There are many stories journalists could report about conflicts of interest and questions about evidence in the treatment of low back pain, perhaps especially with spinal fusion. We talked about many of these with journalists from the American Society of News Editors in a workshop at the Foundation for Informed Medical Decision Making in Boston in May.

John Fauber of the Milwaukee Journal-Sentinel hammers one of these issues, looking at how Medtronic's Infuse product "went from revolutionary advance to public health alert."

Here's his story on MedPageToday.com.

His entire "Side Effects: Money, Medicine and Patients" series is indexed on the Milwaukee Journal-Sentinel website.

The image below is from the Journal-Sentinel's online story.

On MinnPost.com, Susan Perry previews a piece in next month's Mother Jones magazine by Dr. Carl Elliott of the University of Minnesota about the suicide of a young man who was enrolled at the time in a University of Minnesota industry-funded clinical trial of the antipsychotic drug Seroquel (quetiapine). Perry writes:

"It's a disturbing tale (the unsuccessful efforts of (patient Dan) Markingson's mother to get her son released from the trial and into other treatment are particularly heartbreaking) and one that, as Elliott acknowledges, was first told in the Pioneer Press by Jeremy Olson and Paul Tosto.

But Elliott's purpose in writing the article wasn't only to revisit the tragic details of Markingson's story. "[T]he more I examined the medical and court records, the more I became convinced that the problem was worse than the Pioneer Press had reported," he writes. "The danger lies not just in the particular circumstances that led to Dan's death, but in a system of clinical research that has been thoroughly co-opted by market forces, so that many studies have become little more than covert instruments for promoting drugs. The study in which Dan died starkly illustrates the hazards of market-driven research and the inadequacy of our current oversight system to detect them."

The story is a sorry chapter in a checkered history of U of Minnesota medical school research ethics practices.

Perry advises that "The Mother Jones article reaches subscribers' mailboxes today. Everybody else will have to wait until it hits the newsstands on Aug. 31."

On the Croakey blog, Melissa Sweet writes about some burning conflict of interest questions in her corner of the world. Excerpt:

"...it would be useful to have a central online registry where journalists and others could easily search to see the commercial ties and COI policies of health and medical experts. This might also be useful for patients, especially when making major health care decisions. I was heartened to hear one psychiatrist in the audience is considering how best to declare such information to patients.

Meanwhile, I also showed this image of a flier distributed at the Dietitians Association of Australia conference in Darwin last year."

While we're on the Mac attack, a PR company (which I've asked to stop sending me stuff), compared its clients' claims in a head-to-head with McD.

I'm not taking sides. I really don't care. Let 'em fight it out in the gutter.

And to the PR company, I ask again that you stop sending me your fluffy news releases.

Journalist Larry Husten, on his CardioBrief blog, describes a "new one on me" in linking to what he calls "an extraordinary document" describing cozy - indeed, invited and paid-for meeting opportunities between medical industry leaders and physicians at a heart valve conference.

Of a long laundry list, one item got special notice from Husten:

"And for $6000 sponsors get to participate in "Meeting of the Minds":

Choose four faculty members for a private one-on-one meeting. Secure your faculty choice early as faculty will be removed from selection list once chosen.

I think the organizers may have missed a big opportunity here. Why only $6000 for 4 faculty? I'm surprised they didn't think of an auction. I'll bet there are some faculty members who could fetch way more than $1500..."

(Photo credit: from Tracy O on flickr)

See the LA Times' Booster Shots piece that lets readers know about who's behind a survey touting the benefits of chocolate in a healthy diet. And the piece also addresses some concerns about chocolate industry corporate sponsorship of the American Dietetic Association. Excerpt:

"The Hershey Center stepped up its commitment to your health this week by becoming a corporate sponsor of the American Dietetic Assn., the professional group for nutritionists and dieticians. (The organization can be found online at EatRight.org. In doing so, Hershey joined an esteemed list of health food purveyors, including the Coca-Cola Co., PepsiCo and Mars Inc. (Yes, the soda companies also sell juice and water, and Mars makes Uncle Ben's rice, but that doesn't make them health food companies.)

The folks at Fooducate are understandably appalled (if not surprised) that the ADA would let itself be influenced by big bucks from candy and soda makers. "Instead of a very simple message - 'less candy' - we'll hear 'moderation,' 'balance,' 'chocolate is healthy' and other messages that help nudge consumers to buy more snacks instead of less," according to a post on the Fooducate blog.

