Tuesday, July 14, 2009

Announcing the Fish-in-the-Barrel Club, Complete with Spoof Website

Main credit for this item goes to our colleague Danny Carlat and his blog:


I guess I should start off with a blanket apology. I have on many previous occasions (for example, most recently, http://brodyhooked.blogspot.com/2009/04/pharmascolds-strike-back-latest-from.html) used this blog as a forum to rebut the writings and ideas of Dr. Thomas Stossel of Harvard, apparent national leader of the group we have come to call "pharmapologists." These folks think that "conflict of interest" is basically a lot of hooey, that there exists no empirical evidence to show that taking money from pharmaceutical companies has ever caused any harm to anyone, and that we "pharmascolds" who object to these cozy financial relationships are a bunch of envious busybodies who are creating ill health by standing in the way of productive, entrepreneurial relationships between medicine and business, out of which will come new cures for all disease.

The apology is simply that offering rebuttals to this gang feels a lot like shooting fish in a barrel--it just somehow does not seem sporting. Be that as it may, I am here in part to keep you posted on relevant new developments, so here goes.

Stossel and his pharmapologists have formed a new national organization called ACRE, Association of Clinical Researchers and Educators (http://www.acreonline.org/). The reason for the organization is for the beleaguered and outnumbered pharmapolgists to circle their wagons to face the onslaught of us marauding pharmascolds. (Well, OK, they are not outnumbered; they claim to be the "silent majority.") Pointing out that their organization is paid for totally by its members, ACRE proceeds to inform us:

ACRE is to be a forum for what we believe is a hitherto silent majority of individuals engaged in clinical service, medical education and medical innovation ready to oppose (but not debate) a small but well organized and well-funded coterie responsible for an anti-industry movement. This movement has inverted reality by extrapolating from an astonishingly small number of adverse events related to industry compared to the incontrovertible evidence of social good that has eventuated from thousands of industry actions over my lifetime in medicine. The movement particularly demonizes industry marketing, despite the lack of any evidence that, on balance, such marketing impacts anything but positively on patient care.The movement’s success rests in part from its tactical skill. Its initial target, gifts and meals, were too trivial to oppose. But by conceding trinkets, physicians and industry tacitly admitted to an “ethics” problem justifying further sanitizing of medicine from commercial influence. ... The movement also panders to archaic notions of professionalism rooted in pre-scientific medicine and based on contempt of business and trade.The movement has therefore succeeded in goading medical leaders to impose increasingly onerous regulations on physicians and researchers. These rules include forced confession (massive disclosure), censorship (limits on writing, speaking or advising) and coercion (restrictions on association, action and rewards). These rules have no basis in empiric fact and have no benefits. The movement is deeply disrespectful of physicians and industry alike. It is hypocritical, because it has its own conflicts of interest in that its members gain power and wealth by controlling medical education and by managing conflicts of interest. And it has costs: the regulations in force and desired will decrease medical education and innovation.The movement’s overreach, however, has finally begun to dawn on the rank and file. In particular, working physicians are becoming aware of the confusion and potential for embarrassment and even litigation embedded in the soon to be enacted Massachusetts State regulations and how bans on product-based (promotional) speaking will affect their life and livelihood.

Those of us who have been in the pharmascold camp for a while have to be struck by this description in a number of ways. For the vast majority of the time that we have been working at this (I would date "pharmascolding" to 1961, when pediatrician and educator Charles May wrote a ground-breaking critique for the Journal of Medical Education), the David seemed very much to be the pharmascolds, while the role of Goliath was played by the pharmaceutical industry and the reported $57B it spends annually in the US on marketing, plus the 94 percent of US physicians who have one or another sort of relationship with the industry according to Campbell's widely quoted NEJM study. It is only very recently that the scolds seemed to be making any headway at all, though admittedly the degree of momentum that has been generated just in the last year or so is quite impressive. But to imagine that somehow the David and Goliath roles have been switched seems inaccurate to say the least. As interesting as it is to discover for the first time that my friends and I are "well-organized, "well-funded," and have unusual "tactical skill," I have to ask what planet these people come from. I won't address the charges that we are anti-business or rely on an outmoded definition of professionalism as we have hashed over those charges in the past. I note that ACRE promises to "oppose but not debate" us-- draw whatever conclusion from that you wish.

The fun (and unsporting) part of all this is that somebody has already put up a spoof website: http://www.acrenow.com/, which purports to be the home page of "Academics Craving Reimbursement for Everything." It's a real hoot of a spoof and I heartily recommend it, but I am sure that from the point of view of Stossel and Company, its existence merely increases their paranoia about the hostile world that they inhabit.

1 comment:

Roy M. Poses MD said...

I have now written a whole series of posts on confused and fallacious defenses of conflicts of interest, all of which were written by people with (often undisclosed) conflicts of interest.

I love this quote by Joe Collier, "people who have conflicts of interest often find giving clear advice (or opinions) particularly difficult." (See this post for a link:
I haven't seen that much formal psychological research on the effects of conflicts, but it does seem that conflicts really gum up the cognitive works of otherwise reasonably intelligent people.

That may be why responding to their defenses of their own conflicts seems like shooting fish in a barrel.

But those with conflicts remain very influential, so I'm afraid we will have to keep shooting the fish.