Healthy Skepticism Library item: 18733

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: Electronic Source

Silverman E
Living In Unethical Times: Carl Elliott Explains
Pharmalot 2010 Oct 4
http://www.pharmalot.com/2010/10/living-in-unethical-times-carl-elliott-explains/

Full text:

The last several years have seen increasing concern over ethics in the pharmaceutical industry – from the way clinical trials are run and trial data is disclosed to promotional activities aimed at consumers and interactions with the medical community and universities. Among the many observers who make a living by witnessing this unfolding morass is Carl Elliott, a professor at the Center for Bioethics at the University of Minnesota, who has published a book called “White Coat, Black Hat: Adventures on the Dark Side of Medicine.” We spoke with him about his observations and insights…
Pharmalot: Do we live in unethical times?
Elliott: You could definitely make that argument, although the nature of what’s going on is not really new. When I was writing about the drug reps, I asked them about scams and manipulations that are used with doctors and asked is it new? This one rep laughed and said there’s nothing new under the sun, there’s just more of it. I tend to agree with that. But it got a whole lot worse in the 90’s and we’re still living with that. As an ethicist, I don’t like being a self-righteous, finger-wagging, self-appointed expert trying to point out to the world what other people are doing wrong. I don’t think I have any moral expertise more than anybody else. I do think ethics speaks for itself.
Pharmalot: What’s the biggest problem?
Elliott: They all point to the same thing, which is undermining trust in medical knowledge and the profession. The difficulty with the way things are done now is that you don’t know if you can believe what’s in the medical literature anymore. After product-liability litigation, you learn evidence has been faked or ghostwritten and that doctors are getting payments from pharma. You see things on television you may not believe because the news is being spun. Research subjects feel they have been exploited.
Pharmalot: That’s a pretty gloomy picture you paint. Is it really that bad?
Elliott: That’s the problem. You don’t know. Once your trust is undermined, it’s very easy to become paranoid. It’s not all gloom and doom…I do think there are gleams of sunshine peaking through the clouds. One of them is trial lawyers. I think that what has emerged in litigation has opened a lot of eyes – also doctor and expert witnesses are making information available, which is pretty remarkable. I think you can sense a change, as a result, in medicine. It’s a very conservative profession and very hierarchical. And there are lot of people who worked their way up to top by virtue of collaborating with industry. But there are also fairly outspoken ones and when they have that sort of platform and reputation, others take note. And I think medical students, such as the American Medical Students Association, has been encouragingly on the right side of the issue.
Pharmalot: Okay, so let me ask you this: Does the pharmaceutical industry do anything right?
Elliott: Whenever any administratort at my university says something negative about the industry, they paraphrase it by saying how wonderful the industry is at saving lives, etc., as if they’re afraid of the mob. They can’t say anything without prefacing it with all these complements. I’m not sure if it’s a matter of a tin ear or an effort to defuse suspicion, but it happens everywhere. It’s like the Democrats. Before they criticize a government or a policy, they have to go into this long shpiel about how patriotic they are and love their country. But look, I don’t disagree with the idea that industry does make good drugs. But I don’t need to preface my remarks with such comments.
Pharmalot: You’ve also complained that the bioethics field isn’t always transparent. How so?
Elliott: The whole issue of bioethics working for industry grates on me. It’s a small thing in the scheme of things and there isn’t that much money compared with academic medicine thought leaders. But bioethicists shouldn’t be paid consultants…How can I tell my students, ‘Oh, I make $100,000 a year from a company, but don’t worry you can trust me.’ On a larger level, you could say the same thing about for-profit institutional review boards, because the industry needs to have trials done. So they just pay a fee to an ethics board to approve a trial. If turned down, they just go to another. It’s a crazy way to regulate clinical trials, but that’s the system we have.
Pharmalot: A recent study found that some doctors seem to believe they’re entitled to certain freebies. Yet there’s certainly been a lot of publicity about concerns over such things. Why does the issue persist?
Elliott: Medicine is hard and medical training is hard and medical school is miserable and by the time people are out of residency training, in a lot of ways, they’re kind of angry. And a lot of people have the sense that the work is not what I thought it would be like and somebody owes me something. So the finding is totally believealbe, although I don’t want to justify it.
Do ordinary doctors get it? I’ve been involved in this stuff awhile and worked at a lot of different hospitals. At every hospital, there’s always some small group of doctors worried about industry influence and what they always get worked up about are the pizzas and pens and little gifts. ‘We gotta get the reps out of the hospitals,’ they say. I don’t’ disagree with that, but what they never say is we need to get rid of the department chair who is making a half million a year from the industry, which to me is more outrageous than the pens and pizzas. If it were up to me, there’d be no more pizzas and pens, but there’s something self serving about them getting worked up about what students and residents are getting without paying attention to what their colleagues are getting..
Pharmalot: Okay, but on a practical level, does transparency matter? How many people do you think mightl really take action if they find their doctor has a tight relationship?
Elliott: Suppose you find out the doctor you’re going to gets all this money from a company. What do you do with that? Talk? Get another doctor? Try to figure out how it relates to the treatment? In the end, it undermines trust and maybe it deserves to be undermined. I don’t think disclosure is all that helpful unless you say you’re not willing to go to any doctor that takes money from industry. But then you have choices to make. Which doctors will you be able to see? What if all the specialists in your town are on somebody’s payroll? Then what do you do? I don’t think disclosure solves the problem. That seems to be the approach and I think it’s totally misguided. The more doctors who do it and the more widely known people know about it, the more widely it will be done and the practice will become normalized and nobody will feel any compunction about taking money from industry anymore.