The Sustainable Food blog got to the heart of the issue: "If the world's largest group of nutrition professionals is in bed with junk food giants like Pepsi and Mars, how can consumers believe any of the organization's dietary advice?" Instead, the blog suggested that "folks can get better dietary direction from a fortune cookie." "

Universities are obviously struggling with the whole conflict of interest concept. Duff Wilson of the New York Times, who reported recently that the University of Michigan medical school was abandoning industry support for continuing medical education, now reports that the University's president "sits on the board of directors for the pharmaceutical giant Johnson & Johnson. Last year, the company paid her $229,978, roughly half in stock and half in cash, for attending a limited number of meetings, corporate filings show."

One learned observer told the Times: "It strikes me that Michigan may need to spend some time working through this on their own."

"Why Big Pharma should buy your doctor lunch sometimes" is the headline of an article on Slate.com that has upset many readers. I'm not terribly upset about it because it just seems too naive and misinformed to get upset about. The final line of the piece tells you all you need to know about the tone of the column:

"Ousting commercial support is creating a huge chasm in medical education, leaving doctors not only hungry but also starved for knowledge."

Some of the online comments posted in reaction to the piece:

• "This columnist is dangerously misinformed."
• "misleading"
• "this article really dropped the ball on any sort of reasonable defense."
• "Whoever wrote this must be a paid shill for the drug companies."
• "I wonder how many pharma paid lunches the author has had?"
• "This post has a naivete to it that is almost breathtaking."
• 'The manufacturer of Remicade has a huge financial incentive to advocate long-term use of Remicade, yet the author of this article doesn't see the inherent conflict of interest."
• (Physician:) "My experience has been that aside from providing info on new meds, what many salesmen (and a high percentage of stunningly attractive saleswomen) do is trash the competition's drug in an effort to get you to write for their own product. A lot of "new" meds being pushed are not really new but merely re-formulations or new combinations of old drugs designed to extend a soon-to-expire patent."
• "This article is both one-sided and under-researched."
• "I'm a bit disappointed about the one-sidedness of this article. First, I have to admit my biases. I am a physician who used to work in an academic medical center. While I was there, I wrote the policy banning pharmaceutical reps from bringing food and gifts to the medical residents, as well as tightening financial disclosure requirements for the faculty."

Blogger Larry Husten asks, "Why was an Abbott marketing study published in the American Journal of Cardiology?"

It's a great example of some of the fine journalism done by some blogging health journalists.

To a medical historian, especially one who tracks the pharmaceutical industry as Jeremy Greene of Harvard does, last week's Georgetown conference, "Prescription for Conflict: Should Industry Fund Continuing Medical Education (CME)" must have seemed like a flashback.

In his conference talk, Greene gave some of the history of concerns over such industry influence. He's also published on the topic. In this article, for example, he cited Pediatrics journal editor Charles D. May, who warned in 1961:

A vicious cycle is created by a mad scramble for a share of the market: the doctor is made to feel he needs more "education" because of the prolific outpouring of strange brands but not really new drugs, produced for profit rather than to fill an essential purpose; and then the promoter offers to rescue him from confusion by a corresponding brand of "education."

And, while, Senator Chuck Grassley gets a lot of headlines today for his Senate Finance committee investigations into drug company influence on doctors and CME, we may forget the history of past Senate hearings on these issues.

From 1959-1962 Senator Estes Kefauver led historic hearings.

Then, as Greene writes, when there were implications of a firewall between the business and editorial functions of CME:

"...ample evidence of the porousness of these firewalls existed as early as 1976, sufficient to prompt a series of hearings into the subject led by Sen Gaylord Nelson (D, Wisconsin).
...
Despite such hearings, the influence of medical education and communication companies continued to increase throughout the 1970s and 1980s. By the early 1990s, the subject emerged again in another set of hearings--now chaired by Sen Edward Kennedy (D, Massachusetts)--provoked by increasing reports of extravagant marketing practices by the pharmaceutical industry."

He who ignores the past is doomed to repeat it.

In an interview, Greene said the '70s became a turning point.

In that clip, he used the term MEC - which stands for Medical Education Collaborative - which is an organization that provides continuing medical education.

Correction: Dr. Greene advises that it's actually MECC - for "Medical Education and Communication Company."

