{"id":57737,"date":"2015-06-08T22:41:51","date_gmt":"2015-06-09T02:41:51","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=57737"},"modified":"2015-06-08T22:41:51","modified_gmt":"2015-06-09T02:41:51","slug":"got-any-thoughts","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2015\/06\/08\/got-any-thoughts\/","title":{"rendered":"got any thoughts?…"},"content":{"rendered":"
So first there was the New England Journal of Medicine<\/font><\/em> series by Jeffrey Drazen and Lisa Rosenbaum suggesting a relaxation of the restrictions on industry affiliated experts writing editorial or review articles in the NEJM.  Then came strong rebuttals in the British Medical Journal<\/font><\/em> from both sides of the pond [UK: Elizabeth Loder, Catherine Brizzell, and Fiona Godlee][US: Robert Steinbrook, Jerome Kassirer, and Marcia Angell]. Now, Lancet<\/font><\/em> Editor, Richard Horton, weighs in. : <\/div>\n
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Offline: The BMJ vs NEJM<\/em>—lessons for us all<\/a><\/div>\n
by Richard Horton<\/div>\n
Lancet<\/font><\/strong>. 2015 385:2238.<\/div>\n

<\/p>\n

It’s hard to recall now, but there was a time in medicine’s recent past when interactions between physicians and the pharmaceutical industry were seen as positively virtuous. During medical school [a long time ago, 1980–86, at the University of Birmingham], most of our general medicine teaching was organised by the Department of Pharmacology and Therapeutics, led by the inspirational Martin Kendall. In weekly “roadshows”, 180 students would discuss clinical scenarios from a pharmacological perspective. Martin Kendall would lead the class through vignettes of patient management. He would do so by testing the students on stage, a ritual we all endured and enjoyed in equal part. An appreciation of, and respect for, the contribution of the pharmaceutical industry to clinical medicine was embedded in our training, and I think most of us felt better prepared for the practical aspects of subsequent ward work as a result. This mutuality extended to research. In 1985, I spent 3 months working at the Astra Laboratories in Mölndal, near Gothenburg, Sweden. At that time, the great Swedish cardiovascular physiologist, Björn Folkow, was at the University of Gothenburg. It was accepted [and encouraged] that senior faculty in Folkow’s department, together with post-docs and PhD students, would move seamlessly between university and industry. This symbiosis is hard to comprehend today. The conflict between those who see industry as an enemy to the values of medicine and those who see great possibilities from collaboration is exemplified by the recent argument between two great general medical journals, The New England Journal of Medicine<\/em> and The BMJ<\/em>.<\/div>\n<\/blockquote>\n
I was in medical school even earlier [1963-1967], and I saw no split between Medicine and the Pharmaceutical Industry, having had something of the same experience as Horton. When I first started writing about the corruption in what I now think of as the «academic·industrial complex»<\/font><\/strong><\/em>, I repeatedly said that I had only become aware of it after my retirement, around the time of Senator Grassley’s investigation [2008]. But then I read so many critics saying that we [psychiatrists] knew, or should have known, but were in denial, or that we were making lame excuses for some kind of passive collusion. So I stopped saying it. It had begun to sound like excuse making or an attempt to disavow responsibility even to me.<\/div>\n

