the study say the study has major design flaws.

More on the U conflict of interest scandals

"Ethics reform for the medical school could have been open to public perceptions. In the end, it just didn't feel that way." Gary Schwitzer writes in the Daily.

Addendum: Schwitzer follows up on his Health News Blog, including this comment on Frank Cerra's editorial in The Minnesota Daily.

"How does he know the effort was misrepresented? He never attended one of the task force meetings. Whom does he refer to as the 'few who seem to want to influence the outcome outside of the process'? That’s a pretty vague broad-brushed attack against anyone who comments.

But his emphasis on the faculty’s thinking and the faculty’s voice is most troubling of all.

That shows the lack of a grasp for the importance of public input on the school’s conflict of interest policy – the very point of my guest column."

This is your army on drugs

"For the first time in history, a sizable and growing number of U.S. combat troops are taking daily doses of antidepressants to calm nerves strained by repeated and lengthy tours in Iraq and Afghanistan. The medicines are intended not only to help troops keep their cool but also to enable the already strapped Army to preserve its most precious resource: soldiers on the front lines." See "America's Medicated Army" in Time.

My doctor got 3 stars! ..Oh Yeah? Mine Got 4!!

Zagat is asking patients enrolled in the Blue Cross plan offered by Wellpoint Insurance to review their doctors. Reviews will be available online only to enrollees and edited by Wellpoint.

"Ms Zagat said in an interview that unlike food reviewers, patients are not encouraged to be 'pithy and witty' (you will not read how a doctor's 'icy hands' and 'crowded waiting room' made the exam a 'downer')."

I can see your point Ms. Zagat - the last thing we  (or Wellpoint?!) would want in a review is something 'pithy'. 

The empire strikes back

Frank Cerra attacks the Minnesota Daily for reporting on conflicts of interest at the University of Minnesota.

Trust us, it's good for you

Here's a novel argument: Astra Zeneca says it has to hide information about its antipsychotic drug, Seroquel, in order to protect the public. Kris Hundley reports.

FDA approves depressant drug for the annoyingly cheerful

My Drug Problem

"If I lived in New Zealand, I’d be dead," writes Virginia Postrel in the March issue of Atlantic Monthly.

Curious to know why? Read more of the article that Merrill Goozner calls "one of the most irresponsibly inaccurate pieces of medical reporting I’ve ever read."

Babymart

"Want a daughter with blond hair, green eyes and pale skin? A Los Angeles clinic says it will soon help couples select both gender and physical traits in a baby when they undergo a form of fertility treatment. The clinic, Fertility Institutes, says it has received "half a dozen" requests for the service, which is based on a procedure called pre-implantation genetic diagnosis, or PGD." The Wall Street Journal reports.

Drugmakers' push boosts 'murky' ailment

"Two drugmakers spent hundreds of millions of dollars last year to raise awareness of a murky illness, helping boost sales of pills recently approved as treatments and drowning out unresolved questions - including whether it's a real disease at all." The Associated Press reports on recent efforts by Eli Lilly and Pfizer to educate doctors about an illness known as fibromyalgia.

The story behind Zyprexa

"Created to treat schizophrenia, Zyprexa wound up being used on misbehaving kids. How the pharmaceutical industry turned a flawed and dangerous drug into a $16 billion bonanza." Ben Wallace-Wells reports in Rolling Stone. (Print this one out and read it carefully.)

Pharma has a nightmare

Public Citizen's Sidney Wolfe, the drug industry's most caustic critic, has gone to work for the FDA. Read more here.

Doughnuts are the new wheaties

Forget ultra-marathons. Put on a gorilla costume and take the Krispy Kreme Challenge.

Grassley speaks

The Philadelphia Inquirer profiles Sen. Charles Grassley, avenging angel of the anti-pharma insurrection.

FDA approves first pharm animal

"Opening the barn door to a new era in farming and pharmaceuticals, the Food and Drug Administration on Friday approved the first drug produced by livestock that have been given a human gene." More here.

Got milkweed?

"To the casual observer, Robert Holding seemed a kindly milkman who was attentive to his elderly customers as he delivered their daily pints.

To the less casual observer – specifically, a surveillance team from Lancashire police – Holding, 72, turned out to be a drug dealer who was supplying cannabis from his milk float to an elderly clientele.