Consider these statistics:

There are more nurse practitioners (147,000) than there are family physicians (100,000) in the US.

These advance practice nurse professionals can write prescriptions, and it's estimated that the average nurse practitioner writes more than 6,000 a year.

And about 70-80% of those nurses who regularly attended lunch or dinner "continuing education" events sponsored by drug companies said they were more likely to prescribe the drugs that were highlighted in the lunch.

All of these statistics were presented at last week's Georgetown conference, "Prescription for Conflict: Should Industry Fund Continuing Medical Education?"

The presenter was nurse-researcher Elissa Ladd, PhD, RN, Asst. Clinical Professor, Massachusetts General Hospital Institute of Health Professions, who says the possible pharma influence on nurse-prescribers has largely flown "under the radar."

The New York Times had an important story that "highlights what experts say is a troubling situation for patients and doctors: when disputes arise about orthopedic implant safety, there are no independent referees or sources of information because no one tracks the performance of the devices. ...Those with the most to lose are the hundreds of thousands of people who receive an orthopedic device each year."

The Wall Street Journal Health Blog wrote that "The FDA is proposing new rules on consumer prescription drug ads aimed at making the information about side effects more understandable. (Off the top of our heads, we'd just suggest they slooooooowwww down when discussing all the rare, but often-horrific sounding side effects of a given medication.)... The comment period ends Monday (June 28)."

Blogger Brian Reid offered one more important followup about news coverage of the big American Society of Clinical Oncology meeting earlier this month. In so doing, he referenced George Carlin's 7 words, as I've been known to do. Excerpt:

"But during the meeting, the national media -- the New York Times, the Wall Street Journal, USA Today, the broadcast networks and the Associated Press -- wrote on only seven studies, a tiny snippet of what was presented. These seven stories, in turn, were pulled from the small number of studies promoted by the ASCO communications department with press briefings."

And, if you missed it, the New York Times reported that the University of Michigan did what its Big 10 counterpart Minnesota couldn't:

"In the latest effort to break up the often cozy relationship between doctors and the medical industry, the University of Michigan Medical School has become the first to decide that it will no longer take any money from drug and device makers to pay for coursework doctors need to renew their medical licenses."

A committee (on which I served) recommended to the Minnesota med school that it eliminate corporate funding of CME within 5 years, but that recommendation was rejected by the administration. Score one big one for the Wolverines over the gutless Gophers on this one.

You can follow the tweets at http://twitter.com/garyschwitzer

Important issues for not only medicine, but for journalism and for consumer understanding.

Georgetown's PharmedOut.org project, along with the Kennedy Institute of Ethics and the Georgetown University Law Center are hosting an academic conference, "Prescription for Conflict: Should Industry Fund CME?" tomorrow (Friday June 25, 2010). Speakers include Joshua Sharfstein, MD, Principal Deputy Commissioner, FDA, Thomas Insel, MD, Director, National Institute of Mental Health, Daniel Carlat, MD, Carl Elliott, MD, Joel Lexchin, MD, Edmund Pellegrino, MD, and Paul Thacker, Senior Investigator, Office of Senator Chuck Grassley .

Maybe I'll see some of you there.

Conference materials are on the conference website.

An investigation by the BMJ and the Bureau of Investigative Journalism concludes that key scientists advising the World Health Organization on how to prepare for a flu pandemic had done paid work for drug companies that could benefit from these recommendations.

The report is summarized in the BMJ but a subscription is required.

In an accompanying editorial, BMJ editor Fiona Godlee writes that WHO's credibility has been badly damaged.

Excerpts of a BMJ news release:

WHO's advice led to governments around the world stockpiling billions of dollars of antiviral drugs as part of global pandemic preparedness plans. Yet these conflicts of interest have not been publicly disclosed by the WHO. Despite repeated requests, the WHO has failed to provide any details about whether such conflicts were declared by the relevant experts and what, if anything, was done about them.

This report echoes a highly critical inquiry by the Council of Europe, whose findings will also be published today (4 June), and will fuel suspicions that the drug industry was able to exert undue influence on the WHO's decisions about the swine flu pandemic and the mass stockpiling of drugs.

The investigation finds that the WHO's 2004 guidance on the use of antivirals in a pandemic was prepared by an influenza expert who had received payment from Roche, manufacturers of oseltamivir (Tamiflu), and GSK, manufacturers of zanamivir (Relenza), for lecturing and consultancy work. The guidance concluded that ... "countries should consider developing plans for ensuring the availability of antivirals" and that they "will need to stockpile in advance, given that current supplies are very limited."

