Hidden income

[Doc Samson]

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Surprised no-one has posted it yet since everyone I know sent me the link over the weekend:

http://www.nytimes.com/2008/06/08/u...0400&en=9971013dfd33290a&ei=5087 &oref=slogin

 

[Faebinder]

Well, first shame on them for not declaring their funds. I feel that their license should at least be revoked. This is serious enough IMO...

Second, yes it's an honorary thing to declare where the funding is coming from... if you want some sort of serious reinforcement then it's time to pay for it.

Third, I get so frustrated watching how much damage is done to our research. IRBs are just brutal. E.g. I can give Lexapro to treat depression or even an adjustment episode but try and make a study where you want to give narcoleptic patients Lexapro and you will feel the wrath of the IRB asking for justification.

 

[OldPsychDoc]

I think disclosure is a Good Thing.
Just as it is a requirement for candidates for office to disclose the sources of their funding, I think that the public should know whether or not their doctors are moonlighting as "experts" for the industry speakers' bureaus or administering research that is funded by industry. And if "there's nothing wrong with it"--then we shouldn't be embarrassed to declare it. Let's make danged sure that what comes out of our mouths is credible information and not marketing.

 

[BabyPsychDoc]

Well, first shame on them for not declaring their funds. I feel that their license should at least be revoked. This is serious enough IMO...

Second, yes it's an honorary thing to declare where the funding is coming from... if you want some sort of serious reinforcement then it's time to pay for it.

Third, I get so frustrated watching how much damage is done to our research. IRBs are just brutal. E.g. I can give Lexapro to treat depression or even an adjustment episode but try and make a study where you want to give narcoleptic patients Lexapro and you will feel the wrath of the IRB asking for justification.

First, the scandal may do enough damage to their careers that there is no need to revoke their licences.

Second, why are we even talking about licence revocation if declaration of funding source is an honorary thing to do in the first place?😕

 

[Faebinder]

First, the scandal may do enough damage to their careers that there is no need to revoke their licences.

Second, why are we even talking about licence revocation if declaration of funding source is an honorary thing to do in the first place?😕

Because your (as in the researcher) study affected the decisions of thousands of doctors and without disclosure of source of income, the decision was unfairly biased and that affected many patients... the trickle effect. The lack of such ethics requires a punishment/slap-on-the-wrist by the physician community... a probation perhaps might be better, but this is serious. You are dealing with decisions on many people's lives. Would you rather he gets sued? I suppose that's a slap on the wrist although heavy. Either case cheating that affects many lives should not go unpunished.

 

[billypilgrim37]

First, the scandal may do enough damage to their careers that there is no need to revoke their licences.

These are some pretty big careers to take down. Biederman is one of the most prolific, controversial, and important child psychiatrists in the world, and probably no other one individual has more shaped prescribing patterns in child psychiatry over the past several years in ADHD and peds bipolar.

Do these non-disclosures even compare to this?

Point being, there are good scientists who are really bad at managing real and perceived conflict of interests, and there are bad, corrupt scientists. And it's basically impossible to tell the difference.

Heck, for those of you who read the Carlat Report blog, Carlat basically jumped straight to these guys' defense, despite the fact that everything he does is biased AGAINST perceived ethical lapses. But, because of personal relationships, ties to MGH, etc. the guy suddenly, for one blog post, sounds like a pharma apologist. And he got reamed for it. And the point isn't whether these guys did something "bad" or not, but the fact that even those people who make their careers out of exploring scientific bias can't put human tendencies aside.

It's nearly impossible to be objective in a small knit community like academic psychiatry. And THAT is why management of conflict of interest is so important.

 

[BabyPsychDoc]

These are some pretty big careers to take down. Biederman is one of the most prolific, controversial, and important child psychiatrists in the world, and probably no other one individual has more shaped prescribing patterns in child psychiatry over the past several years in ADHD and peds bipolar.

I am aware of Biederman's influence on development of child psychiatry within the last decade (or so); especially, his role in establishing peds bipolar as a diagnostic entity. I would have thought (but I may be misreading the situation, as your posts suggests) that the higher you are, the easier it is to crash on falling.

Andrew Wakefield committed a similary dishonest act with his MMR "research", but he was not really that big a fish, so he has got away with it (so far, though there are some rumours that GMC wants to talk to him in "fitness to practice" proceedings). In fact, he seems to have a pretty decent career in the US at present. If Biederman was to be shunned by the medical community in the US, and if the Big Pharma starts avoiding him because of his tainted reputation, than his licence might as well have been revoked.

That's just my thoughts, though. Feel free to critisize them.

 

[BabyPsychDoc]

Because your (as in the researcher) study affected the decisions of thousands of doctors and without disclosure of source of income, the decision was unfairly biased and that affected many patients... the trickle effect. The lack of such ethics requires a punishment/slap-on-the-wrist by the physician community... a probation perhaps might be better, but this is serious. You are dealing with decisions on many people's lives. Would you rather he gets sued? I suppose that's a slap on the wrist although heavy. Either case cheating that affects many lives should not go unpunished.

I know, I know. But, then it really should not be an "honorary thing to do", then, should it?

 

[Doc Samson]

When you read a study though, it says Dr. X discloses financial support/grants from Lilly, Pfizer, AstraZeneca, Forrest, Sepracor, Janssen, etc. It doesn't say how much they received. Did anyone ever read a study from the MGH child group or anywhere else and not think the investigators were getting a lot of money from pharma? Does the dollar amount (which we were never privvy to in the first place) really make that much difference in how we read their studies?