His customers, who smoked the resin to relieve their aches and pains, would leave notes with their empty milk bottles to say how much of the drug they required. His reputation as a drug dealer spread rapidly among 17 of his customers in Burnley, Lancashire.

When detectives searched Holding's home last July they were astonished to find wraps of cannabis resin stashed among the eggs in his milk crates."

The Guardian reports.

How much for a kidney?

"The woeful inadequacy of our nation’s transplant policy is due to its reliance on 'altruism.' According to the guiding narrative of the transplant establishment, organs should be a 'gift of life,' an act of selfless generosity. It’s a beautiful sentiment, no question. In fact, I, myself, am a poster girl for altruism. In 2006, I received a kidney from a (formerly) casual friend who heard secondhand about my need for a transplant. In her act, there was everything for me to gain, and, frankly, not much for her. My glorious donor was moved by empathy and altruism as purely as anyone could ever be.

Yet, it is lethally obvious that altruism is not a valid basis for transplant policy. If we keep thinking of organs solely as gifts, there will never be enough of them. We need to encourage more living and posthumous donation through rewards, say, tax credits or lifetime health insurance."

More on organ markets from Sally Satel here.

Saturday, February 07, 2009

Moral

Distress

More and more health care providers find themselves conflicted over a wide array of perceived obligations that may not reflect the best interest of their patients:

http://www.nytimes.com/2009/02/06/health/05chen.html

Cosmetic neurology on demand

Stimulants for everyone? Martha Farah of the University of Pennsylvania defends the cosmetic neurology manifesto she and her colleagues produced for Nature on the WBUR public radio show, On Point. Among her critics is Tom Murray of the Hastings Center. Listen online here. Or download the mp3 file here. Subscribe to the podcast on iTunes, or here.

Lilly rep blows the whistle

"Robert Rudolph knew he was about to end his lucrative career at Eli Lilly & Co., but he had to say something.

Why, he asked management, was the Indianapolis pharmaceutical company marketing its antipsychotic drug Zyprexa to elderly people when the drug was not approved for that group?

Why had the company violated privacy rules by culling patient lists at doctors' offices?

Why was the company counting drug samples as sales, which would boost the stock price?

He went on for about 10 minutes during a sales meeting in 2002. The other 25 Lilly sales representatives stared at him, stunned.

'I'd just been wrestling with this stuff for so long," he said in a telephone interview today. 'I was put in a position of breaking the law, in my view, or quitting.'"

Read more in The Philadelphia Inquirer.

For some, health care is a lottery

"People young and old crowd the hallway outside the locked door of the Arlington Free Clinic. They grip small pieces of paper that will determine whether they get in -- or give up and go home. It's lottery day, and 45 county residents who lack health insurance and money to pay for medical care are competing for 30 openings on a cold afternoon in January." The Washington Post reports.

Will Bush drug rule endure?

In the waning days of the Bush administration, the Food and Drug Administration issued new guidelines to make it easier for drug manufacturers to promote "off-label" prescription drug uses, which can be deadly for patients. McClatchy Newspapers reports that the Obama administration will have to decide whether to try to modify or reverse this late change in the FDA's oversight of off-label drug marketing.

An intellectual gigolo and the greatest analyst who ever lived?

"In November 1984, Jeffrey Masson filed a libel suit against writer Janet Malcolm and the New Yorker, claiming that Malcolm had intentionally misquoted him in a profile she wrote for the magazine about his former career as a Freud scholar and administrator of the Freud archives. Over the next twelve years the case moved up and down the federal judicial ladder, at one point reaching the U.S. Supreme Court. Had a successful Freudian scholar actually called himself an intellectual gigolo and the greatest analyst who ever lived? Or had a respected writer for the New Yorker knowingly placed false, self-damning words in her subject's mouth?"

Kathy Roberts Forde will be discussing her new book, Literary Journalism on Trial: Masson v. New Yorker and the First Amendment, on Thursday, February 5 at 4:00 p.m. at the University of Minnesota Bookstore in Coffman Memorial Union.

The new administration

"University of Minnesota Medical School Dean Dr. Deborah Powell is out. Senior Vice President of Health Sciences Dr. Frank Cerra is in – at least for now. The only question now is why." Emma Carew at the Minnesota Daily reports.

Tom Daschle's ethics troubles

Merrill Goozner at the Center for Science in the Public Interest has an interesting take on Tom Daschle's conflicts of interest.