In addition, the investigation found two other scientists who prepared annexes to the WHO 2004 pandemic guidelines had recent financial links to Roche.

According to Deborah Cohen of the BMJ and Philip Carter of The Bureau of Investigative Journalism, the WHO did not publicly disclose any of these conflicts of interest when it published the 2004 guidance. It is not clear whether these conflicts were notified privately by WHO to governments around the world, many of which followed its advice.

The WHO deny any industry influence on the scientific advice it received. It also says it takes conflicts of interests seriously and has the mechanisms in place to deal with them. But the BMJ and the Bureau suggest that WHO seems not to have followed its own rules for the decision making around the pandemic.

And, despite repeated requests, the WHO has refused to provide any information about the conflict of interest declarations made to it, leaving the investigation to wonder "whether major public health organisations are able to manage the conflicts of interest that are inherent in medical science effectively."

Dr. Adriane Fugh-Berman of Georgetown is hosting the conference, "Prescription for Conflict: Should Industry Fund Continuing Medical Education?" While the primary audience is physicians, nurses, and other health care providers, she says the session will be of interest to diverse groups, including educators, regulators, policymakers, ethicists, consumer activists, and students.

See the conference agenda.

Register here.

Before we close out colon cancer awareness month, I want to draw attention to another important paper in the journal Gastroenterology, "Understanding differences in the guidelines for colorectal cancer screening," by Thomas Imperiale and David Ransohoff. (subscription required, published online March 16 ahead of print).

The authors start with the broad message that guideline-setting in general is of such concern that the Institute of Medicine has formed a committee "to develop standards (that) ensure that clinical practice guidelines are unbiased, scientifically valid and trustworthy." They remind readers that:

"The problem of varying quality is highlighted by the fact that there are nearly 300 guidelines-making organizations that have created over 2300 guidelines in a process described as "essentially unregulated."

But their focus was on colorectal cancer screening guidelines, and specifically different updates issued by two major guidelines organizations in 2008:

• The "multi-society" guidelines issued jointly by subspecialists in cancer prevention, gastroenterology and radiology.

• The US Preventive Services Task Force.

The authors focus on the first group's "preference for tests that image the colon" - especially colonoscopy.

The authors say that the USPSTF, on the other hand, "considered several strategies to be similar in terms of years of life saved and reduction in colorectal-specific mortality," including colonoscopy and less expensive blood stool tests. The USPSTF stated no preference among methods. But the USPSTF did not share the multi-society group's endorsement of newer virtual colonoscopy and fecal DNA testing.

These are significant differences, according to the authors:

"The current differences in CRC screening guidelines raise practical questions not only about what doctors and patients should do in the face of disagreement, but also about the larger process by which guidelines are made and how "trustworthy" they may be.
...
Further, the potential for conflict of interest is real when subspecialists support or recommend procedures from which they derive income is real; that conflict should be acknowledged and managed rigorously. Conflict may be not only financial; it may also be intellectual, when professional enthusiasm causes one to favor what one has learned to do and knows best."

I encourage journalists to find and read the full Imperiale/Ransohoff paper.

Gastroenterology. 2010 Mar 16. [Epub ahead of print] Understanding differences in the guidelines for colorectal cancer screening.

Imperiale TF, Ransohoff DF.

Division of Gastroenterology and Hepatology, Department of Medicine,
Indiana University School of Medicine, Indianapolis, IN; Regenstrief
Institute, Inc., Indianapolis, IN.

PMID: 20302867 [PubMed - as supplied by publisher]

And I encourage them to be aware of the Institute of Medicine's review of guideline setting. Many "awareness month" campaigns are far too simplistic and incomplete and may, indeed, mislead consumers in the certainty they seem to convey. This is far from a certain field at this point in time.