 

[OldPsychDoc]

When you read a study though, it says Dr. X discloses financial support/grants from Lilly, Pfizer, AstraZeneca, Forrest, Sepracor, Janssen, etc. It doesn't say how much they received. Did anyone ever read a study from the MGH child group or anywhere else and not think the investigators were getting a lot of money from pharma? Does the dollar amount (which we were never privvy to in the first place) really make that much difference in how we read their studies?

As the punch line goes, "We already know what kind of girl you are--now we're just haggling about the price." 🙄

(Ok, that was glib--but the point is that I think if we as the reader knew how much an investigator had received from which company and for what purpose, we might be able to make a better determination ourselves as to the degree to which a conflict of interest exists. A vaguely designated $100,000 "consulting fee" might be seen differently than administering a $2500 unrestricted educational grant to fund a residency education event, for example. The failure to disclose a funding source, however, deprives all of us of that opportunity.)

 

[Faebinder]

As the punch line goes, "We already know what kind of girl you are--now we're just haggling about the price." 🙄

Wow, i love that punch line... 😀

 

[Doc Samson]

Wow, i love that punch line... 😀

Winston Churchill I believe.

Anyway, I do think it'd be nice to know how much money researchers get, but the point is that since we don't know anyway, I don't think we're going to be reading those studies any differently (unless you were completely naive to begin with).

 

[skee lo]

I find this absolutely sickening, although not suprising in the least. Anyone who does anything other than firmly rebuke this degenerate creep is a professional disgrace.

 

[Doc Samson]

I find this absolutely sickening, although not suprising in the least. Anyone who does anything other than firmly rebuke this degenerate creep is a professional disgrace.

Sickening? Ok. Firmly rebuke? Sure. Degenerate creep? Really? The same guy who has done more to advance the study of mental illness in children than anyone else of his generation? Let's not throw the baby out with the bathwater here.

 

[skee lo]

Sickening? Ok. Firmly rebuke? Sure. Degenerate creep? Really? The same guy who has done more to advance the study of mental illness in children than anyone else of his generation? Let's not throw the baby out with the bathwater here.

If his major achievements were the product of financial interests rather than good science, then he injured the field of child psychiatry, not advanced it.

 

[billypilgrim37]

If his major achievements were the product of financial interests rather than good science, then he injured the field of child psychiatry, not advanced it.

Precisely.

That's why your point is moot.

 

[Doc Samson]

What we have thus far is evidence of undeclared income from drug companies. Wrong? Undoubtedly. Suspicious? Absolutely. But so far there's not a shred of hard evidence that the studies by Biederman, Wilens, et al have been skewed or are otherwise bad science. Demonstrate that, then I'd be happy to join the rest of the townsfolk with my torch and pitchfork.

 

[Faebinder]

Yeah, you lost me on the degenerate creep term.... Heck in some cases I would consider a good study even if funded by pharm drug companies. A slap of the wrist is what I call for.... but degenerate creep is more of a personal attack.

 

[BabyPsychDoc]

Yeah, you lost me on the degenerate creep term.... Heck in some cases I would consider a good study even if funded by pharm drug companies. A slap of the wrist is what I call for.... but degenerate creep is more of a personal attack.

I thought you wanted their licences revoked?

 

[whopper]

I think reporting association with pharm companies should not be so much honor based but required.

The conflict of interest that pharm companies have introduced into medicine has increased over the years, and I think there needs to be counters to the conflict of interests with research.

That being said, a mistake made by the man doesn't invalidate all of this guy's work. No one is perfect and so long as the work he did was valid, it should still be used for the benefit of patients.

If his major achievements were the product of financial interests rather than good science, then he injured the field of child psychiatry, not advanced it.

A problem with the argument here is sometimes the product of financial interests can still be good science. Of course financial interests can mess up & cause conflict of interest. This is why IMHO financial ties must be disclosed as a requirement. However, sometimes even the corporations at times will fund a good study that stands up to 3rd party replication. Corporations have several times in the past acted responsibly. Several times in the past, meds they were researching didn't stand up to their own efficacy or satefy standards, so those meds were dumped--at the costs of millions to the corporation. Is that bad science or medicine? I don't think so. Often times its actually better for them in terms of the bottom line to act responsibly.

Add to that, if it is found that corporations have committed unethical or illegal behavior-there can be heck to pay on their parts. Not every single corporation will always use the unethical quack approach to selling meds.

And as far as science goes, the scientific community in general shouldn't really adopt clinical practice until a study has had good replication in 3rd party objective studies. As long as Bierderman's work had been replicated by another party, I see no reason to dump it.

Pharm companies entangling themselves into several aspects of research--from the FDA to several scientific journals of course does cause problems, and we should combat those problems.

 

[Faebinder]

I thought you wanted their licences revoked?

Ya, license revoked or even placed on temporary probation is a slap on the wrist. A person can try and reinstate it after a certain period or get a license elsewhere. The state medical boards do that for even lesser deeds "like writing for an antibiotic to your relative who is not a patient in the hospital when you only have a temporary license". What I dont want to see a lawsuit that makes him pay money for something he was supposed to volunteer or crazy punishment like "jail".