{"id":58388,"date":"2015-07-20T23:38:31","date_gmt":"2015-07-21T03:38:31","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=58388"},"modified":"2015-07-21T14:16:30","modified_gmt":"2015-07-21T18:16:30","slug":"a-snails-pace","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2015\/07\/20\/a-snails-pace\/","title":{"rendered":"a snail&#8217;s pace&#8230;"},"content":{"rendered":"\n<div align=\"justify\" class=\"small\">First there was the editorial and a three&nbsp; part series in the <font color=\"#200020\">New England Journal of Medicine<\/font> that advocated dropping their ban on authors with conflicts of interest writing editorials or review articles&#8230;<\/div>\n<ul><sup> <\/p>\n<div align=\"justify\"><a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMe1503623\" target=\"_blank\">Revisiting the Commercial&ndash;Academic Interface<\/a><\/div>\n<div align=\"justify\"><a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMMS1502493\" target=\"_blank\">Reconnecting the Dots &mdash; Reinterpreting Industry&ndash;Physician Relations<\/a><\/div>\n<div align=\"justify\"><a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMMS1502497\" target=\"_blank\">Understanding Bias &mdash; The Case for Careful Study<\/a><\/div>\n<div align=\"justify\"><a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMms1502498\" target=\"_blank\">Beyond Moral Outrage &mdash; Weighing the Trade-Offs of COI Regulation<\/a><\/div>\n<p> <\/sup><\/ul>\n<div align=\"justify\" class=\"small\">I&nbsp; obviously didn&#8217;t care too much for that idea, and I was in good company. These posts of mine catalog many other dissenting voices&#8230;     <\/div>\n<ul><sup><\/p>\n<div align=\"justify\"><a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/index.php\/2015\/05\/18\/a-contrarian-frame-of-mind\/\">a contrarian frame of mind&hellip;      <\/a><\/div>\n<div align=\"justify\"><a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/index.php\/2015\/05\/21\/wtf-3\/\">wtf?&hellip;&nbsp;      <\/a><\/div>\n<div align=\"justify\"><a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/index.php\/2015\/05\/22\/wtf-for-real\/\">wtf? for real&hellip;&nbsp;      <\/a><\/div>\n<div align=\"justify\"><a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/index.php\/2015\/05\/24\/a-narrative\/\">a narrative&hellip;&nbsp;      <\/a><\/div>\n<div align=\"justify\"><a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/index.php\/2015\/05\/25\/57179\/\">not so proud&hellip;&nbsp;      <\/a><\/div>\n<div align=\"justify\"><a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/index.php\/2015\/05\/27\/unserious-arguments-seriously\/\">unserious arguments seriously&hellip;&nbsp;      <\/a><\/div>\n<div align=\"justify\"><a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/index.php\/2015\/06\/03\/real-editors-speak-out\/\">the real editors speak out&hellip;&nbsp;      <\/a><\/div>\n<div align=\"justify\"><a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/index.php\/2015\/06\/08\/got-any-thoughts\/\">got any thoughts?&hellip;&nbsp;      <\/a><\/div>\n<div align=\"justify\"><a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/index.php\/2015\/06\/12\/not-backward\/\">not backward&hellip;&nbsp;      <\/a><\/div>\n<p> <\/sup><\/ul>\n<div align=\"justify\" class=\"small\">Now we have other versions. This from the Canadian Medical Association Journal suggesting that only industry can afford to support innovation&#8230;<\/div>\n<blockquote>\n<div align=\"center\" class=\"big\"><a target=\"_blank\" href=\"http:\/\/www.cmaj.ca\/site\/earlyreleases\/16july15_competing-interests-are-a-complex-problem-cmaj.109-5103.xhtml\">Competing interests are a complex problem<\/a><\/div>\n<div align=\"center\" class=\"middle\"><strong><font color=\"#200020\">Part I of a series on conflicts of interest in medicine<\/font><\/strong><\/div>\n<div align=\"center\" class=\"big\"><strong><font color=\"#200020\">Canadian Medical Association Journal<\/font><\/strong><\/div>\n<div align=\"center\" class=\"middle\">by Roger Collier<\/div>\n<div align=\"center\" class=\"small\">July 16, 2015 <\/div>\n<p align=\"justify\">&#8230;  In an ideal world, there would  perhaps be no need  for a conversation  about conflicts of interest in medical  research.  