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Update 2009-03-10

Healthy Skepticism Update March 2009

Latest Healthy Skepticism International News Editions



March 2009 Vol 27 No 3

Advertising of therapeutic goods in Australia – a case study of FatMagnet (.pdf 773 Kb)

by Ken Harvey

"...This case study is just the latest of many in which sponsors of complementary medicine have ignored the determinations of the CRP and the TGA has also failed to follow-up or take any action in these matters…"



February 2009 Vol 27 No 2

Introduction to On speed : the many lives of amphetamine

by Nicolas Rasmussen

Before there was Prozac, and even before the tranquilizer craze of the 1950s, there was Benzedrine, Dexadrine, and Drinamyl (Dexamyl). Energetically marketed as the first outpatient antidepressant by the pharmaceutical industry in the 1940s, and using remarkably modern strategies including pharma-controlled clinical research by some of the top names in academic medicine, amphetamine blazed the trail for all subsequent mass-market psychiatric pharmaceuticals. It also created an iatrogenic addiction epidemic that seems to have been conveniently forgotten by today’s supporters of stimulant medications and amphetamine-class weight loss drugs. Is this grim history repeating itself? This month’s international news reproduces the introduction to On Speed: The Many Lives of Amphetamine.



January 2009 Vol 27 No 1

International Society of Drug Bulletins General Assembly

Summary by David Menkes representing Healthy Skepticism



In other news…



Review of Therapeutics Initiative

Therapeutics Initiative (TI www.ti.ubc.ca) is based in British Colombia, Canada. Its mission is to provide medical doctors and pharmacists with up-to-date, evidence-based, practical information on prescription drug therapy.



Two years ago TI was threatened with withdrawal of funding. Following protests from many people and groups around the world, including Healthy Skepticism, the provincial government announced that instead of withdrawing funding there would be an academic review.



Last year many HS members signed a letter to the review in support of TI.



Recently the review report was released. It recommended ongoing funding of TI.



The response from TI states that: "We are in overall agreement with the conclusions and recommendations of this review and look forward towards expanding, enhancing and restructuring the activities of the Therapeutics Initiative as suggested by the reviewers."



The reviewers found that TI has a very high reputation internationally. It seems that finding may have helped lead to a positive outcome.



Healthy Skepticism on Facebook

Thanks to Dr Elaine Leung, who has volunteered to administer the group there, Healthy Skepticism now has a Facebook presence:

http://www.new.facebook.com/group.php?gid=19289777252

 

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Update 2008-09-17

Healthy Skepticism Update September 2008

This months’s International News feature

“Is the American Academy of Pediatrics Helping Babies R Us Promote Formula?”
Matt Anderson’s article examines the confusing involvement of the AAP in a catalogue distributed to doctor’s waiting rooms amongst other places. See if you think the AAP should have endorsed information in this booklet, when the primary aim of the publication was to advance sales, including sales of breast-milk substitutes, rather than to educate.
http://healthyskepticism.org/news.php

Healthy Skepticism, the MHRA and paroxetine

Earlier this year, the UK’s Medicines and Healthcare products Regulatory Agency commissioned Market Sentinel to conduct a stakeholder analysis, looking at web traffic about Seroxat (paroxetine). The report shows that Healthy Skepticism has played an important role. This is an extract:

“The key table is perhaps the “Betweenness” table showing as it does how the Healthy Skepticism blog (sic) is present as a link in an astonishing 29.85% of all the “random walks” in this network and Aubrey Blumsohn’s Scientist Misconduct blog has 28.54% and the Fiddaman blog is not far behind on 18.08%. The MHRA is present on 12.01% of walks and the BMJ and GSK trail far behind, with scores around 6%. In an analysis of a mainstream topic one would expect the Betweenness rankings to be dominated by conventional media (e.g. BBC) or generalist information sites. It is highly unusual that sites with strong agendas occupy this position…The Betweenness scores tell us that the running in this story has been dominated by bloggers. They are linking the vast majority of influencers and providing information to them…”

The full report is available here: http://www.mhra.gov.uk/home/groups/es-foi/documents/foidisclosure/con025748.pdf (Warning: 12.6MB file. Report begins on p.217.)