Trovan Lawsuit is Revived

In 2001, a group of Nigerian families sued Pfizer following the deaths of 11 children, and the severe injuries of many more, who had taken part in tests of Trovan, a drug to treat meningitis. The suit also alleged that children in the trial's control group were under-dosed. After years of legal battles, a federal appeals court has allowed the trial to go ahead in the United States, according to the Washington Post.

Playing footsy with pharma?

"The FDA has for decades been playing footsy with the drug industry, and it reached new lows under George W. Bush." Will this change with Obama? asks James Ridgeway at Mojoblog.

Why health care reformers should look at the banking collapse

"Instead of competing with one another for the best outcomes, providers compete for patients with the most profitable diseases. Hospital care for cancer and heart surgery makes more money than hospital care for diabetes, pneumonia, or mental health. While all these services get reimbursed, some bring in more cash than others—in effect, cancer care is like gold while diabetes is like silver."

Read "Sicko-nomics" in Slate.

Unemployed making ends meet with medical experiments

From ABC News:

U of M medical school reorganizes; Dean out by summer

"A reorganization will put the Dean of the University of Minnesota Medical School out of a job by this summer," says MPR. And here is what the Star Tribune has to say.

More firings from Pfizer

Pfizer says its merger with Wyeth will mean more lay-offs. Read here.

The WSJ Health Blog says the numbers will be ugly -- as many as 19,500 people. More here.

You are what you buy

And you were what you bought even in 17th century Britain, where consumer culture was born.

"Possessions were symbols of refinement and politeness. They helped to define individual identity. They even shaped their owners’ physical deportment and behaviour, for knives and forks, cups and teapots, fragile porcelain and increasingly delicate furniture imposed a distinctively mannered way of eating, drinking, moving and sitting. In this way the consumption of goods created social differences as well as expressing them." So writes Thomas Keith in "To Buy or Not to Buy: The Origins of Good Taste."

Ex-health chief in NY liked to shop -- a lot

The New York Times reports that Dr. Antonia C. Novello, former state health commissioner in New York, is under investigation by the state inspector general's office. The allegations? That she "turned her staff at the Health Department into her personal chauffeurs, porters, and shopping assistants during her seven-year tenure" - at taxpayers' expense. The Inspector General's report portrays Dr. Novello as "preoccupied with shopping" and "abusive toward her employees" - even ordering them to drive her on shopping trips to department stores in Manhattan and outlet malls in Albany.

No room for idealism in health care reform

"The country has this one chance, the idealist maintains, to sweep away our inhumane, wasteful patchwork system and replace it with something new and more rational. So we should prepare for a bold overhaul, just as every other Western democracy has. True reform requires transformation at a stroke. But is this really the way it has occurred in other countries? The answer is no. And the reality of how health reform has come about elsewhere is both surprising and instructive."

So says Atul Gawande in The New Yorker.

Pfizer Buys Wyeth for $68 Billion

As the patent for Lipitor nears expiration, Pfizer postpones disaster by taking over Wyeth. Here is what the WSJ Health Blog has to say.

Wyeth University

In 2002, just as the rest of the world was reading headlines about the dangers of hormone replacement therapy, the University of Wisconsin was setting up a Wyeth-funded CME course encouraging doctors to prescribe it. "For the next six years, thousands of doctors from around the country took the online course that was funded entirely by a $12 million grant from Wyeth Pharmaceuticals, which makes the hormone therapy drugs used in the study, Prempro and Premarin. The university received $1.5 million of that total, and university faculty received money as well." Read more in the Milwaukee-Wisconsin Journal Sentinel.

Pharmakon: A Novel

"Wittenborn psychiatric rating scales take their name from Dr. J. R. Wittenborn, a research scientist whose fields of expertise included psychopharmacology and the evaluation of responses to psychotropic drugs. Now his son, Dirk Wittenborn, has written a guide to evaluating his father. Pharmakon is the younger Mr. Wittenborn’s novel about the family of a narcissistic, opinionated and dangerous patriarch whose work’s influence extends to the lives of his relatives — and beyond. 'If there’s brain candy in your medicine cabinet,' the narrator maintains, 'chances are my father’s messed with your head, too.'" Read Janet Maslin's review of Pharmakon in The New York Times.