<\/p>\n

The changes in 1980 had a dramatic effect on my life. But after the dust settled, I think I had a Solomon-like view of things. It just wasn’t "a time for<\/font><\/em><\/strong>" my likes<\/font><\/em> or the likes of me<\/font><\/em>. Things were good in my world and my drifting away from mainstream psychiatry was more because it was irrelevant than anything else. My cluelessness was genuine. More than that, I hadn’t even considered the possibility of a corrupt «academic·industrial complex»<\/font><\/strong><\/em>. That’s all the more remarkable considering I was on the faculty at Emory University, teaching in a Psychoanalytic Institute that was part of the Department of Psychiatry, whose chairman was Charlie Nemeroff, now seen as the poster-child for the «academic·industrial complex»<\/font><\/strong><\/em>. The office where I practiced was minutes from the office I had when I was on the full time faculty – literally around a couple of corners.<\/div>\n
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Writing in The BMJ<\/em> this week, two former Editors-in-Chief of the NEJM<\/em>, Jerry Kassirer and Marcia Angell, call three recent NEJM<\/em> articles [by the journal’s national correspondent, Lisa Rosenbaum] and an editorial [by the journal’s current Editor-in-Chief, Jeff Drazen],<\/em> “A seriously flawed and inflammatory attack” on financial, largely pharmaceutical and device manufacturer, conflicts of interest. “We find it sad”, they write, “that the medical journal that first called attention to the problem of financial conflicts of interest among physicians would now backtrack so dramatically, and indulge in ad hominem attacks on those who disagree”. They accuse the NEJM<\/em> of downplaying the importance of conflicts of interest in medicine. They allege the journal has “little understanding of the meaning of the term”. They call Lisa Rosenbaum’s three essays “rambling”, “fanciful”, and “data-free”. They also attack Drazen, their successor, for weakening the NEJM<\/em>‘s conflict of interest policy. In an accompanying editorial, the BMJ<\/em>‘s Editor-in-Chief, Fiona Godlee, together with the journal’s heads of research and education, notes that they are “deeply troubled” by Drazen’s “possible retreat from policies that prevent experts with relevant commercial ties from authoring commentary or review articles”. “We don’t find much to agree with in NEJM<\/em>‘s anecdotal analysis…It is a mistake by NEJM<\/em> to suggest that rigorous standards should be revisited.” There have been few such sharp rebukes by one journal editor against another. What led to this surprising assault?<\/div>\n<\/blockquote>\n
Here’s where Horton loses me. I may have been naive about the «academic·industrial complex»<\/font><\/strong><\/em> before 2008, but it was sure easy to catch up. There was no surprising assault<\/font><\/em>, just a reaction to a preposterous series in the New England Journal of Medicine<\/font><\/em>. Has Horton been in suspended animation? One is tempted to think he’s being ingenuous here.<\/div>\n
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Lisa Rosenbaum posed a series of questions that have upset those who believe in the inimical influence of industry in medicine. For example, Rosenbaum asked whether it was reasonable to conclude that a physician with industry ties is motivated by a desire for financial gain? To what extent are reactions to industry influenced by reason or emotion? Why do we not take non-financial conflicts as seriously as financial entanglements? What unanticipated negative consequences might accrue from a hunt for wrongdoing? Why are the benefits of industry–academic collaborations persistently ignored? It would seem within the spirit of scientific inquiry to pose questions that challenge received orthodoxies. Rosenbaum accepts that gifts to doctors can have unacceptable influence. She agrees that past wrongdoings should not be excused. She believes that oversight of industry should not be eliminated. And she discusses evidence that industry-sponsored studies are more likely to be positive. Therefore, I don’t agree with the NEJM<\/em>‘s critics that the Rosenbaum papers represent a reversal of policy by the NEJM<\/em>.<\/font> But while I don’t agree with these critics, I do think that the BMJ<\/em>‘s analysis should be welcomed. A clear division of opinion in this argument helpfully clarifies both positions. The truth is likely to lie somewhere between these extremes. It’s time we found it.<\/font><\/strong><\/div>\n<\/blockquote>\n
I’ll be honest. I don’t even follow what Horton is saying. Of course it’s a reversal of policy. They even say it in their series [see Understanding Bias — The Case for Careful Study<\/a>].  And I don’t know where his middle ground "somewhere between these extremes<\/font><\/strong>" would be. This post has been sitting on this screen all day while I went about doing this-and-that, and every time I glance over it, it makes me a little madder. Are he and Drazen pals? Or was he looking to not cross either set of colleagues? I wondered what policy the Lancet<\/font><\/em> had but couldn’t find anything that made things clear. Anybody else got any thoughts?<\/div>\n","protected":false},"excerpt":{"rendered":"

So first there was the New England Journal of Medicine series by Jeffrey Drazen and Lisa Rosenbaum suggesting a relaxation of the restrictions on industry affiliated experts writing editorial or review articles in the NEJM.  Then came strong rebuttals in the British Medical Journal from both sides of the pond [UK: Elizabeth Loder, Catherine Brizzell, […]<\/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":[5],"tags":[],"class_list":["post-57737","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/57737","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=57737"}],"version-history":[{"count":5,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/57737\/revisions"}],"predecessor-version":[{"id":57744,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/57737\/revisions\/57744"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=57737"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=57737"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=57737"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}