Here are some recent posts raising important questions about what we know and don't know about colon cancer screening:

http://www.healthnewsreview.org/blog/2010/03/kaiser-takes-blood-stool-test-kit-campaign-to-youtube.html

http://www.healthnewsreview.org/blog/2010/03/colon-cancer-awareness-month-often-means-claims-but-no-evidence.html

http://www.healthnewsreview.org/blog/2010/03/memo-to-harry-smith-cbs-news-re-colonoscopy-crusading.html

http://www.healthnewsreview.org/blog/2010/03/journal-editor-troubled-by-obamas-ct-scan-for-coronary-calcium-virtual-colonoscopy.html

http://www.healthnewsreview.org/blog/2010/02/the-overselling-and-overpromising-of-colonoscopies.html

http://www.healthnewsreview.org/blog/2010/02/what-reporters-missed-at-the-nih-colon-ca-screening-state-of-the-science-conference.html

The Journal of the American Medical Association this week published a commentary, "Psychiatrists' Relationships With Pharmaceutical Companies: Part of the Problem or Part of the Solution?" by the chief of the National Institute of Mental Health.

On his blog, psychiatrist Daniel Carlat praises the "power (and courage) of the country's chief psychiatrist calling his own profession out on the carpet for bad behavior."

But on the Health Care Renewal blog, Dr. Bernard Carroll, past chair of the Duke psychiatry department, writes:

"With ludicrous optimism and a series of straw man discussions, Dr. Insel (NIMH chief) makes the case that things are not really as bad as they seemed to be or, if they were, then other specialty physicians were doing much the same things. Dr. Insel needs to recalibrate his ethical compass.

Why is an NIH Institute Director issuing this apologia for the corruption of academic psychiatry? Does he not have better things to do, such as ensuring that longstanding NIH regulations on conflict of interest are enforced?"

Read the entire blog posts cited above to get a fuller flavor of the dispute.

As Reuters reports, "virtually all of the experts who wrote favorably about GlaxoSmithKline Plc's troubled diabetes drug Avandia (rosiglitazone) had financial ties to drug makers, a finding that shows the need for reform of such relationships, U.S. researchers said on Thursday."

The study appears in the BMJ.

Mayo's Dr. Victor Montori told Reuters:

"It was almost three to four times more likely that somebody who had a relationship with a pharmaceutical company had a favorable opinion about the medication. If you were to look at the proportion of people with favorable opinions, 94 percent of them had a relationship with a pharmaceutical company. If you were to look at the folks with an unfavorable opinion, 28 percent had a relationship with a pharmaceutical company."

Because the team found that a quarter of the scientific papers about Avandia did not disclose that the authors had financial relationships with the drug company, they wrote that the findings "underscore the need for further changes in disclosure procedures in order for the scientific record to be trusted."

Cleveland Clinic cardiologist Steve Nissen knows how to choose his moments, and so, chose the American College of Cardiology convention in Atlanta to criticize that group for allowing ties with industry to influence its policies and education programs for doctors.

The AP reports:

"The flap caused a stir at the conference and riled doctors and industry members alike. Dr. Robert Harrington, head of heart research at Duke University, who also spoke at the session, said scientists and professional societies need to do more to have "firewalls" to protect their work from corporate influence. However, most research in the United States is paid for by industry, and fair and ethical partnerships are needed to develop treatments, he said. "While it's easy to say all of this should be funded by the NIH, that's not the reality," Harrington said."

MedPageToday.com posted Twitter entries during the talk. Two comments attributed to Nissen:

• designed talk to try to offend everybody in the room

• patients don't trust physicians anymore believe we are bought and paid for

Milwaukee Journal Sentinel health and science reporter John Fauber reports that, "as universities tighten ethics policies, drug firms turn to private physicians to promote products." He profiles one doctor who received $45,000 from GlaxoSmithKline during a three-month period for which records were released - up to $3,000 a talk for 15 talks in the three-month period, according to the drug company.

MedPageToday.com published another version of Fauber's story, in the start of a new partnership between the online site and the Milwaukee paper. MPT says this will be the first of at least 10 this year in the partnership - to produce what they call "dig-deeper pieces -- in-depth reports on topics that stretch beyond daily news to look at trends and critical issues." The piece includes an almost 9-minute video interview Fauber conducted with Dr. George Lundberg, former editor of the Journal of the American Medical Association, who recently joined MedPageToday as editor-at-large.

Syracuse reporter James Mulder cracked this story.

As with the Chicago Tribune story cited earlier today, this story ends with a powerhouse quote from one observer:

"You may not think you are being biased, but if you make 10 minor decisions in a row that are all slightly biased, all those little biases add up in the end. It's an unhealthy situation."

Hat tip to Pia Christensen for the tip on this.

Here's another problem with the practice of TV networks using physician "contributors" to comment on health care news. They may have a clear conflict of interest that is not addressed.