Pharmaceutical Company Says its New Antidepressant is "Worthless and Dumb"

Hear more from Doyle Redland at The Onion Radio News.

The Device Industry Gets Worried

The prospect of a Physician Payments Sunshine Act has the device industry concerned, says this article in the New York Times. An "ethical makeover" is underway.

Geron will test human embryonic stem cell therapy

Geron will be allowed to proceed with a safety trial of embyronic stem cell therapy in patients with spinal cord injuries. Read more here.

How Big Drug Companies Hamper Innovation

Malcolm Gladwell talks with Safi Bahcall, CEO of Synta Pharmaceuticals, about how mistakes lead to discoveries and Big Pharma hampers innovation. The video is from a 2007 New Yorker conference.

Lilly Pays for Illegal Zyprexa Marketing

"Eli Lilly, the drug company, is expected to agree as soon as Thursday to pay $1.4 billion to settle criminal and civil charges that it illegally marketed its blockbuster antipsychotic drug Zyprexa for unauthorized use in patients particularly vulnerable to its risky side effects." Read more here.

Doping Deficit Disorder

"Would you like to take performance-enhancing drugs to boost your pro sports career? Are the drugs banned as a form of cheating? No problem. Just find a doctor willing to certify that you have a 'deficit' of the performance factor in question." So says William Saletan in "Doping Deficit Disorder."

Bigger Stronger Faster

This documentary by Chris Bell hits most of the high points in the enhancement technologies debate. Click here to watch the trailer.

The undercover anthropologist and the kidney market

Newsweek has published a profile of Nancy Scheper-Hughes, the Berkeley anthropologist whose methods of exposing illegal kidney sales have drawn ethical criticism.

Take a ride on the love train

Saturday Night Live says: Come on, old people, get on board right here.

Pressure rising

"Three pharmaceutical companies donated $700,000 to a medical society that used most of the money on a series of dinner lectures last year to brief doctors on the latest news about high blood pressure." Read more in the New York Times.

Oprah pimps cosmetic medicine

See "The Oprah Treatment" in The New York Times.

Script-tracking backlash

The AMA makes $40 million a year peddling information about doctors to pharma without their consent. In the face of legislation to prohibit the practice, the AMA now says that it will allow doctors to opt out. Only the procedure for opting out doesn't really mean doctors can opt out. See "Doctors Object to Gathering of Drug Data" in The New York Times.

Pre-diagnosis drugs for Schizophrenia

Mixed Result in Treating Schizophrenia Pre-Diagnosis

"In recent years, psychiatric researchers have been experimenting with a bold and controversial treatment strategy: they are prescribing drugs to young people at risk for schizophrenia who have not yet developed the full-blown disorder."

"Daily doses of the antipsychotic drug Zyprexa, from Eli Lilly, blunted symptoms in many patients and lowered their risk of experiencing a psychotic episode in the first year of treatment, the study found. But the drug also caused significant weight gain, and so many participants dropped out of the study that investigators could not draw firm conclusions about drug benefits, if any.

The long-awaited study, which was financed by Eli Lilly and the National Institute of Mental Health, raised more questions than it answered, experts said."

Outsourcing guinea pigs

According to the BBC:

"India's outsourced call centres are well known, but not its outsourced patients. By 2010, some estimate there will be two million patients in India on clinical trials. An entire industry has sprung up, specialising in recruiting patients and managing experiments. And a BBC investigation into the conduct of these trials has found that some patients are unaware they are being experimented on at all. "

See "Drug trials outsourced to India," and a trailer for the BBC documentary.

The monkeys read Nietzsche

See Dance Monkeys Dance

Wheelchair Unbound

Harriet McBryde Johnson, a disabled lawyer from South Carolina, visits the Holocaust Museum.

"Then I see the wheelchair. It's similar to other prewar wheelchairs I've seen, but there's something unusual about the frame. Is this a tilting mechanism? A fancy suspension system? Looks like fine German engineering. I like vintage wheelchairs. An obsolete Everest & Jennings drive belt hangs in my office as a bit of nostalgia, like an old wagon wheel in a barbecue shack. I have an urge to jostle the chair, to see what that frame does. The sign mentions a German institution. So, no single owner. But even in institutions, people manage to bond with chairs. A state-owned chair may be occupied by the same person every day, parked beside that person's bed at night."