Academic                                researchers with good ideas for new  medications would  have  all the funding and resources they need to  manufacture compounds                                and launch  large-scale clinical trials   without support from industry. That, however, is  not reality. Today,   like it or not,                               the expensive and risky  process of getting   new medications into the hands of patients requires  resources  unavailable in academic                                laboratories. &quot;We are in the business  of making  patients better,&quot; said  Drazen, a pulmonologist. &quot;When you  develop something and  want to                                take it that last step, from a general  idea  to making a difference for  patients, you really need a way to work   with commercial entities&quot;&#8230;<\/p>\n<p align=\"justify\">&quot;The problem is  that  people are  taking the marketing arm, where doctors are selling a  drug,  and they conflate  it with the                                discovery arm, where we want to encourage  interaction,&quot; said  Drazen.  &quot;We need to figure out a way for researchers  to work                                with commercial  entities that won&#8217;t paint  them as having  sold their soul to the devil.&quot;<\/p>\n<p align=\"justify\">If negative  attitudes about all  financial ties between doctors and industry don&#8217;t  change, they will continue to  undermine                                innovation in medicine, according to Dr.&nbsp;Thomas Stossel, author of  the  book <em>Pharmaphobia<\/em>. Over the  course of his lengthy career, the  practice of medicine has improved  tremendously, said Stossel. He  attributes                               that improvement to better  tools,  most of which came from the medical-products industry. &quot;We get  that stuff at  great  difficulty and at great expense,&quot; said Stossel,  director of  translational  medicine at Brigham                                and Women&#8217;s Hospital in Boston,  Massachusetts. &quot;With  respect to  innovation, intelligent, educated  people &mdash;&nbsp;even doctors &mdash;&nbsp;have                                no  idea. They think this stuff comes from  Santa  Claus&quot;&#8230;<\/p>\n<div align=\"justify\"><strong><font color=\"#200020\">Next: Part II: The costs of  vilifying pharma<\/font><\/strong><\/div>\n<\/blockquote>\n<div align=\"justify\" class=\"small\">Here&#8217;s a useful commentary that sees full disclosure of conflicts as key and also proposes that we find alternative ways of funding science&#8230;  <\/div>\n<blockquote>\n<div align=\"center\" class=\"big\"><a href=\"http:\/\/healthaffairs.org\/blog\/2015\/07\/16\/to-support-physician-decision-making-re-evaluate-industry-funding-of-science\/\" target=\"_blank\">To Support Physician Decision-Making, Re-Evaluate Industry Funding Of Science<\/a><\/div>\n<div align=\"center\" class=\"big\"><strong><font color=\"#200020\">Health Affairs Blog <\/font><\/strong><\/div>\n<div align=\"center\" class=\"middle\">by Christopher Robertson<\/div>\n<div align=\"center\" class=\"small\">July 16, 2015<\/div>\n<p align=\"justify\">In 1984, the <em>New England Journal of Medicine<\/em> [<em>NEJM<\/em>]  began requiring authors of research papers to disclose financial  relationships with the pharmaceutical or device industry. The policy was  controversial then, and even a decade later still faced criticism, with  noted scholars <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8192721\" target=\"_blank\">charging<\/a> that it &ldquo;thwarts the principle that a work should be judged solely on its merits.&rdquo;<\/p>\n<p align=\"justify\">Though every respectable scientific journal has now adopted such a policy, this critical view has received <a target=\"_blank\" href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMms1502497\">new attention<\/a> in a three-part series on conflicts of interest appearing in <em>NEJM<\/em>, again asking whether disclosures &ldquo;foster an ad hominem approach to evaluating science.&rdquo; Three former <em>NEJM<\/em> editors <a href=\"http:\/\/www.bmj.com\/content\/350\/bmj.h2942\">fired back<\/a> in the pages of <em>The BMJ<\/em>,  calling this a &ldquo;seriously flawed and inflammatory attack&rdquo; on a  longstanding consensus about conflicts of interest. Who is right?<\/p>\n<div align=\"justify\">It is tempting to answer with heated rhetoric about &ldquo;industry greed&rdquo;  and the &ldquo;taint&rdquo; of industry money, or with a romantic account of the  &ldquo;life-saving innovations&rdquo; funded by industry. But both arguments miss  the point. <strong><font color=\"#200020\">The question should be simply whether disclosures will  support physician decision-making and ultimately enhance patient health  outcomes. And more fundamentally, whether there are better models for  funding science&#8230;<\/font><\/strong><\/div>\n<\/blockquote>\n<div align=\"justify\" class=\"small\">I particularly liked this framing of a dichotomy, because most commentaries fall in one or the other of these two categories: &quot;<em>It is tempting to answer with <strong><font color=\"#990000\">heated rhetoric about &ldquo;industry greed&rdquo;   and the &ldquo;taint&rdquo; of industry money<\/font><\/strong>, or with<strong><font color=\"#990000\"> a romantic account of the   &ldquo;life-saving innovations&rdquo; funded by industry<\/font><\/strong>. But both arguments miss   the point.