Wednesday, April 29, 2009

Dr. James Stein, Noted Cardiologist, "Bares His Soul" -- About the Influence of Pharma's Pay

This morning, The Milwaukee Journal Sentinel Online has a fabulous, on the record interview with James Stein, MD -- one of the outside experts who reviewed the ENHANCE study irregularities in late 2007, and then objected, in writing, to what he called Schering-Plough's "mischaracterizations" of the expert panel's advice, and proposed courses of action. You may read about all of that in this older backgrounder of mine -- see images (clickable), at right.

Today, Dr. Stein explains how the drug companies recruit, influence and subtly manipulate young doctors into feeling that they are "thought leaders" -- and, then, via increasing speakers' and consultancy fees, feed their egos -- and bend them toward subtly promoting the pharma companies offerings.

To be fair, the PhRMA Code, and the Adva-Med Code (effective July 1, 2009) now curtail a large chunk of the most-blatant forms of this sort of influence-peddling -- but compliance with these codes is presently voluntary (though widely adopted by US public pharma players). Here is the full-story -- and the snippet I had to smile about. The breath of reform, from the throats of those once enmeshed in the process. Do go read it all:

Physician found money, acclaim seductive, but ethical considerations troubled Stein's conscience

. . . .Stein got first-class airfare to Dallas. A limousine took him to a luxury hotel for the talk.

He walked off the stage, and a doctor from the conference handed him an envelope containing a $500 check.

"I got a pat on the back and he said, 'There's more where that came from, son.' I had no idea what that meant, but I went home and paid off part of my student loans," Stein said in a presentation at UW this month.

Stein was among dozens of UW doctors and an untold number of physicians nationwide who have pulled in large sums doing talks or working as consultants to drug and medical device companies. . . .

Stein told his cautionary story to medical students, doctors and others at a UW conference this month on conflicts of interest in medicine.

"It was a compelling personal story of someone who tried to have it both ways and realized he couldn't do it," said Norman Fost, a professor of pediatrics and director of the bioethics program at UW. . . .

Another firm, Schering-Plough, paid him about $12,000 for two days as a lecturer. . . .

This is a truly important, courageous and ground-breaking piece of journalism. Will other papers run it? We'll see. Kudos to Dr. Stein -- for standing up and speaking on the record.


Anonymous said...

And I assume you saw this:

"Institute of Medicine: Time to nix pharma gifts, influence."

The government's top medical advisers are now putting their two cents into the pharma-doctor relationship debate. The Institute of Medicine says that collaborations between medical professionals and drugmakers can be benefit society, but financial ties are getting in the way. In the 353-page report, IOM's Committee on Committee on Conflict of Interest in Medical Research, Education, and Practice warns that current industry practices are negatively influencing research and patient care.

Julia said...

I am wondering, if it is the money or the fame that is most likely to create a bias?

I would like to see more non-profits get into the game and start funding CME events, lectures and the like.

There's no reason why big pharma has to dominate the market. Give physicians a choice so they can educate and inform without fear of unintentional bias.

Condor said...

Julia -- if you are interested, take a look at pharmedout.

I know the person who runs it -- it is a very-credible attempt at the sort of approach you posit.

It even has put together some accredited CME modules -- cool!