When the American Cancer Society released its updated guidelines on prostate cancer screening today, Fox News reported:

"Dr. David Samadi, a Fox News contributor and chief of Robotics and Minimally Invasive Surgery at Mount Sinai School of Medicine in New York City, said he thinks the new guidelines could cause unnecessary deaths.

"In my practice, we find men in their 30s and 40s that are at high-risk and develop prostate cancer," Samadi said.

"Knowing your PSA is power, it is educational; you follow it all the time. You can find a silent prostate cancer that will not affect you, and there is a possibility to over-diagnose, but that's a risk the patient needs to take. You could also find cancer that could lead to death."

The number of prostate cancer deaths continues to decline because of regular screening, Samadi added.

"I really recommend (the age) of 40 as a baseline age," Samadi said."

Doesn't Fox see that he has a blatant conflict of interest on this topic as one who runs a robotic surgery center? There are countless ways to counter these short quotes from Dr. Samadi, but I'm not going to run through them here. Read the Cancer Society report and you'll find all of them there - in dispassionate, non-conflicted, evidence-based depth.

Look at how Katie Hobson of US News & World Report included an expert urologist's input, and one with a much more open-minded and balanced perspective.

"... the gist of all this is a firm end to the notion, still held by some clinicians, that screening for prostate cancer is "the same as colorectal cancer screening or cholesterol screening," says Durado Brooks, director of prostate and colorectal cancers for the ACS and coauthor of the report.

"There has to be a conversation," says John Davis, assistant professor in the department of urology at the M. D. Anderson Cancer Center in Houston. "And these guidelines give some very nice bulleted points and Web links you could build into an information sheet and give to patients."

Blogger Alison Bass jumps on a Journal of Bioethical Inquiry article that says that "while evidence-based medicine is a noble ideal, marketing-based medicine is the current reality."

Bass consistently tracks medicine's conflict of interest issues. Her blog would be a good bookmark for you if you care about these issues. And her book, "Side Effects: A Prosecutor, a Whistleblower, and A Bestselling Antidepressant on Trial," is terrific.

I've told my students that covering health care conflicts of interest could be a fulltime beat - and you still wouldn't keep up.

The NY Times today reports:

In the first half of this year, the drug giant Eli Lilly paid 3,971 doctors and other medical professionals an average of about $11,230 each. The payments were for participating in an average of 12 speaking or consulting engagements during those six months, according to a company spokeswoman.

Dr. Manoj V. Waikar, for example, a physician among the top five earners this year, received $74,850 for consulting and speaking at 51 events, according to Lilly's on-line faculty registry. The company caps payments at $75,000 for each health care provider in any calendar year.

He's an adjunct instructor at Stanford. Stanford's ban on regular faculty members participating in drug company speakers' bureaus doesn't apply to adjuncts - as long as they're not using the Stanford name.

As blogger Merrill Goozner writes:

Waikar gave 51 talks last year to earn that $75,000. That's one a week, week after week, all year at $1,500 a pop. Think about it. Same slides, same talk. Just show up for two hours and the check is in the mail. Do that for three companies and you're earning over $200,000 annually. And you were wondering how the man earns a living on an adjunct faculty's salary.

Meantime, it doesn't take the NY Times to dig into conflict of interest issues. A student journalist with the Minnesota Daily points out how medical students receive free textbooks from drug companies promoting their products. Case in point: an otolaryngology text given out by a company making an ear infection drug - with the company's logo on it, and with the beginning of each chapter crediting the drug company.

The student journalist also pointed out that the University of Minnesota has no policy to ban such practices.

It's good that this student journalist starts looking at conflict of interest issues now. If she stays on this beat, she's going to be busy on COI stories for a long time.

Start lining up the awards for the series on conflict of interest published by the Milwaukee Journal-Sentinel this year.

Excerpts of the latest:

"As fears were growing about the link between hormone therapy and breast cancer, a drug company paid the University of Wisconsin to sponsor ghostwritten medical education articles that downplayed the risks, records obtained by the Journal Sentinel show.

The five articles were funded by Wyeth, the company that made the top-selling hormone therapy products. The articles, published in 2001, appeared under the names of doctors who specialized in diseases common to menopausal women, but actually were written by professional writers paid by the company.

