Wednesday, May 14, 2008

Striking a Nerve: The Unbranded Expert Campaign

Some unanticipated consequences of an effort by two journalists to share the names of medical experts who have no financial ties to industry illustrates a few fascinating features of the present state of Pharma affairs.

This whole thing started when Jeanne Lenzer and Shannon Brownlee (full disclosure--as a result of sharing info on a number of stories and projects regarding the drug industry, I have become friends with both of them) asked all of us in their Rolodex whether we would be willing to have our names listed as "experts" (in whatever field) who had certified that we had received no industry support or payments or other bribes in the past 5 years. They had gotten tired of the industry claim that all the really good docs in the US, who actually know what they are talking about, are paid Pharma consultants. What eventually happened with this list is described in an article the two journalists wrote for Slate: http://www.slate.com/id/2190775/.

At this point two odd things happened that Lenzer and Brownlee say they had not anticipated.

First, the media when crazy over their list. You would have thought that the media were all chocaholics and discovered that Lenzer and Brownlee had the last Hersey bar on the face of the earth. Everyone and his duck wanted a copy.

Among those who wanted copies were a number of sources very close to industry. Lenzer and Brownlee have, at least for now, restricted the list to their fellow journalists, in part because that was all those of us on the list signed on for. But now industry folks are demanding to see the list and making threats, veiled or otherwise, of subjecting all the people on it to independent scrutiny to see whether we are what we claim to be. One accusation has been that we are all a bunch of whores for plaintiff's attorneys who help concoct baseless lawsuits against the noble and blameless drug companies, and that conflict of financial interest has not been disclosed. The result has been some ad hominem attacks against Lenzer and Brownlee on industry-friendly blogs (such as http://www.pointoflaw.com/archives/2008/05/the-shannon-brownlee-and-jeann.php and http://drugwonks.com/ on which you have to scroll down some to find the relevant entry). Lenzer and Brownlee have also had some defenders against these attacks, such as http://www.furiousseasons.com/archives/2008/05/slate_responds_to_the_infinite_minds_criticism.html and http://fray.slate.com/discuss/forums/post/1242630.aspx .

I think on the one hand that trying to keep this list a secret was probably a poor strategic move. On the other hand I am reminded of an ugly incident that pretty much ended the academic career of one of my family medicine colleagues many years ago. This particular fellow worked on the faculty of a medical school in a tobacco-growing state and had the questionable judgment to do some research on the affect of cigarette advertising on children. He chose to study the infamous Joe Camel ads in which a cartoon character peddled cigarettes, and showed quite conclusively that contrary to the claims of the company, the actual impact of this ad fell squarely on children. The tobacco company's response was to claim that his research was flawed; to demand to recalculate his statistics; and to demand in a FOIA suit that he release the names of all his survey respondents (who had all been promised confidentiality as part of the consent for the research). The worst outrage occurred when the medical school, bowing to state political pressure, elected to side with the tobacco company against their own faculty member. In hindsight the company had no intention of doing any real data analysis. All they wanted to do was to send a highly chilling message to the research community--don't mess with us. I suspect a chilling effect of this sort is exactly what the industry is seeking here by demanding the infamous list.

The point in all this, as Lenzer and Brownlee shared in an e-mail, is that the industry appears to feel threatened by this list in a way that is quite unprecedented and unexpected. How and why that is so is worth pondering. As an erstwhile member of The List, I can only repeat the words of our highly popular President: bring 'em on. Like that highly popular President I might also regret those words in the not too distant future.

2 comments:

Trevor said...

I'm sorry, the idea that the only trustworthy scientists out there are those whose research hasn't been funded by industry is philosophically and scientifically bogus.

There's just as much useless, badly done "independent" research as there is useless, badly done "industry-sponsored" research. Look at the studies on BPA - journalists keep touting work by Frederick Vom Saal et al without mentioning that it has been rejected as methodologically and statistically flawed by risk assessments in Europe, Japan and the U.S. If you're going to follow the money, you need to follow the statistics too.

Ms. Lenzer and Ms. Brownlee have succumbed to the dark side of skepticism: paranoia; they should pay more attention to p values and confidence intervals. And if they're going to compile a list of the great, the good, and the honest, they shouldn't then try to keep it secret. Since when have these two journalists supplanted the FDA?

(Disclsosure, I've written very critically about their piece for Slate, which I've argued was an ethically flawed piece of journalism; I have not taken industry money, tho Ms. Lenzer has tried to pin that on me too.)

Mara said...

You write very well.