Healthy Skepticism’s prominence in this report is due mostly to our work to call attention to the lack of evidence of efficacy and safety of paroxetine and other SSRIs used for depression in adolescents. See, for example: http://healthyskepticism.org/documents/PaxilStudy329.php and:

Jureidini JN, McHenry LB, Mansfield PR.
Clinical trials and drug promotion: Selective reporting of study 329
International Journal of Risk and Safety in Medicine 2008 May;20(1-2):73-81

Shahram Ahari at IFMSA Conference

You will recall we asked recently for donations to enable former drug rep, Shahram Ahari, to speak at the International Federation of Medical Students Associations General Assembly. Here are some extracts from his report:

“Eight years ago I left my job as a former sales representative for Eli Lilly who sold Prozac and Zyprexa well to work in public health and health advocacy. The past 2 years in particular I have focused on issues related to pharma. My primary area of interest (and knowledge) is drug marketing; secondary is global health issues related to medicines. I lecture health professionals, speak to the press, defend helpful legislation and advise law makers on relevant policies as my preferred methods of advocacy…

Right now, I’m at the International Federation of Medical Students Associations (IFMSA) General Assembly Conference (compliments of several donations from Healthy Skepticism members who have funded my travel) where I’ve finished a series of presentations on pharma marketing, global health and related issues - my first international presentations. The results have been excellent and we (the American Medical Students Association and I) are capitalizing on the momentum created…

My presentations have translated well and are relevant to the experiences in other countries…”

So, many thanks to those members and subscribers who helped.

Honorary membership for student campaigners

Students are very important to Healthy Skepticism. We would be grateful if you would alert student health professionals to the following new policy.
Healthy Skepticism is now offering free Honorary Membership to all student health professionals, in any country, who have contributed their time to campaigning in accord with the aims of Healthy Skepticism. This offer lasts as long as they are still students.
Honorary members have the same benefits as paid members. They can join our international email discussion list, access more of our website and can participate in elections for our management group.
If you would like to nominate a student who might like to take up this offer, or take it up yourself, please contact .(JavaScript must be enabled to view this email address)

In other news…

HealthNewsReview. Several Healthy Skepticism members have agreed to be available to journalists seeking expert sources who do not have financial ties to drug or medical device manufacturers. The list of experts compiled so far by journalists Shannon Brownlee and Jeanne Lenzer is at
http://healthnewsreview.org/independentexperts.php

“Life before pharmaceutical profits! Patents can be deadly". Action against AIDS Germany have invited us all to visit http://www.aids-kampagne.de/en/home/ to learn how patents prevent access to medical care for some people, and to support this campaign. 

The New Epidemic.  DVDs of The New Epidemic are now available, and are a great tool for educating students or colleagues about the dangers of disease mongering and some of the pharmaceutical industry’s marketing strategies. The New Epidemic is 25 minutes long and uses a humorous narrative to explore the unhealthy influence that the drug industry can have over health professionals, patients and the public. Spice up your next conference or lecture - this DVD is guaranteed to generate some lively debate! To check out a promo on YouTube go to:
http://www.youtube.com/watch?v=SfPSA44y2SU
To purchase a copy, please contact producer Miranda Burne on .(JavaScript must be enabled to view this email address)
 

 

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Update 2008-08-09

Healthy Skepticism in the Media



Recent media appearances include:

* Peter Mansfield - Salud, El Mundo, Spain, 31 May

* Ken Harvey, Jon Jureidini - Australia Talks, Radio National, Australia, 23 July: www.abc.net.au/rn/australiatalks/stories/2008/2311121.htm

* Peter Mansfield - Worldview, Chicago Public Radio, USA, 29 July: www.chicagopublicradio.org/Program_WV.aspx?episode=26902



Support for the next generation of healthy skeptics



On 22 July we received a request from the American Medical Students Association for US$ 1,315 to enable a whistle-blowing former drug rep, Shahram Ahari, to speak at the General Assembly of the International Federation of Medical Students’ Associations. We asked our supporters for donations and are very pleased to report that have already received pledges for almost all the money needed. If you would like to make a donation to support this or other projects to help student health professionals please tell Robyn Clothier: .(JavaScript must be enabled to view this email address) how much money you would like to give and what country you live in.



Healthy Skepticism International News



Available at www.healthyskepticism.org/news.php



August 2008 Vol 26 No 8

Pushing Pills: A CHOICE Research Report

There is strong evidence to indicate that pharmaceutical promotion is not in the best interests of consumers. It can lead to inappropriate prescribing practices which expose consumers to unnecessary risk. It also may not be in the interests of taxpayers. In this report, the Australian consumers group, CHOICE, discusses the various ways pharmaceuticals are promoted to doctors. They go on to examine advertising in doctors’ publications over a 12-month period and look more closely at drugs used to treat high blood pressure.



