Let's grant that Dr. Hampshire did find a serious problem with Pro-Heart and that Wyeth responded not by addressing the facts of the matter instead challenged Dr. Hampshire because she received $160 for prescribing a competitor's products through a website that gave her a cut of the drug sales.
Once the supposed "conflict" was identified, all the alarms went off at the FDA. Senator Grassley and the media depicted this as some sort of intimidation of a whistleblower.
How is Wyeth's behavior and the hell that Dr. Hampshire went through any different than when the roles reversed on any well meaning physician or researcher who follows the data but then is undercut by the COI canard? Is it only a COI when a drug company is involved?
How about this...recently the Josiah Macy Foundation released a report demanding that industry funded CME must end and that any academic who receives industry funding should be barred from participating in CME events because of this COI stuff.
Turns out that the report, was prepared as thecarlatblog.com notes by the brightest minds in medicine "The report was the product of a conference attended by many of the brightest minds in medicine", including Catherine DeAngelis, editor-in-chief of JAMA, David Blumenthal of Mass General and head of the Soros funded Institute on Medicine as a Profession which is leading the purge of academics who deign to work with industry; Harvey Fineberg, president of the Institute of Medicine, and David Leach, recent executive director of the Accreditation Council for Graduate Medical Education. Dan Duffy a senior adviser to the ABIM Foundation is a spin-off of the American Board of Internal Medicine, which profits from compulsory certification by internists and internal medicine subspecialists. As of 2005, the ABIM Foundation had over $60 million in its reserves, and its leadership has declared â€œprofessionalism,â€ as it defines it, as its mission.It was chaired by Suzanne Fletcher, emeritus primary care professor at Harvard Medical School
The conference was held in lovely Bermuda not in downtown Baltimore.
Next month, the IOM is holding a meeting on the issue of COI in CME as part of a study funded in part by...the Josiah Macy Foundation and the ABIM Foundation.
Last year the IOM held a meeting, also paid for, in part, by Macy and ABIM. Here were some of the participants:
David Korn, VP for Research, AAMC and colleague of David A. Davis
Eric Campbell, Phd who works under David Blumenthal at the Massachusetts General Hospital -- and is also associated with the Soros funded IMAP -- where he regularly compiles based on surveys what physicians have what financial connections with industry. These surveys are also paid for by IMAP. High profile medical journals publish the data. The New England Journal of Medicine appropriately prevents him from interpreting the results, but in response to press inquiries he clearly imparts that these relationships are dangerous and was quoted comparing company gifts to physicians to baseball umpires being wined and dined by team management. The JAMA let him conclude that
â€œfinancial relationships are prevalent and therefore must be disclosed and managed.â€
Who is on the IOM Conflict of Interest Committee?
Eric Campbell for one.
Here is the sampling of the orientation of others on this supposedly objective panel:
Bernard Lo, MD, Chair. He is an ethicist from UCSF who participated in the 1990s Clinton health plan. He has not published extensively on FCOI, although he published a survey of FCOI policies in The New England Journal of Medicine in 2000 (â€œConflict of interest policies for investigators in clinical trialsâ€ volume 343, pp 1617-1620). In that publication he states:
â€œWe suggest that university-based investigators and research staff be prohibited from holding stock, stock options, or decision-making positions in a company that may reasonably appear to be affected by the results of their clinical research.â€
Robert P Kelch, MD, Executive VP, University of Michigan Health System whose last publication listed on Pub Med is entitled: â€œMaintaining the public trust in clinical research,â€ a summary in the New England Journal of Medicine in 2002 of the AAMC COI guidelines. Its conclusion states:
â€œOne cannot work simultaneously as an inventor-entrepreneur and a physician or other health care provider and maintain the trust of patients and the public.â€
And my favorite:
George Lowenstein, PhD, Professor of psychology at Carnegie Mellon University and in the vanguard of the â€œsocial science researchâ€ that concludes physicians, contrary to their beliefs, do not know when they are being manipulated by sales techniques. At the AAMC symposium on â€œThe scientific basis of influence and reciprocityâ€ Loewenstein â€œstressed the following conclusions (pp. 23-24):â€
â€œConflicts of interest will inevitably bias physician behavior, however honorable and well-intentioned specific physicians may be. Bias may distort their choices, or they may look for and unconsciously emphasize data that support their personal interests.
The only viable remedy is to eliminate COIs whenever possible â€“ e.g. eliminate gifts from pharmaceutical companies to physicians. This should include gifts of any size, because even small gifts can result in unconscious bias."
So perhaps Dr. Hampshire was likewise suffering from unconscious bias or false consciousness. Or more generally, does that transcendent property only adhere to cash from drug firms and not trips to Bermuda from the same Foundation that is underwriting both the study designed to influence the IOM study and the IOM study itself?
As I have written before, the issue of COI is largely a red herring. COI is all about the Left's discomfort with perceived corporate influence in medicine. The giveaway of course is this absurd idea that doctors don't know when a pen will corrupt them psychobabble that is the scaffolding of this purge.
The compiling of gift and speaking registries, the movement to centralize all commercial support of research and education, conduiting it through central AHC administrations instead of to individual faculty members, ban all corporate samples and gifts to physicians and prohibit company sales representatives from visiting AHC faculty are all assaults on the free exchange of information and a threat to very canons of science. This assault on the free speech of academics -- which as I will show is nothing more than a thinly veiled and funded effort by trial attorneys to make it easier to sue doctors and overturn the FDA pre-emption doctrine with respect to what is on a drug label -- will not stand.
The Academic Senate of the University of California System, recently rejected such proposals (â€œProposed Guidelines Regarding Vendor Relationsâ€), declaring them â€œvague, overbroad, addressing perceived rather than real concerns and in violation of academic freedomâ€ (reported in Nature 448: 394, 2007). So to did the University of Medicine and Dentistry of NJ.
This is just the beginning of a fight to take back medicine from the ideologues and tort lawyers.
Ambrose Bierce defined hypocrisy as "prejudice with a halo." Exactly. Time to knock that halo off.