See "Wheelchair Unbound" in The New York Times Magazine.

Amy Laura Hall at the U

This Friday, April 21: Duke theologian Amy Laura Hall will give a talk titled "Human Mistakes and Mishaps: Disability, Children, and Atavism During the Center of Progress. It will be in 2-122 Molecular & Cellular Biology Building (MCB).

Grading health journalism

Gary Schwitzer has launched Health News and Review, which gives grades to health stories in the media based on accuracy, balance and completeness. It is modeled on Media Doctor, an Australian project that inspired a similar website in Canada.

Side Effects at the U

Side Effects, an independent fiction film about a drug rep, directed by Kathleen Slatter-Moschkau (a former rep for Johnson and Johnson) will be shown in Moos Tower 2-620 on Monday, April 17, at 5 pm. Kathleen Slattery-Moschkau will be here to answer questions after the film.

More symptoms to ADHD coming your way...

"Overly Wired? There's a Word for It"
"The frenzy of our wired world, he argues, is giving nearly all of us the symptoms of attention deficit disorder. To conquer the enemy, he says, we first need to name it."
So he has come up with the following suggestions, among others:

¶Screensucking, which he defines as "wasting time engaging with any screen — for instance, computer, video game, television, BlackBerry." He goes on to use his new word in a sentence: "I was supposed to write that article, but instead I spent the whole afternoon screensucking." That concept hits particularly close to home.

¶EMV, or E-Mail Voice. This, Dr. Hallowell writes, is "the unearthly tone a person's voice takes on when he is reading e-mail while talking to you on the telephone." Researchers at M.I.T., he tells us, have developed a program that can electronically measure how engaged people are in a conversation, giving scientific certainty to your suspicion that you are not being listened to.

And more!

Merck loses another one

Delivering a sharp blow to Merck, a New Jersey jury found Wednesday that the company had not properly warned patients of the dangers of its drug Vioxx and had caused a heart attack suffered by John McDarby in 2004. The jury awarded Mr. McDarby, who had taken Vioxx for four years, $3 million in compensatory damages and Irma, his wife, an additional $1.5 million. Read about it here.

Another drug trial accident....

Another drug trial accident: a healthy volunteer had to go to the hospital because a reaction to the drug makes his face "look like elephant man"...

Four out of five doctors surveyed

Cosmedicine™": endorsed by Johns Hopkins Medicine. (Seriously.)

"Our business relationship with KAA is an opportunity to apply our expertise to an industry that we believe can benefit from our research and clinical experiences and a company that has expressed a commitment to representing its products' capabilities based on quantifiable study."

"We look forward to exploring with KAA other ways we can bring value to their company and, perhaps, to the skin health marketplace generally."

"Johns Hopkins Medicine faculty members receive standard fees for consulting with KAA on both their service business and Cosmedicine™. Johns Hopkins Medicine receives fees from KAA, holds stock in the company, and has a voting seat on KAA's board."

Problems with Body World...

"An exhibit of real human corpses is the most popular show ever at San Francisco's Masonic Center. But problems uncovered by the ABC7 I-Team threaten to shut down the exhibit. The most obvious problem is the corpses are leaking...."

This little piggy went to market

Cloned pork, coming to a restaurant near you.

Life coaching goes mainstream

Life coaches are in the style section of this Sunday's New York Times:

"But behind the scenes life coaches are also finding plenty of work in the entertainment business. As their ranks swell nationwide — the International Coach Federation says its membership has doubled to 9,500 personal and business coaches since 2001, 56 percent of them in the United States — a growing roster is specializing in celebrities and Hollywood. "

"Although the federation does not keep track of coach specialties, coaches who devote themselves to the entertainment business — many of them former actors, television network executives, film producers or scriptwriters who sell their services as insiders — say they have seen more acceptance and a doubling and even tripling of demand for their services in the last three or four years."

Watching Coolhunters in action

Here are two PBS- Frontline shows that parallel the class discussion on Wednesday.

"The Merchants of Cool" is all about marketing strategies for teenagers with a section
 where they show cool hunters hitting the streets looking for people and other pretty
 sneaky marketing strategies,which are especially worrisome because they target younger
and younger kids. There's also another Frontline 90 minute documentary, "The Persuaders"
which is all about how we're so overwhelmed by traditional advertisements that marketers
 have to come up with more creative strategies...there's this one guy in it who
is especially interesting (and creepy) because he makes millions selling his ad strategies
 to big companies, but his way of extracting what customers are looking for is this strange
pseudoscience/hypnosis practice which he does on focus groups.