July 2008 Vol 26 No 7

Book review By Melissa Raven

A brief review of Living under liberalism: The politics of depression in western democracies, by Pam Stavropoulos



June 2008 Vol 26 No 6

La incierta prevención del cáncer de cuello de útero con la vacuna contra el virus del papiloma humano. Rev Port Clín Geral. 2007;23: 547-55

By Juan Gérvas ‘Prevention of cervical cancer by the HPV vaccine is not definitive.’ Abstract with Eleven Questions & Answers in Spanish and English. English translation by Juan Gérvas and Joana Ramos



Many other recent publications by Healthy Skepticism members are referenced at www.healthyskepticism.org/library/byus.php



Director’s presentations in 2008



So far this year, Healthy Skepticism director Peter Mansfield has given 34 presentations and had many more conversations about drug promotion in 23 cities in Europe, Nth America and Australasia. One conversation was with Matthew Anderson who posted an entry about it on the Social Medicine blog. www.socialmedicine.org/2008/06/13/big-pharma/a-short-drive-with-healthy-skepticisms-dr-peter-mansfield/



Peter has concluded: “Whilst the details differ from place to place, the important issues are the same. Everywhere there seems to be 5 stages we need to help people to go through to help us achieve our aim of reducing harm from misleading drug promotion:



1. Becoming aware that misleading drug promotion is an important problem.

We can help by telling people about avoidable drug disasters caused by misleading promotion.



2. Understanding the problem.

Some people think the main problem is bad people intentionally causing harm. I think the main problem is unintended bias amongst good people in bad systems. People are more vulnerable to misleading promotion if they are overconfident about their ability to resist it. If people feel accused of intentionally causing harm they will respond with denial and reactance. To win support we need to help people accept that all good people, including themselves, have human strengths including potential for compassion, imagination and humour etc but also human weaknesses including vulnerability to misleading persuasion regardless of intelligence, education and good intentions etc.



3. Deciding what changes are needed.

If the problem was only bad people then the solution would be easy: replace them. If part of the problem is good people in bad systems then we must change the systems. Doing so would solve the bad people problem also. Many people are working on understanding the details of the problems but few people are working on developing solutions. Around the world there has been high levels of agreement with the Healthy Skepticism reform agenda for system changes: improve regulation, improve incentive systems, improve treatment decision-making.



4. Becoming optimistic.

Many people are pessimistic that the changes needed are achievable. Such pessimism can be self-fulfilling by reducing willingness to act in ways that could be effective or provide opportunities for learning. Some people can be helped to become more optimistic by being told about the experiences of people I met in Berlin and Belfast. In those cities change was like an earthquake - it seemed that nothing was happening but forces were building up that gradually reached a tipping point releasing sudden dramatic changes that surprised all but the most optimistic.



5. Deciding to work alone or together.

Inevitably many of the leaders working on drug promotion issues are independent thinkers who do not naturally work together. It is useful to consider:

"If you want to go fast, go alone. If you want to go far, go together."

- African proverb”



If you want to go together, please get more involved in Healthy Skepticism Inc. To do that - please contact Robyn Clothier .(JavaScript must be enabled to view this email address)

 

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Update 2008-04-09

HS Publications
Recent Healthy Skepticism News issues include an update from Janne Larsson about reports of harmful effects from the ADHD drug Strattera (atomoxetine) and the response of regulatory authorities so far. Joel Lexchin has also argued that the priorities of Health Canada are skewed in favour of rapid approval of new drugs at the expense of the postmarketing surveillance in a submission to a Canadian House of Commons standing committee. Both pieces are at: http://healthyskepticism.org/news.php

A slew of interesting new books:

Boston Women's Health Book Collective
Our Bodies, Ourselves: Pregnancy and Birth
Touchstone; Mar 2008
“… will help you sort fact from fiction, giving you the most accurate research, up-to-date information, and the firsthand experiences of numerous women who have been exactly where you are today.”

Orla O'Donovan and Kathy Glavanis-Grantham (Eds.)
Power, Politics and Pharmaceuticals: Drug Regulation in Ireland in the Global Context
Cork University Press; Feb 2008
“Public concerns about the regulation of the pharmaceutical industry have intensified in recent years … Paradoxically, these concerns centre on the over-consumption of medicines of dubious benefit in Western societies, and lack of access to essential medicines in the Global South…”  (Several chapters written by Healthy Skepticism members.)

Barton Cobert and Pierre Biron
Practical Drug Safety from A to Z
Jones and Bartlett Publishers; Jan 2008
"... guide to drug safety monitoring (pharmacovigilance), covering literally, the "A to Z" of maintaining drug safety..."

