WHO and Conflict of Interest; Chan versus Godlee

Without base, or substance, the WHO has come under fire for not having disclosed financial ties of some of its advisers regarding the influenza pandemic of last year.  It turns out the BMJ published an accusatory article, and accompanying editorial.  These accusations will persist in the blogosphere, despite very forceful and rightful fight back by Dr Chan (WHO director) and colleagues.  It seems that the BMJ editors are only is interested in self promotion of an agenda that has no basis.  If no influence is found (which will not be) then the WHO should press on with a request for a retraction, or at the very least an apology.

It is worth noting that criticisms for those who work with industry come  from people like Dr. F Godlee, who has no track record in having worked ever with industry. A quick Pub Med search reveals that most of her publications are commentaries while on editorial boards, and little in the way of original research.  One can easily conclude that her agitation and suspicion arises from a fundamental lack of understanding of the process of research involving industry.

Caught in the act! (Good Job Jenny)

Thought we should share this story ... Institutions have been concerned for a long time about the interactions of docs and drug reps.  After all they must be dangerous individuals (tongue in cheek) since so much credentialing is necessary for them to access hospitals and clinics.  TB testing, criminal background checking, drug testing and the like.  So we were surprised to find out that a Facebook friend, who works as a representative for a pharmaceutical company, posted a campaign to raise money for a someone diagnosed with cancer.  "It must be an aberration!"  (the critics would say).  The reality is that the current anti industry environment has created an environment for representatives of the pharmaceutical industry that is outright disrespectful and discriminatory.  She did not have to do what she is doing, but she did.  Keep up the good work Jenny!!

Names have been masked for privacy

Forbes Tackles the Off-Label Question

A great article just published in Forbes highlights an often neglected topic; that "off label" usage of medications can lead to good outcomes. The authors correctly state that "off label" accounts for about 20% of all prescription writing and in some cases up to 50% as in cancer and cardiology. There are many cancer diseases where there is no "on label" option. For many patients not having on label options will mean no treatment. There is description of how malpractice can result if the standard of care includes "off label" use and a patient is not treated with such drug.  Medicare allows for off label use and reimburses for that. Yet it is ironic that the off label aspect if often cited by industry critics as one of the key evil practices. So much so that the largest monetary settlements have occurred often associated with "off label" promotion. If the purist would insist that all CME communications be limited to on label that would be highly limited, destructive and infringing on First Amendment.   CME events will become robotic interactions that will defeat their own purpose. This is what we see now in the case of drug reps who have to stay on label. Their value goes down if they have limited freedom speech. Freedom must prevail.

Endocrine Today: ACRE Members Weigh-In

Hat-tip to the Policy and Medicine blog for their coverage of a recent article in Endocrine Today, "Conflict of interest’ outdated phrase for physician-industry relationship?", that features several ACRE members. Tom Stossel, Carey Kimmelstiel, Jeff Garber, Michael Weber, and Lance Stell provided commentary on a range of conflict of interest issues, from industry support for medical organizations to the inherent "framing bias" that the terminology "conflict of interest" sets up.  

It's worth reading the original HERE and the commentary over at  Policy and Medicine HERE.