JAMA Session

There’s much to mull over in the latest issue of the Journal of the American Medical Association, which devotes a good chunk of pages to industry funding of Continuing Medical Education, following this history of industry involvement in CME last month.  In a commentary, Arnold Relman, former editor of the New England Journal of Medicine, says there is no justification for industry to be involved in educating doctors on drugs that constitute industry’s own livelihood and profit margins.

But in looking at two proposals this year that sought to limit industry involvement in physician education and their outcomes, Relman writes: “The implications are clear: neither the AMA’s House of Delegates nor the Executive Council of the AAMC is prepared to cut off industry support of CME because at this time they see no other source of funding to replace it,” though he notes “a slowly gathering consensus that it is unprofessional and unseemly for physicians, residents, and medical students in teaching hospitals to continue to accept gifts, food, and other rewards from industry.”

Dr. Carlat at Carlat Psychiatry Blog weighs in, as does Gooznews.  We were interested in this particular Goozpoint: “Given the regulatory imperative behind CME, it is perfectly legitimate for states to begin amending their CME requirements to forbid classes paid for by industry.”

In another JAMA commentary this week, David Rothman and Susan Chimonas of the Prescription Project look at the steps many academic medical centers have taken to reduce conflicts of interest among faculty and students.

And at the close of their letter to the editor, three researchers who wrote to protest the characterization of their contributions to a Vioxx study in a JAMA paper earlier this year had twenty-two printed lines of financial disclosures.  Despite claiming faulty methodology, the Vioxx researchers concede the paper was initially drafted by Merck, a central discovery in the newsmaking paper by Ross et al., “Guest authorship and ghostwriting in publications related to rofecoxib.”

Howard Brody at the Hooked blog says Whoa There — checking the original manuscript against the one they reviewed – as Ross and colleagues did — is as sound as the methodology gets, and we tip our hat to Brody for the conflict line-count.

Please Come To Boston

Carlat Psychiatry Blog led us to this story in the Boston Globe: three big biosciences firms announced they are moving to or expanding their operations in Massachusetts, making threats from the sector this summer to leave the Bay State if the gift disclosure and restrictions bill passed (it did) sound tinny.

UK hospital records show industry payments

Though we’re a bit late coming to this one, the Reader was interested to see The Guardians analysis of payments to physicians in the UK.  The paper culled the data from registries UK hospitals are required to keep – and into which physicians are expected to self-report. The breakfasts and conference travel, it all sounds familiar — all except for the industry-funded Rugby outing to Twickenham.

Still, the data collection was a less than perfect system.

“Payments to doctors are far from transparent,” the Guardian reported.  “The Department of Health requires NHS trusts to compile registers of their medical staff’s and directors’ possible conflicts of interest and to make them available to the public. Only a minority do so. The Guardian requested the registers for 90 hospital trusts under freedom of information legislation. Only around a quarter returned data that included the names of the doctors and the sponsoring companies and the amounts of money received. Some refused to give any information at all.”

Joe Collier, a member of the Medicines Commission, told the Guardian: “Declarations of interest are a key way to help break the pharmaceutical industry’s stranglehold. It is not a trivial issue. Public declarations by doctors are essential if prescribing is to be sensible and appropriate and according to patients’ needs.”

Words that, while a pond away, seem fitting testimony for something like the Physician Payments Sunshine Act, a bill currently being considered by the U.S. Congress that would require pharmaceutical and medical device companies to disclose payments to physicians, which would be listed on a public website.  We’ll watch for it as Congress returns from summer recess.

DTCds of doubt

Using the Quebecois as a control, Harvard’s Stephen Soumerai and investigators from the University of Alberta asked whether direct to consumer ads really work, and their findings may throw a wrench in the conventional wisdom. They compared sales of three drugs over five years, in both English-speaking Canada (where citizens are exposed to American drug ads by watching U.S. television) and French-speaking Quebec, where state run French TV is hardly ever interrupted by the people who bring you Lipitor.

For the arthritis and allergy medication, sales did not change when the DTC ads began; for the third, Zelnorm, sales in the ad-watching regions spiked when the ads first appeared, but returned to Quebec-like levels after a year, adding question marks to the ROI for many drug companies that try to reach their audience via TV. But some argue that looking at the effects of DTC ads in a country they weren’t designed for may not be the last word.

The article appears in the British Medical Journal.

While we’re on DTC, the Philadelphia Inquirer takes a good look at the lengths to which drug firms have gone in recent days to keep patients filling their prescriptions.  The report pays special attention to the Jaws cameo in a new GlaxoSmithKline ad warning patients from switching AIDS drugs – and more importantly, away from GSK’s Combivir and Trizivir, which are losing market share.

The ad has drawn lots of free press, fire from HIV/AIDS advocates who decry the shameless scare tactics, and counter-ads from the AIDS Healthcare Foundation.

Disclosing Time

The Psychiatric Times has announced it will begin to disclose the financial conflicts of its editorial board.  Here’s the word from Pharmalot, which reminds us that according to the International Committee of Medical Journal Editors, there shouldn’t be anything to disclose in the first place.