Thursday, February 01, 2007

Speaking Truth

A prior post regarding the Paxil/Seroxat for adolescent depression debacle focused on an academic who seemed to have acted as a huckster for GlaxoSmithKline. He could have been naïve or he could have been on the take or some combination thereof. In any case, his behavior does not reflect well on the academic research community.

However, I want to take this opportunity to publicly give praise where it is due. Dr. David Healy was also interviewed on Panorama and I will provide two quotes (according to my transcription of the episode), the nature of which few in academia have the guts to say publicly.

If you heard the experts talk, they all said the drug was extremely safe and very effctive. We were all hoodwinked, misled, duped. They use these clinical trials which appear to be evidence and they aren’t – they’re adverts.

[Later in the broadcast]

…people who are ill generally have been deeply betrayed by the whole process, deeply betrayed by the pharmaceutical companies and by all the experts that have been willing to actually lend their names to the process.

I give Healy oodles of credit for making the above statements. Making much softer statements than those above ended up costing him a lucrative academic job in the past. It is a sad state of affairs when people such as myself feel the need to write anonymously when questioning the interface between marketing, academia, and science. This makes the public statements by Healy all the more commendable.


Anonymous said...

The next logical step from Healy's accurate description:

For all of those patients who have been betrayed - directly or indirectly - or any of us who are on the "outside" should/do not really care whether this was complicity or whether many were (as I think) hoodwinked.

Accountability must be demanded from the entire system (academic - research - clinical): we don't care how you do it, you just need to not have these results. If you are a clinician and you get fooled, then I don't feel you to be gaining personally, but I would like to see the scrutiny that people like you are demanding, or else, how do we know this sort of thing won't keep happening.

That trust is fragile, and that is why (a) I truly appreciate the outrage we can from you - CL Psych and the likes of Healy, Avorn, etc., and (b) am completely frustrated and disturbed by the general lack of such a response from the mainstrean medical community.

For a profession that demands - and is mostly granted - autonomy in its decision-making, I don't really care - to a large extent - how or why bad knowledge was propagated. Obviously those directly responsible should individually be held to account, but at the institutional or professional level, these are examples of a systemic failure.

I feel that many doctors reach Healy's conclusion, shrug their shoulders, and say, "damn, those bastards fooled us, but I didn't do anything personally wrong so whatayagonnado?" Why do we not hear more outrage? Where is the outrage about Vioxx for example?

Regardless, I know Healy means well, but it is quite an indictment of the entire system - not just the pharmaco. or specific academics and clinicians involved. I feel that organized medicine (and doctors generally), love to point the finger at the insurance companies, the pharmaceutical companies, hospitals, anyone besides themselves.

Unfortunately, this causes them to ignore the obvious fact that the practicing doctors on the frontline and the honest and honorable academics researchers (such as CL Psych) have the most power and could be the most effective at remedying these problems. And they ignore this at their own peril because if they don't demand accountability then ultimately soneone has to.

CL Psych said...

More scrutiny from practitioners would indeed be a good step. I suspect that a large majority of clinicians have no idea of the degree to which the system has been corrupted.

How can anyone practice Evidence Based Medicine when the Evidence Base is full of half-reported data that is often sold like a used car in such forums as industry-sponsored consensus guidelines, continuing medical education, journal supplements, doctor dinners, and conferences which resemble Disneyland more than a scientific learning environment?

My thoughts: Med schools need to step up their ethics training. Likewise, when the vast majority of of physicians are not trained in research design or statistics during med school, they are not well trained to sniff out the BS in studies.

I believe, perhaps naively, that a class in research/stats and a class that details the numerous examples of what can go wrong when industry and science mix would really awaken med students. That would allow them to have a chance at bucking the system. Reforming the infomercial continuing medical education system would also be a nice touch.

There are surely other ways to go about this, but those are my initial thoughts.

Thanks for your kind comments toward myself -- I don't consider myself particularly "honorable" -- I'm just trying to raise awareness.

Anonymous said...

You know it is both sad - generally - but also further support of "honorable" remark:

You are right that there should be nothing especially "honorable" about doing what science is supposed to do . . . .look at the facts . . . look at the data . . . remain skeptical. Basically calling it like you see it.

However, given the current state of affairs, I would say that "honor" and "integrity" are both very valid and frankly often lacking.
Others in your field with your understanding should be able to catch these very same things, and tho' perhaps they do not have a blog, I feel there are too many who won't utter a simple, "hey! hold on . . .just one sec!" let alone a "you know this is not right!"

Why don't we go with admirable?

CL Psych said...

A lot of clinicians and researchers lack some combination of research/stats/ethics training, ethical fortitude, and/or knowledge about the current state of affairs, which leads to complicity or, worse, serving as mouthpieces for industry. For most, it's not an inherent lack of ethics, just a lack of knowledge.

Instead of admirable, I'd rather go with straight shooter. Of course, it's easier to shoot straight when one is anonymous and has fewer fears of Healy-like (or worse) repercussions on one's livelihood.