1 Boring Old Man

I added back in what I think Editor Jeffrey Drazen is leaving out of his argument in this current campaign. I’m not as unsympathetic to some of his argument as one might think. Thirty-five years ago, I was in an academic department under a Chairman who had shown a surprising amount of skill in his thirty year tenure financing a growing department in a place where there really wasn’t anything to start with. But by the time I came along, he had run out of tricks. We had virtually no institutional support, which is pretty much the rule in medical academic departments. He’d always maximally utilized Federal Grant support. Resident and faculty salaries came from City/County, State, VAH, and private hospital placements. And he had done well with private donations. But it was all drying up at an almost palpable rate. Increasingly, my job was juggling the training needs of our residents with literally selling their services to earn their pay.

After I left, it was obvious that the post-DSM-III medical psychiatry was a more lucrative enterprise and that they were no longer operating on a shoestring, and I wasn’t so naive that I didn’t know how they brought it off. I guess I assumed that they were doing Clinical Trials and drug research to bring in the needed funding. I don’t recall thinking about it very much beyond that. So when I became reacquainted with such matters a quarter of a century later, I wasn’t surprised about the unrestricted institutional grants or the clinical trials. Their new money had to be coming from some place. But I was oblivious to the direct payment to faculty by industry in the form of Grants, Advisory Committees, or Speakers Bureaus. And that’s what Drazen is talking about, "academician$ who are receiving per$onal money from the pharmaceutical companie$". He’s implying that they can render editorial or review article opinions unbiased by the fact that they are being paid in some form or another by the manufacturer of the drugs being reviewed. It’s not the dialog between academia and industry that’s in question, it’s the money. And his opening sentence …

^{"Over the pa$t two decade$, largely becau$e of a few widely publicized epi$ode$ of unacceptable behavior by the pharmaceutical and biotechnology indu$try, many medical journal editor$ [including me] have made it harder and harder for people who have received indu$try payment$ or item$ of financial value to write editorial$ or review article$.}

I thought it was just psychiatry for a while, selling out to industry justified by dire straights. But it’s increasingly apparent that it’s all of medicine that’s playing with the same fire that has been so disastrous for my own specialty. And Jeffrey Drazen, editor of the New England Journal of Medicine is taking a lead in not just condoning it, but telling us it’s a good idea. After suggesting that experts who have personal financial Conflicts of Interest can write unbiased editorials and review articles [an obvious impossibility], he follows up a few months later with an attack on people who re-analyze data they think has been jury-rigged, calling  them  us "data parasites." And then later, he puts a cherry on top of this Sundae by dismissing confrontations about articles reporting drug trial results in his journal with protocol violations [How did NEJM respond when we tried to correct 20 misreported trials?].