Provigil rejected for ADHD

An FDA advisory panel has recommended rejecting Cephalon's application to market Sparlon, a clone of its narcolepsy drug Provigil, for ADHD in children. "The advisory committee voted 12-to-1 against recommending Sparlon's approval, citing its concerns about Stevens-Johnson syndrome, a rare and vicious blistering of the skin that can be caused by certain drugs."

Doctor slipped a twenty

Doyle Redland reporting, from The Onion Radio News.

Put me in, life coach

The Daily Show, on life coaches.

Drug czar

"Donald Rumsfeld has made a killing out of bird flu. The US Defence Secretary has made more than $5m (£2.9m) in capital gains from selling shares in the biotechnology firm that discovered and developed Tamiflu, the drug being bought in massive amounts by Governments to treat a possible human pandemic of the disease." Read more...

British guinea pig update

More on the Parexel study from The Times of London: "Experts knew that drugs similar to the one that nearly killed six men at a London hospital last week could have had dangerous side effects. Trials last year in America of a similar “monoclonal antibody” caused severe toxic reactions in patients. But the UK study went ahead after the regulatory authority failed to consult outside specialists who would have warned against proceeding." The full story is here.

Provigil by another name

Cephalon wants the FDA to approve its narcolepsy drug modafanil (also known as Provigil) for ADHD. Why? Because the patent has expired; they have paid generic manufacturers not to make it; and approval for pediatric use will give Cephalon six more months of exclusivity. Merrill Goozner of the Center for Science in the Public Interest blogs the story in "Pawns in Their Game."

Psychotropic love affair

"When it comes to psychotropics, we are all men easily swept off our feet, composing bad love poems, willing to wine and dine at sky-high prices, only to break off our engagement with a stamp and a pout once we see our bride-to-be without her makeup." Lauren Slater writes about America's love affair with psychoactive drugs in the New York Times.

The Bitter Pill Awards

Per our conversation on DTCA several weeks ago, I thought we might all get a laugh out of the Bitter Pill Awards. Here, you can nominate your pick for most heinous DTC drug campaign whether it air on TV, radio, Internet, or even in print advertising. Also, check out the winners from last year. My favorite is the Viagra ad described here:

"Pfizer ran ads for Viagra in 2004 that featured the drug's blue "V" logo as devilish horns behind a man's head, with statements like "Remember that guy who used to be called `Wild Thing?' The guy who wanted to spend the entire honeymoon indoors? Remember the one who couldn't resist a little mischief? Yeah, that guy. He's back." The ads were suggestive enough that the FDA issued one of its rare enforcement letters, asking Pfizer to stop running the ads."

Guinea pigs to the world

Half of all clinical trials are being conducted in countries like India, China, and Brazil, writes Jennifer Kahn in Wired. The consulting firm McKinsey predicts that the market in India for outsourced trials will hit $1.5 billion by 2010. See "A Nation of Guinea Pigs."

Lunesta v Sonata v Ambien

Alan Cassels weighs in on The Sleeping Pill Wars.

All you have to do is dream

Mark your calendars: only one month to go until National Sleep Awareness Week. This means a week of non-stop news stories about sleep-deprived Americans, and tons of press for sleeping pills and other sleep products, courtesy of the industry-supported National Sleep Foundation. You can prepare yourself by reading the Forbes cover story, "The Sleep Racket," or listening to the On Point public radio show, "To Sleep Via Pill."

We are all ADHD now

75,000 Americans show signs of addiction to stimulant drugs such as Ritalin and Adderall, says a new study in the journal Drug and Alcohol Dependence, and over 1.6 million have misused the the drugs. Students are using stimulants to boost their academic performances. But the study itself was funded by Eli Lilly, the manufacturer of Strattera, a non-stimulant alternative. The full story appears in The Washington Post.

Have a look as well at Joshua Foer's 2005 article in Slate.com, "The Adderall Me: My Romance with ADHD Meds." Larry Diller writes about marketing stimulants in his 2001 Salon.com article, "An end run to marketing victory." The WBUR radio show On Point ran a program last week on ADHD drugs, especially the recommendation of an FDA advisory panel that stimulants be tagged with a "black box" warning.