The articles came shortly before a long-term $1.5 million arrangement between Wyeth and UW to educate doctors and patients around the country about hormone therapy. The initiative promoted the benefits and softened the risks of drugs that produced sales of more than $1 billion a year."

The article also showed two faces of health care on this issue. Excerpt:

"The company's ultimate goal is to sell more drugs, said Steven Miles, a physician and professor at the Center for Bioethics at the University of Minnesota Medical School.

"These ghostwritten articles are advertising masquerading as scientific reviews," he said. "It's dishonest."

One of the listed authors, Leon Speroff, then a professor of obstetrics and gynecology at Oregon Health Sciences University...said the practice of ghostwriting remains commonplace, and he defended it.

"There is nothing dishonest about it," he said.

He laughed at the idea that someone might be offended by the lack of transparency.

"If you don't like the way it works, that's your business," Speroff said."

In another in a continuing series of stories about doctors, drug companies and conflicts of interest, John Fauber of the Milwaukee Journal-Sentinel writes about the disease-mongering promotion of low testosterone or "Low T." Excerpts:

"A rash of television commercials in recent months have told millions of middle-age men that their diminished sex life and somber mood may be the result of low levels of testosterone.

Setting the stage for the ads was a series of medical journal articles that first appeared four years ago. The articles, which were sponsored by the University of Wisconsin School of Medicine and Public Health, read more like promotions than rigorous research, touting the benefits of testosterone and downplaying the risks.

While the TV commercials were intended for consumers, the medical articles were written for thousands of doctors who could earn continuing medical education credit by reading them. Presumably, they also would write more testosterone prescriptions.

Both the ads and the articles were paid for by Solvay Pharmaceuticals, the company that dominates the testosterone therapy field and which allegedly conspired to pay off generic drug makers to keep their testosterone products off the market.

The campaign seems to have paid off.

Over the last few years, prescriptions for testosterone, especially Solvay's AndroGel, have boomed despite concerns that it may increase the risk of prostate cancer and cardiovascular disease. Aside from the potential health risks, there is a lack of science that the expensive drugs provide real benefit for middle-age and older men whose testosterone levels are declining as a result of normal aging. ...

UW was an active participant in the testosterone surge. Solvay paid about $1 million to fund UW-sponsored doctor education in 2005, 2006 and 2007 such as dinner meetings around the country and newsletters designed to reach more than 50,000 physicians. UW directly received about $115,000 of that amount."

Read the full article.

Here's how Solvay bought space on WebMD to promote AndroGel in an ad that is meant to look like normal editorial content.

The Politico.com story about the Washington Post "pay for access" proposal isn't astonishing to Merrill Goozner, who writes:

It's a long standing practice by one of the few sections of the news business that remains profitable -- the newsletter and trade journal business. There's also a vibrant conference sponsorship industry that sells exclusive access to top government officials.

For instance, a Texas-based outfit called Pharma Education Concepts, Ltd. is running one of its trademarked "Pharma Conferences" in Cambridge, Maryland in late-August. Dubbed "GMP By The Sea," the meeting brings top drug industry executives together with Food and Drug Administration officials to hear the latest thinking on globalization and the regulation of drug and biologic manufacturing processes. Featured speaker this year is Murray Lumpkin, deputy FDA commissioner for international and special programs. Pricetag: $1,495 a ticket.

In mid-June, a scrappy industry newsletter called FDAWebview filed a citizens petition with the FDA demanding journalistic access to this and any private meetings where FDA officials appear. Its editor couldn't afford the $1,495 needed to send a reporter to cover the GMP By The Sea meeting where Lumpkin, a public official, might say something newsworthy.

The real issue is what will be the ground rules for these Post-sponsored conferences. The public has the right to know what gets said in these meetings with its elected representatives and civil servants. I stand with FDAWebview. Any session where a top government official appears should be open to the news media, right on down to the lowliest blogger.

As always, thanks for the perspective, Gooz.

Paul Scott writes about the documentary, "Depression: Out of the Shadows," which won a Peabody Award.

He criticizes that "its broad survey of the science of the illness included frequent appearances by Charles Nemeroff, M.D., a leading--some say powerful--mood disorders researcher from Emory University. Last fall, Nemeroff also became one of the most prominent psychiatrists to be rebuked for failing to disclose funds earned from the drug industry." ...