<\/em>&quot; I guess I&#8217;m usually in the <em><strong><font color=\"#990000\">heated rhetoric about &ldquo;industry greed&rdquo; <\/font><\/strong><\/em>camp. It would be hard to be a psychiatrist and end up anywhere else. To quote Richard Friedman [in the recent <font color=\"#200020\">New York Times Op-Ed<\/font>, <a target=\"_blank\" href=\"http:\/\/mobile.nytimes.com\/2015\/07\/19\/opinion\/psychiatrys-identity-crisis.html\">Psychiatry&#8217;s Identity Crisis<\/a>]:  <\/div>\n<blockquote>\n<div align=\"justify\">&quot;With few exceptions, every major class of current psychotropic drugs &mdash;  antidepressants, antipsychotics, anti-anxiety medications &mdash; basically  targets the same receptors and neurotransmitters in the brain as did  their precursors, which were developed in the 1950s and 1960s.&quot;<\/div>\n<\/blockquote>\n<div align=\"justify\" class=\"small\">I don&#8217;t think many [if any] of the post-50s-60s drugs were developed by academics. They came to us from the labs of the pharmaceutical industry. But it doesn&#8217;t seem reasonable to use the word &quot;<em><font color=\"#200020\">innovation<\/font><\/em>&quot; to describe them. In fact, we usually call them the &quot;<em><font color=\"#200020\">me too<\/font><\/em>&quot; drugs. And the academic professors who refer to themselves as &quot;<em><font color=\"#200020\">researchers<\/font><\/em>&quot; are in fact doctors who rarely [if ever] see a lab bench and mainly involve themselves with clinical trials [often signing on to articles about trials conducted by Contract Research Organizations, analyzed by the Pharmaceutical Company Statisticians, and written by the Pharmaceutical Company&#8217;s hired Medical Writing Firms AKA ghost-writers]. At least in psychiatry, the academics have occupied themselves talking about drugs developed by others, often up to their necks in Conflicts of Interest themselves.  <\/div>\n<p align=\"justify\" class=\"small\">So I, for one think that the New England Journal&#8217;s argument is not applicable to psychiatry, and probably equally flawed in other specialties. If there are no &quot;<em><font color=\"#200020\">untainted<\/font><\/em>&quot; academics to write editorials and review articles, then I&#8217;d just as soon we do without editorials and review articles. In fact, the point being made in the CMAJ article above that only Pharmaceutical Companies have the resources to do drug research is an even stronger argument to keep academics that write editorials and reviews free of industry connections. Who else is going to counter the barrage of hype that comes when each new drug becomes available?  <\/p>\n<div align=\"justify\" class=\"small\"><em><font color=\"#200020\">Truth-be-told, the field of Medicine moves much more slowly than you might imagine &#8211; at a snail&#8217;s pace. Left to my own devices, there are only two medications that I would regularly prescribe that weren&#8217;t available to me on the day I finished my psychiatric residency in 1977 &#8211; one SSRI and one Atypical Antipsychotic. That was forty years ago. And my patients and I could get by if they weren&#8217;t around. They&#8217;re just a little gentler and better tolerated than the older drugs. But, if anything, they&#8217;re also just a little less effective. Both are now available as generics. <\/font><\/em> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>First there was the editorial and a three&nbsp; part series in the New England Journal of Medicine that advocated dropping their ban on authors with conflicts of interest writing editorials or review articles&#8230; Revisiting the Commercial&ndash;Academic Interface Reconnecting the Dots &mdash; Reinterpreting Industry&ndash;Physician Relations Understanding Bias &mdash; The Case for Careful Study Beyond Moral Outrage [&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":[5],"tags":[],"class_list":["post-58388","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/58388","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=58388"}],"version-history":[{"count":25,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/58388\/revisions"}],"predecessor-version":[{"id":58448,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/58388\/revisions\/58448"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=58388"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=58388"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=58388"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}