Bioethicist to Wyeth: "Walk it Off, Crybaby"

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To cap off a week on this blog that featured several posts about drug industry influence on medicine or on journalism, here are excerpts of Dr. Carl Elliott’s column on the Hastings Center’s Bioethics Forum:

“…consider the indignant letter posted recently in PLoS Medicine by an attorney for Wyeth Pharmaceuticals. Apparently, Wyeth is upset about an article by Adriane Fugh-Berman titled “The Haunting of Medical Journals: How Ghostwriting Sold ‘HRT’.” Drawing on internal documents made available to her when she testified as an expert witness against Wyeth, Fugh-Berman describes how the company used ghostwritten journal articles to promote Prempro, its hormone replacement therapy.

So what is the crime Wyeth is so worked up about? That Fugh-Berman – who writes in her introduction that she got access to the documents through her work as a paid expert witness in litigation against Wyeth, and also discloses that fact in her competing interests statement – did not specifically state that she is still working as an expert witness. Yes, that’s the crime. Not the breast cancer, not the heart disease, not the strokes or emboli linked to Prempro. The crime is using the incorrect verb tense.

Wyeth, of course, is the company that became notorious in the 1990s for covering up the lethal side-effects of its diet drug, Fen-Phen, which was linked to valvular heart disease and primary pulmonary hypertension. The bill for the Fen-Phen disaster is currently $13 billion and counting. In 2009, Wyeth was acquired by Pfizer, a three-time felon which paid out $2.3 billion last year to settle criminal and civil allegations that it illegally marketed Bextra, Geodon, Zyvox and Lyrica. The Pfizer settlement was the largest health care fraud settlement in U.S. history and the largest criminal fine of any kind. And now that Wyeth is being sued yet again – this time, by 14,000 patients who developed breast cancer while taking Prempro – it has apparently decided to take a lesson from Wall Street. Not only is Wyeth upset about Fugh-Berman’s expert testimony, it is angry that PLoS Medicine joined with The New York Times to force the company to make the ghostwritten documents public.

It is worth remembering exactly what we owe to people like Fugh-Berman, and to organizations like PLoS Medicine. Most physicians are terrified of the pharmaceutical industry, and most medical journals are financially dependent on it. As a result, the extent of industry wrongdoing was largely hidden from the public for years. That began to change when expert witnesses who had testified against the pharmaceutical industry began to make their findings public.

In a just world, the complaints of Wyeth about its unfair treatment at the hands of a single academic physician would be met with the ridicule that they deserve. Instead, these complaints will probably just frighten physicians even more. And that, I suspect, may be the real purpose of the letter: to intimidate anyone who might be thinking of testifying against them.”

P.S. Do you think this topic will be discussed at the Pfizer-funded National Press Foundation journalism “training” sessions being held twice yet this year?

How about a discussion about the BMJ journal editors accusing Pfizer – as the New York Times put it – “of undermining the integrity of evidence relied on by regulators, doctors and patients.” This after an analysis in the BMJ concluded that a Pfizer antidepressant was “overall an ineffective and potentially harmful antidepressant.”

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Comments (4)

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Jan Henderson

October 15, 2010 at 11:27 pm

I like what Elliott said right before that, when he set up Wall Street for comparison with pharma:
“When one banker was asked by This American Life why Wall Street doesn’t seem more grateful for the federal bailout, he seemed offended by the very question. “I mean, survival of the fittest!” he said, explaining that his wealth has nothing to do with aid from the federal government. Why is he rich? “Because I’m smarter than the average person!” he said. “The fact that I benefited from that is because I’m smart.”
“If anyone in America ought to be saying a silent prayer of thanks for the arrogance of Wall Street bankers, it is pharmaceutical industry executives. Finally, someone has taken their place alongside tobacco and oil industry executives as the most vilified businessmen in America.”
I just finished reading Elliott’s book. The topics he covers — with the exception of the chapter on bioethicists — aren’t new, but he has a wonderful knack for getting at the essence of what’s so troubling about the issues.
When you combine Elliott’s observations with the BMJ comment you mention – that the behavior of Pfizer undermines “the integrity of evidence relied on by regulators, doctors and patients” – you’d think the medical profession would start to realize how much their image and credibility are damaged by the behavior of pharma.
Of course medicine is now a commercial business too, not the respected profession it was just a few decades ago. But financially it can’t compete with the influence of pharma. Elliott cites the statistics from Public Citizen from 2002: the combined profits of the top 10 pharmaceuticals companies in the Fortune 500 exceeded the combined profits of the other 490 companies.

Susan FItzgerald

October 19, 2010 at 2:24 pm

Why should doctors be afraid of PhRMA? It should be the other way around. But apparently not:
Here’s the paradox: PhRMA uses doctors because other doctors and people believe them, but the more they are used, the less we can believe them.
Basically, my sense is that if there’s an ad for a medication, let the buyer beware.