{"id":64508,"date":"2016-04-07T12:49:52","date_gmt":"2016-04-07T16:49:52","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=64508"},"modified":"2016-04-07T12:49:52","modified_gmt":"2016-04-07T16:49:52","slug":"already-gone","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2016\/04\/07\/already-gone\/","title":{"rendered":"already gone?&#8230;"},"content":{"rendered":"<div align=\"justify\"><em><font color=\"#660033\"><sup>&quot;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$. The concern ha$  been that $uch people have been bought by the drug companie$. Having  received indu$try money, the argument goe$, even an acknowledged world  expert can no longer provide untainted advice. But i$ thi$ divide  between academic re$earcher$ and indu$try in our be$t intere$t? I think  not &#8211; and I am not alone. The National Center for Advancing  Tran$lational $cience$ of the National In$titute$ of Health, the  Pre$ident&#8217;$ Council of Advi$or$ on $cience and Technology, the World  Economic Forum, the Gate$ Foundation, the Wellcome Tru$t, and the Food  and Drug Admini$tration are but a few of the in$titution$ encouraging  greater interaction between academic$ and indu$try, to provide tangible  value for patient$. $imply put, in no area of medicine are our  diagno$tic$ and therapeutic$ $o good that we can call a halt to  improvement, and true improvement can come only through collaboration.  How can the divide be bridged? And why do medical journal editor$ remain  concerned about author$ with pharma and biotech a$$ociation$? The  rea$on$ are complex. Thi$ week we begin a $erie$ of three article$ by  Li$a Ro$enbaum examining the current $tate of affair$.&quot;<\/sup><\/font><\/em><\/div>\n<div align=\"right\"><sup><a target=\"_blank\" href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMe1503623\"><font color=\"#660033\">Revisiting the Commercial-Academic Interface<\/font><\/a><\/sup><\/div>\n<div align=\"right\"><sup><font color=\"#660033\">by Jeffrey M. Drazen, MD, Editor<\/font><\/sup><\/div>\n<div align=\"right\"><sup><strong><font color=\"#660033\">NEJM<\/font><\/strong><!--$trong--> <font color=\"#660033\">2015 372:1853-1854.<\/font><\/sup><\/div>\n<hr size=\"1\" \/>\n<p align=\"justify\" class=\"small\">I added back in what I think Editor Jeffrey Drazen is leaving out of his argument in this current campaign. I&#8217;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&#8217;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&#8217;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.   <\/p>\n<p align=\"justify\" class=\"small\">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&#8217;t so naive that I didn&#8217;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&#8217;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&#8217;t surprised about the <em><font color=\"#200020\">unrestricted<\/font><\/em> institutional grants or the clinical trials. Their <em><font color=\"#200020\">new money<\/font><\/em> had to be coming from some place. But I was oblivious to the direct payment to faculty by industry in the form of <img decoding=\"async\" border=\"0\" align=\"right\" width=\"120\" hspace=\"4\" src=\"http:\/\/1boringoldman.com\/images\/bs.gif\" \/>Grants, Advisory Committees, or Speakers Bureaus. And that&#8217;s what Drazen is talking about, &quot;<em><font color=\"#660033\">academician$ who are receiving per$onal money from the pharmaceutical companie$<\/font><\/em>&quot;. He&#8217;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&#8217;s not the dialog between academia and industry that&#8217;s in question, <em><font color=\"#200020\">it&#8217;s the money<\/font><\/em>. And his opening sentence &#8230;<\/p>\n<ul>\n<div align=\"justify\"><sup><em><font color=\"#660033\">&quot;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$.<\/font><\/em><\/sup><\/div>\n<\/ul>\n<div align=\"justify\" class=\"small\">&#8230; is like calling <font color=\"#200020\">Europe&#8217;s Black Death<\/font> epidemic &quot;<em><font color=\"#660033\">a few widely publicized cases of Pasteurella pestis.<\/font><\/em>&quot;     <\/div>\n<p align=\"justify\" class=\"small\">I thought it was just psychiatry for a while, selling out to industry justified by dire straights. But it&#8217;s increasingly apparent that it&#8217;s all of medicine that&#8217;s playing with the same fire that has been so disastrous for my own specialty. And Jeffrey Drazen, editor of the <em><font color=\"#200020\">New England Journal of Medicine<\/font><\/em> is taking a lead in not just condoning it, but telling us it&#8217;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&nbsp;<strike> them&nbsp;<\/strike> us &quot;<a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMe1516564\" target=\"_blank\">data parasites.<\/a>&quot; 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 [<a href=\"http:\/\/compare-trials.org\/blog\/how-did-nejm-respond-when-we-tried-to-correct-20-misreported-trials\/\" target=\"_blank\">How did NEJM respond when we tried to correct 20 misreported trials?<\/a>].     <\/p>\n<div align=\"justify\" class=\"small\">I suppose that we should&#8217;ve expected this when the <em><font color=\"#200020\">New England Journal of Medicine<\/font><\/em> fired <em><font color=\"#200020\">Jerome Kassirer<\/font><\/em> and hired <em><font color=\"#200020\">Jeffry Drazen<\/font><\/em> in 1999 over these self-same issues. But it&#8217;s a bitter pill to swallow following editors like <em><font color=\"#200020\">Arnold Relman<\/font><\/em>,<em><font color=\"#200020\"> Jerome Kassier<\/font><\/em>, and<em><font color=\"#200020\"> Marcia Angell<\/font><\/em> [see <a href=\"http:\/\/1boringoldman.com\/index.php\/2015\/05\/24\/a-narrative\/\" target=\"_blank\">a narrative&hellip;<\/a>] who were champions in Medicine&#8217;s navigation between the <span class=\"st\">Scylla of Managed Care and Charybdis of Industrial Conflicts of Interest &#8211; trying to preserve some semblence of a medical ethic. In my last post, I said &quot;<em><font color=\"#200020\">he has to go<\/font><\/em>&quot; but should&#8217;ve added &quot;<em><font color=\"#200020\">before the <\/font><\/em><\/span><em><font color=\"#200020\">New England Journal of Medicine goes with him<\/font><\/em>.&quot; But maybe that&#8217;s my <span class=\"st\"><span class=\"st\">na&iuml;vet\u00e9<em> <\/em><\/span>once again in failing to accept that the <\/span><span class=\"st\"><em><font color=\"#200020\">New England Journal of Medicine <\/font><\/em>may already <\/span><span class=\"st\"><span class=\"st\">be <\/span>gone&#8230;<\/span><\/div>\n","protected":false},"excerpt":{"rendered":"<p>&quot;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$. The concern ha$ [&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-64508","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/64508","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=64508"}],"version-history":[{"count":15,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/64508\/revisions"}],"predecessor-version":[{"id":64523,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/64508\/revisions\/64523"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=64508"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=64508"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=64508"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}