CMAJ editors sacked

The Canadian Medical Association (CMA) has fired John Hoey and Anne Marie Todkill, the editors of its flagship journal, the Canadian Medical Association Journal (CMAJ), after a controversial article on Plan B. The CMA is getting hammered by critics for interfering with the editorial policy of the journal.

Hallmark MD

The American Medical Association has decided to launch an ad campaign for itself. It is running TV ads on shows like The O'Reilly Factor and Project Runway; in print, it is distributing thank-you cards for patients to send to their doctors. "Your doctor is always there for you. Helping you to feel your best. Now is your chance to return the favor with a specially designed card from the AMA."

Corporations, universities: same thing

The chancellor of the University of California-San Diego, Marye Anne Fox, received at least $339,260 in cash and stocks in the past year from corporate consulting and advisory board positions. Her links include a medical device manufacturer and a contract research organization. Fox says that “All things involved in managing and directing and envisioning for corporate entities are virtually the same things you have to do for universities."

FDA staff objects, FDA approves anyway

Scientists at the FDA unanimously recommended rejecting the application of Cyberonics Inc. to sell its surgically implanted vagus nerve stimulator as a treatment for depression. The only clinical trial failed to show effectiveness. But Dr. Daniel G. Schultz, director of the FDA's Center for Devices and Radiological Health, decided to approve it anyway. Why, asks The New York Times?

Abbott is suspended

Abbott Laboratories has been nailed for entertaining doctors at dog races and lap dancing clubs. (PharmaGossipp has an interesting take on the story as well.)

The Strib plumps a weight loss pill

The story in Wednesday's Star Tribune on a new, as yet unapproved diet drug from Sanofi Aventis reads as if it came from a press release, complete with enthusiastic endorsement by Sanofi's paid doctor-shills.

Alan Cassels to speak at the U

Thursday, Feb. 16 2006
12:15 PM to 01:15 PM

Student Committee on Bioethics Lecture Series

Disease Mongering 101: The Marketer's Guide to Selling Sickness
Alan Cassels

Moos Health Sciences Tower - 2-650
University of Minnesota

Alan Cassels is a drug policy researcher in Victoria, BC, Canada. He led a team of researchers which produced Canada’s first evaluation of the quality of media reporting of prescription drugs. He recently co-authored the book Selling Sickness: How The World's Biggest Pharmaceutical Companies Are Turning Us All Into Patients (Nation Books, 2005).

After reading the Conrad essay on medicalization, I looked for the paxil self-test he mentions online and took it: http://www.paxilcr.com/Social_Anxiety_Disorder_Test.jsp

Very amusing...As I expected, it told me "Your score in not typical of a person suffering from SAD," but then went on to say " We strongly encourage you to make an appointment with a qualified healthcare professional to discuss your symptoms." What symptoms??

Plus, you can see why so many people think they have SAD when according to the self-test, avoiding talking to people you don't know or finding it distressing to swear in public count as symptoms.

Embryos R Us

Fertility is not a miracle; it's a market. Or so says Harvard Business School professor Debora Spar in her new book, The Baby Business: How Money, Science, and Politics Drive the Commerce of Conception (Harvard Business School Press, 2006.) Spar is interviewed by Lynn Harris in Salon.com, and (by podcast) on "The Leonard Lopate Show."

A black box for the stimulants?

An FDA advisory panel has recommended that stimulants such as Ritalin, Adderall and Concerta carry a black box warning because of their dangerous effects on the heart.

Writing for dollars

While the country works itself into a frenzy over the $2 billion a year that lobbyists spend to influence politicians, it fails to notice that the drug industry spends nearly 10 times that much to influence doctors. Or so writes former NEJM editor Jerome Kassirer in The Boston Globe.

Are you PharmFree?

The American Medical Student Association is the only mainstream American medical group to take a principled stand against gifts from the drug industry. When they demonstrated at Pfizer headquarters on PharmFree Day, Pfizer called the police.

Are you PharmFree?

The American Medical Student Association is the only mainstream American medical group to take a principled stand against gifts from the drug industry. When they demonstrated at Pfizer headquarters on PharmFree Day, Pfizer called the police.

Bribing doctors is bad, etc etc

So says The New York Times.