The heart of his critique, though, is this:

"That PBS producers either did not know about Nemeroff's drug industry entanglements or did not believe they tainted his discussion of the science of depression is disappointing. Indeed, the science of the illness and antidepressant medications is far less uniformly agreed upon than is depicted in the documentary. Disputes are ongoing over the efficacy, mechanism of action, and "targeted" nature of antidepressants--blockbuster drugs that remain the recipient of favorable press coverage even while now going off patent.

But what made the praise bestowed on this PBS documentary particularly troubling were the erroneous, drug-industry serving statements made by Nemeroff within the film--statements which had the potential to negatively affect public health, and which the documentary left unchallenged."

Read the entire piece.

I have written to the National Press Foundation stating my concern with the fact that they have accepted funding from the drug company Pfizer to offer journalism fellowships on cancer issues.

I read about this in an e-newsletter sent by the Society of Professional Journalists. The SPJ newsletter wrote that "Fifteen fellowships will be awarded and they all include lodging, airfare and most meals."

This is the notice as it appeared in the SPJ newsletter:

I wrote to the SPJ president about my concerns, stating that "I don't think SPJ should be encouraging journalists to take these pharma-funded all-expenses-paid trips by promoting them in the newsletter."

All I got was a "Thanks for your note" response.

As an SPJ member, and as the keynote speaker at a recent SPJ ethics week event, I expected more. As a thank you gesture for my participation in that SPJ event, the national president gave me a plaque with the SPJ code of ethics on it. I remind SPJ that its own code of ethics includes these clauses:

Journalists should:

• Avoid conflicts of interest, real or perceived.



• Remain free of associations and activities that may compromise integrity or damage credibility.



• Refuse gifts, favors, fees, free travel and special treatment, and shun secondary employment, political involvement, public office and service in community organizations if they compromise journalistic integrity.

If taking free airfare, lodging and meals from a drug company whose work you cover isn't at least a perceived conflict of interest, I don't know what it is. And I don't think SPJ should promote events in its own newsletter that, in my reading, invites journalists to violate the SPJ code.

More on SPJ in a moment.

I also wrote to the National Press Foundation and had a long e-mail exchange with its president. In a nutshell, he defended their acceptance of the drug company money - just as he did when Merrill Goozner wrote about his concerns with NPF's handling of another drug company-sponsored journalism event last fall. (See "Jeer to the National Press Foundation")

Now back to SPJ.

At its national conference in Indianapolis this August, SPJ will offer a tour of the Eli Lilly drug company corporate headquarters and "a professional development session on the reporting of mental health issues." SPJ invites journalists on its website, with: "you can participate in a networking reception with Lilly leaders to learn more about Lilly's history--and future--from the very individuals who are working to shape it."

Lilly makes:

• Cymbalta for depression and "generalized anxiety disorder"


• Prozac


• and Zyprexa for schizophrenia and bipolar disorder

Why don't journalists see any problem with these arrangements? Actually journalists did see problems with such activities - at one time. The ones who wrote the SPJ code of ethics. Something about "Refuse gifts, favors, fees, free travel and special treatment....avoid conflicts real or perceived...etc."

In their article, "Who's Watching the Watchdogs?" in the BMJ on November 19, 2008, Schwartz, Woloshin and Moynihan wrote:

"As watchdogs the media play a vital role in highlighting interconnections between doctors, researchers, and the drug industry. But who watches the watchdogs? Financial ties between medical journalists and for-profit companies they cover in their reporting have received little attention in the media or from the research community. Such ties warrant scrutiny, not least because many of us first learn about new treatments from the news media, and these reports can affect the way the public uses health care."

The authors conclude:

"Training and further education of medical journalists should not be funded by the healthcare industries that the journalists cover."

We urge the National Press Foundation and the Society of Professional Journalists to re-evaluate their policies.

Merrill Goozner, who headed the Integrity in Science Watch project at the Center for Science in the Public Interest for the past five years, has been axed by CSPI.

The good news is that he'll now have more time to devote to his terrific blog, GoozNews.com, for which, in the past, he had to cobble together an hour or two in the morning or an hour or two in the evening - or more - to fuel the blog. Or maybe he'll come up with a new initiative worth watching. He won't sit still - although he says a few rounds of golf will come first.

Gooz helped put health care conflict of interest on the public radar screen during his five years at CSPI. He has an eye and an intellect to hone in on troublesome tidbits that others may miss. We can't lose his regular contribution to journalism in whatever form that takes.

We wish him the best.