PsychNet

If you want to see what "thought leader" management looks like from the inside, have a look at this document from GlaxoSmithKline, courtesy of Senator Grassley. It concerns PsychNet, the GSK speaker's program that trained Paxil champions.

Love and serotonin

"There's every reason to think SSRIs blunt your ability to fall and stay in love," said Helen Fisher, a Rutgers University biological anthropologist who has pioneered the modern science of love." A reason, maybe, but is there any evidence? Read more in Wired.

More Seroquel secrets

Astra Zeneca buried unfavorable studies about Seroquel, according to internal emails uncovered in litigation. Bloomberg.com reports. And the WSJ Health Blog says, "Court documents suggest AstraZeneca told U.S. sales reps to say the antipsychotic drug didn’t cause diabetes, even though a company doctor had previously said that the drug could be linked to the disease in some patients."

A new kind of drug ad?

"What if consumers could calculate the benefits and risks of taking a prescription drug as easily as they can gauge the carbs and calories of an Oreo cookie?" Dartmouth researchers say the FDA could make this happen, in the New York Times.

Should I fake or should I faux ...

In a Ted lecture entitled "What Consumers Really Want" Joseph Pine offers a provocative argument for a marketing movement he sees as 'rendering authenticity'. Viewed through the lens of medical enhancement technology one can't help but wonder about the 'pharmaceutical experience' and the quest for the real self.

Sex and Seroquel

The Seroquel litigation gets stranger and stranger. The complaint is posted on the Furious Seasons blog.

Are violent video games adequately preparing children for the apocalypse?

The Onion News Network reports.

The philosophy experiments

"A dynamic new school of thought is emerging that wants to kick down the walls of recent philosophy and place experimentation back at its centre. It has a name to delight an advertising executive: x-phi. It has blogs and books devoted to it, and boasts an expanding body of researchers in elite universities. It even has an icon: an armchair in flames. If philosophy ever can be, x-phi is trendy. But, increasingly, it is also attracting hostility." Dave Edmonds and Nigel Warburton examine experimental philosophy in The Prospect.

Surgeons successfully reconstruct man's face using leftover fingers

Doyle Redland reports for the Onion Radio News.

Illegal marketing by Forest?

"A Complaint was unsealed today in U.S. District Court in Massachusetts against a New York pharmaceutical company for alleged False Claims Act violations arising from the company’s marketing the drugs Celexa and Lexapro for unapproved pediatric use and for paying kickbacks to induce physicians to prescribe the drugs." Read the Department of Justice press release here.
The New York Times reports here.

Seroquel secrets

"A showdown is looming in a Florida courtroom over an issue that has long bedeviled business: How much internal information can a company be forced to make public simply because it has become a defendant in a lawsuit?" Read more in BusinessWeek about Astra Zeneca's Seroquel.

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.