{"id":27709,"date":"2012-09-20T20:53:32","date_gmt":"2012-09-21T00:53:32","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=27709"},"modified":"2012-09-20T21:05:41","modified_gmt":"2012-09-21T01:05:41","slug":"accountability-2","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2012\/09\/20\/accountability-2\/","title":{"rendered":"accountability&#8230;"},"content":{"rendered":"\n<div align=\"justify\">We&#8217;ve recently witnessed something rather remarkable &#8211; the Romney <a href=\"http:\/\/www.youtube.com\/watch?v=MU9V6eOFO38\" target=\"_blank\"><u><strong><font color=\"#200020\">video<\/font><\/strong><\/u><\/a>. <\/div>\n<ul>\n<div align=\"justify\"><strong><sup>I&#8217;ve sworn off blogging about politics and this is no exception, I have another point in mind. I used up my political blogging libido during the second Bush term. The point I want to make has to do with transparency.<\/sup><\/strong><\/div>\n<\/ul>\n<div align=\"justify\">I expect that most of us sort of knew that Romney felt the way he spoke behind the closed doors of a private fund raiser. In some ways, he&#8217;s the most honest of the modern conservatives, so his views are relatively public even when sanitized by his speech-writers. But what&#8217;s remarkable is what happened when he said it in person on a public video. It made what was suspected into something very real. But how did it happen?                     <\/div>\n<ul><sup>                     <\/p>\n<li>\n<div align=\"justify\"><strong><font color=\"#200020\">1994<\/font><\/strong>: <strong>Tim Berners-Lee creates html [the &quot;World Wide Web&quot;]<\/strong><\/div>\n<\/li>\n<li>\n<div align=\"justify\"><strong><font color=\"#200020\">1996<\/font><\/strong>: <strong>1boringoldman&#8217;s first Internet connection and email<br \/>                  <\/strong><\/div>\n<\/li>\n<li>\n<div align=\"justify\"><strong><font color=\"#200020\">1996<\/font><\/strong>: <strong><font color=\"#660033\">PubMed introduced<\/font><\/strong><\/div>\n<\/li>\n<li>\n<div align=\"justify\"><strong><font color=\"#200020\">1998<\/font><\/strong>: <strong>Google incorporated<\/strong><\/div>\n<\/li>\n<li>\n<div align=\"justify\"><strong><font color=\"#200020\">2000<\/font><\/strong>: <strong><font color=\"#660033\">ClinicalTrials.gov<\/font><\/strong><\/div>\n<\/li>\n<li>\n<div align=\"justify\"><strong><font color=\"#200020\">2005<\/font><\/strong>: <strong>YouTube incoporated<\/strong><\/div>\n<\/li>\n<li>\n<div align=\"justify\"><strong><font color=\"#200020\">2007<\/font><\/strong>: <strong>iPhone introduced<\/strong><\/div>\n<\/li>\n<p>                      <\/sup><\/ul>\n<div align=\"justify\">When Martin Keller and Neal Ryan proposed what became Study 329, there was no World Wide Web. When they actually did the clinical trial, there was no ClinicalTrials.gov. And yet in the 1990&#8217;s, we thought of ourselves as living in the Information Age. Now apply those dates to these two charts:             <\/div>\n<div align=\"center\"><img decoding=\"async\" vspace=\"5\" height=\"182\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/bttf-5.gif\" \/>&nbsp;<img decoding=\"async\" vspace=\"5\" height=\"200\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/sell-seroquel-beach-6.gif\" \/><\/div>\n<div align=\"justify\">When Alex Gorsky was deposed in May, he was questioned using subpoenaed emails &#8211; it probably never occurred to him that they would&#8217;ve seen the light of day. Mitt Romney had no clue that his private fundraiser would have an iPhone in the audience that would record his speech for YouTube. And some of our most popular television shows [the ones I call <em>bad-person tv<\/em>] count on on the ubiquitous CCTV cameras, access to vast databases, and DNA evidence to catch the bad guys, instead of our classic reliance on brilliant eccentric detectives. We live in an time beyond the age of information, it&#8217;s becoming an age of accountability that could barely be imagined even ten years ago.<\/div>\n<hr width=\"75%\" size=\"1\" \/>             <\/p>\n<div align=\"justify\">There are some interesting posts on <strong><font color=\"#004400\">Pharmalot<\/font><\/strong> today, among them <strong><a href=\"http:\/\/www.pharmalot.com\/2012\/09\/the-op-ed-a-suggestion-to-restore-faith-in-pharma-studies\/\" target=\"_blank\"><u><font color=\"#200020\">The Op-Ed: A Suggestion to Restore Faith in Pharma Studies<\/font><\/u><\/a><\/strong> is a call for clinical trial data transparency that comes from a different perspective than my own. Dr Harlan Krumholz of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation points to a recent NEJM article saying:<\/div>\n<blockquote>\n<div align=\"justify\"><sup>A <strong><a target=\"_blank\" href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMsa1202397#t=articleTop\"><u><font color=\"#200020\">study<\/font><\/u><\/a><\/strong> in this week&rsquo;s New England Journal of Medicine  reveals that industry sponsorship of clinical trials negatively  influences physicians&rsquo; perceptions of the study quality and their  willingness to change practice based on the results.<\/sup><\/div>\n<\/blockquote>\n<div align=\"justify\">Now there&#8217;s a study I&#8217;d believe without even bothering to read it. He goes on to say:          <\/div>\n<blockquote>\n<div align=\"justify\"><sup>Unfortunately, the result serves as an impediment to progress. The  pharmaceutical industry is replete with respected and dedicated  scientists who devote their professional lives to advance our ability to  prevent and treat disease. Many landmark trials owe their support to  the pharmaceutical industry. Many of these professionals are undoubtedly  frustrated that their efforts may be less valued due to general  impressions about industry.