Bioethics Discussion Blog: Self-Interests and Disinterest in Science and the Patient’s Best Interests

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Saturday, December 30, 2006

Self-Interests and Disinterest in Science and the Patient’s Best Interests

Do you actually believe that articles written in medical journals, particularly about medications, that your doctor reads and that the science reporter on radio or TV broadcasts to the nation all are based on the facts and interpretation of the facts obtained by independent and unbiased researchers? If so, you, as patients and even we, as doctors, are sadly misinformed. Just read this article "How Great Researchers Get By-lines, Get Paid, and Get Medicine in Trouble" by Kate Jirik in the Hastings Center Bioethics Forum to get a perspective of the extent pharmaceutical companies and medical education companies are using the authority of the names of prominent and respected researchers to publish articles in prominent and respected medical journals all to promote their own goal of getting physicians to prescribe and patients to accept (and pay for) their drugs. This behavior increases the pharmaceutical company profits presumably with little regard to science, reputations, patient benefit and the social costs of medical care. And the sad part is that this behavior on the part of these companies and those researchers who are willing to get money just for their names to be attached to a “ghost written by pharmaceutical company” medical article is that it is not being substantially prevented by prompt disclosure,legal or administrative action. If physicians cannot have faith in medical research information as provided by the medical journals or other medical education resources, we will not deserve the trust of our patients who depend on us to “know and do” the right thing for them.

Go and read the article and then return and let me hear from you about this important but not well publicized aspect of medical care. ..Maurice.

5 Comments:

At Saturday, December 30, 2006 6:28:00 PM, Blogger Maurice Bernstein, M.D. said...

my life starts at forty-two, by error, posted this commentary on the wrong last thread. I presumed it belongs here. ..Maurice.


At Saturday, December 30, 2006 4:43:19 PM, my life starts at forty-two said...

Dr. Berstein;
Having spent over 12 years in the pharmaceutical industry, I find it hard to believe that you would find this hard to believe. Most of the drugs that are being promoted in the last several years are me-too drugs - not that much different from the ones all ready on the market. Of course, pharma companies need the support and physicians want the money. Hence, an industry is born...

 
At Saturday, December 30, 2006 6:54:00 PM, Blogger Maurice Bernstein, M.D. said...

my life starts at forty-two, is it your experience and do you believe that pharmaceutical companies are really so unethical to callously
disregard, as I have stated, "science, reputations, patient benefit and the social costs of medical care" just to increase their profits? ..Maurice.

 
At Monday, January 01, 2007 7:48:00 AM, Anonymous My life starts at forty two said...

I had this discussion with my husband last night Maurice. When I worked for these companies, everyone loved pharma because they were making money for them - whether it be in stocks, their 401K, or their mutual funds or they were physcicians getting paid a lot of money to speak for them. Medical coverage was also not an issue - most insurance would have a great drug benefit, so physicians could prescribe any drug and it would be paid for.
Times have changed as the baby boomers are entering into their "Medicare years", employers are feeling the pinch of the cost of insurance. Pharma is feeling the pinch to lower their profit, yet still make the drugs that will cure anything that ails.
The day of the blockbusters are gone - and each company needs to continue to squeeze out profits from a smaller and smaller pool of income. So, articles are written to "show" the benefits of these drugs so doctors will continue to prescribe them.
Is this unethical? Probably. I guess I also have a problem with the physicians who let their names be used on these articles - is the medical community wiling to hold a mirror up to themselves as well?

 
At Monday, January 01, 2007 8:48:00 PM, Blogger Maurice Bernstein, M.D. said...

My life starts at forty two, I, too am concerned about the behavior of those physicians and other researchers who allow their names to be used on such unethical journal articles. They cannot say that they didn't know what they were doing because certainly they were aware that they did not participate in the experiments and did not prepare the manuscript for which patently they are responsible. They certainly know their own motivation.. money from the pharmaceutical company and an additional paper to add to their list of publications. The latter incentive is also of ethical concern as applied to universities and other institutions who place a great deal of interest in the researchers' publication quantity in accepting them for employment or advancement. ..Maurice.

 
At Tuesday, January 30, 2007 7:08:00 AM, Anonymous NeuroscienceGuy said...

I have been involved in scientific research for the last 12 years. It think it's important to point out that, in most fields of scientific research, this kind of thing doesn't happen for the simple reason that the area of study has no immediate financial value to anyone. No company is going to pay anyone to stick his name on a ghostwritten paper involving the measured length of the upper arm bones in Homo erectus fossils.

That said, it is obviously a reality that some scientific work has the potential to bring immediate profits to industry. It's also a reality that companies will do whatever they can to make sure the science that gets reported benefits their bottom line.

Frankly, this is a betrayal of everything that science is supposed to be. Where objectivity is compromised, science is crippled.

Science has been one of the most successful enteprises that our species has ever come up with -- precisely because error correction is built into the scientific process. The scientific process is designed to -- as much as humanly possible -- facilitate "BS" detection. The process, however, doesn't work when greedy industry executives start paying researchers to stick their names on ghostwritten articles.

What can be done about it? As a scientist, I would suggest the following:

1. Some journals require financial conflict of interest statements. For example, here is the requirement for the JAMA Physicians should look for these statements. My personal opinion is that, if the article does not include a statement saying that the authors have no conflicts of interest, then the paper should go in the trash. If you can't verify that the authors were objective, then the results are worthless.

2. All research involving products that are marketable (drugs being only one example) should be funded by tax dollars through independent government sources. When the funding is coming from a source that has a strong interest in a particular outcome, this kind of thing is *GOING TO HAPPEN*. In my opinion, science should be paid for by tax dollars, not a company that has a financial axe to grind. At the risk of moving the thread in a political direction, we need to bring an end to the war in Iraq and use some of the money saved to fund research. It should go without saying that scientists should get the same pay regardless of the results that they publish.

3. Any scientist caught putting his name on a ghostwritten manuscript should be fired immediately (tenured or not), and should never work as a scientist again.

4. Perhaps even better, participating in this ghostwriting process (as described in the original article) should be a felony criminal offense. If a few pharmaceutical company executives end up serving 10 year sentences, I bet this practice will decrease rather quickly. Why should this NOT be a felony? This amounts to using deception to willingly and knowingly endanger the health of thousands (or millions) of people. If that's not a moral justification for making something a felony offense, I don't know what is.

The answer, I think, is to come down hard on the people that do things like this. And THAT will require public pressure from scientists and physicians.

 

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