<\/p>\n<p>         Society depends on sponsorship by the pharmaceutical industry. It is  the largest funder of biomedical research, accounting for about $40  billion and is responsible for supporting about a third of the studies  in the government registry of clinical trials. The current environment of mistrust does a disservice to both society  and industry. If physicians negatively perceive a study based on  sponsorship, then it is likely that many good studies will be ignored  and the translation of science into practice will be slowed.<\/p>\n<p>        Restricted access to industry data is, I suspect, an important factor  that contributes to the lack of confidence in industry-sponsored  efforts. Studies are kept behind closed doors and problems become public  primarily when data are revealed through litigation. Calls for  voluntary data release usually go unheeded&#8230;<\/sup><\/div>\n<\/blockquote>\n<div align=\"justify\">Dr Harlan Krumholz is an Internist, and what he says might be applicable to Internal Medicine. I don&#8217;t even question that the &quot;<em>pharmaceutical industry is replete with respected and dedicated   scientists who devote their professional lives to advance our ability to   prevent and treat disease.<\/em>&quot; But as for psychiatry, when I look at the charts posted above, there&#8217;s no single drug on the list that didn&#8217;t employ major scientific deceit in its marketing, and I can document most of those accusations with previous blog posts on this little out of the way blog. My problem isn&#8217;t with the &quot;<em>respected and dedicated   scientists,<\/em>&quot; it&#8217;s with the marketing departments and the executives that created a layer of deceit that has taken decades to expose.  <\/div>\n<hr width=\"75%\" size=\"1\" \/>  <\/p>\n<div align=\"justify\">Most of my professional friends and colleagues are &quot;<em>respected and dedicated   scientists,<\/em>&quot; psychiatrists and other mental health practitioners whom I&#8217;ve known for years and who have made their life&#8217;s work helping people with significant mental problems have better lives &#8211; as hard as that is to do in the modern world. But I would never mount a defense of psychiatry based on those people, because those who&#8217;ve shamed psychiatry in the last several decades actually do exist, and so long as their influence is felt so strongly, the specialty will live under a recurring dark cloud.   <\/div>\n<p align=\"justify\">My call for transparency is for two reasons. First, it&#8217;s because it&#8217;s finally possible eg the first section above. The mechanisms for accountability are in place now. We didn&#8217;t have that when these drugs flowed from the pipeline and people with questionable motives had their field days. So we actually can avoid the all-to-well documented misadventures of the past. Second, the amount of lousy and deceptive scientific publication in the last thirty years is a matter of public record. It&#8217;s the Augean Stables I spoke of in an earlier post. It needs to be cleaned out or at least clarified. In the realm of psychopharmacology, we need an accurate compendium of what the drugs really do for and to the people who take them. We don&#8217;t have that right now. Transparency about the data from the past would go a long way towards setting the record straight. I am not swayed by this argument, &quot;<em>The current environment of mistrust does a disservice to both society   and industry. If physicians negatively perceive a study based on   sponsorship, then it is likely that many good studies will be ignored   and the translation of science into practice will be slowed.<\/em>&quot; In psychiatry, that&#8217;s not true. &quot;<em>translation<\/em>&quot; is out, <em>accountability<\/em> is in. For us, the &quot;<em>current environment of mistrust<\/em>&quot; is a hard-won position still not widely enough accepted to have the necessary impact. <\/p>\n<div align=\"justify\">From my perspective, I would levy the same complaint towards the Third Party carriers. They&#8217;ve so misshaped psychiatry that it can&#8217;t really be practiced effectively right now, even by the best of our ranks of any theoretical persuasion. A little transparency in that direction would be a breath of fresh air. Managed Care has not been held accountable. People complain that their doctors don&#8217;t talk to them anymore, don&#8217;t spend enough time evaluating them. That is absolutely true for very demonstrable and concrete reasons. But there&#8217;s no way to mount an argument from within the wounded psychiatry of the present to oppose that force. If it is to be countered at all, it will have to come from the outside, and I just don&#8217;t hear any voices right now. So the only right thing to do is fight the enemy we know how to fight&#8230;  <\/div>\n","protected":false},"excerpt":{"rendered":"<p>We&#8217;ve recently witnessed something rather remarkable &#8211; the Romney video. I&#8217;ve sworn off blogging about politics and this is no exception, I have another point in mind. I used up my political blogging libido during the second Bush term. The point I want to make has to do with transparency. I expect that most of [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-27709","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/27709","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=27709"}],"version-history":[{"count":47,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/27709\/revisions"}],"predecessor-version":[{"id":45510,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/27709\/revisions\/45510"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=27709"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=27709"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=27709"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}