Joanna Moncrieff.
The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment
Palgrave Macmillan; Dec 2007
“This book exposes the traditional view that psychiatric drugs correct chemical imbalances as a dangerous fraud. It traces the emergence of this view and the way it supported the vested interests of the psychiatric profession, the pharmaceutical industry and the modern state…”

Alan Cassels
The ABCs of Disease Mongering: An epidemic in 26 letters.
Emdash Publishing; Dec 2007
“Alan Cassels, co-author of the international bestseller Selling Sickness: How the World's Biggest Pharmaceutical Companies are Turning Us All into Patients, returns to his favourite topic armed with outrageous humour and even more outrageous facts…”

Kimberly Cheryl
Escape From The Pharma Cartel
Outskirts Press; Oct 2007
“… takes the reader on a shocking, revealing, and provocative tour of the pharmaceutical industry of America as only an insider can.”

New resources from PharmedOut
Two new free, pharma-free, web-based CME modules are accessible via the PharmedOut web-site. Drug Approval in the US provides a brief history of the FDA and describes the process by which new drugs are approved in the US, and Generic Drugs: Prescribing Sensibly describes how generic drugs are approved, and how they compare to branded drugs. “We want to educate doctors about the fact that generic drugs are held to exactly the same standard as different batches of branded drugs,” says Adriane Fugh-Berman, MD, director of PharmedOut and Associate Professor of Physiology & Biophysics at Georgetown University.

Also on offer at PharmedOut are a power-point presentation titled The Physician-Pharma Relationship suitable for grand rounds, and a guide developed in conjunction with the American Medical Students Association, called How to Hold Pharma-free Meetings. All well worth a visit to: http://www.pharmedout.org/index.htm

 

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Update 2008-03-16

Recent Publications

Healthy Skepticism members have hit the ground running in 2008 with journal publications covering nurses and the pharmaceutical industry, the regulation of complementary medicines, advertisements in clinical software, and pharmaceutical promotion expenditures in the US, amongst other things.



Two editions of Healthy Skepticism International News have also been published on the web-site, one responding to misinformation about the HPV vaccine in Canada and the other to a meta-analysis published last year in JAMA of the studies of antidepressants in children. If you haven’t yet caught up with these, they can all be accessed via: http://healthyskepticism.org/new.php



Director’s speaking tour

Preparations are well underway for the tour of Europe and North America by HS Director, Dr Peter Mansfield in April, May and June. He will be speaking in numerous cities and covering various aspects of the influence of pharmaceutical promotion on healthcare. Once the details have been finalised, we will let subscribers know, so that you can organise to attend one of these meetings if you have the opportunity.



Visit to Adelaide by Joel Lexchin

Healthy Skepticism is an international organisation but it is based in Adelaide, in South Australia. Members of the management group conduct most business by email, so we are very pleased when we are able to see them in person. One member, Dr Joel Lexchin, is visiting Adelaide on sabbatical currently. Joel is a lecturer in health policy and management at York University, Toronto and an emergency physician. We look forward to working with him more closely over the next few months.



Vale Barbara Seaman

Barbara Seaman, 72, journalist, activist and HS member, died on Feb. 27 at her home in Manhattan.

Barbara had worked hard on pharmaceutical safety issues ever since the early days of the contraceptive pill and hormone replacement therapy. Her main concern was that women have access to more information with which to make their own decisions. She was the author of several influential books and co-founder of the National Women’s Health Network in Washington, DC.

For a copy of the Washington Post obituary for Barbara see:

http://groups.google.com/group/alt.obituaries/browse_thread/thread/cb6adfc8c92d4b76/9edf7067bfbf996d



US Physician Payments Sunshine Act

In the US Congress last week, the House counterpart to the Senate Physician Payments Sunshine Act was introduced. Both House and Senate bills would require pharmaceutical and medical device companies to disclose gifts and payments to doctors. The Prescription Project is coordinating a national coalition to support these measures. US-based groups and individuals are invited to join. For more detail, please visit:

http://prescriptionproject.org/newscenter?id=0049

http://www.prescriptionproject.org/assets/pdfs/APC_invite_RxP.pdf



Maintaining the HS Library

The HS Library is an important database of articles relevant to drug promotion, accessed over a million times per year by people from all around the world. However, it requires quite a bit of work to keep it up-to-date. At present we are seeking more volunteers for “media monitoring”, and would like to increase our coverage of non-English sources. If you think you could help with this work, or would like to make a donation to help keep the library going, please contact .(JavaScript must be enabled to view this email address) (Many thanks to those who already send us articles of interest or have recently offered to help).

 

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Update 2007-11-18

New Gallery
Healthy Skepticism's new Gallery is now avalaible for viewing at: www.healthyskepticism.org/gallery
This is a good place to share picture, video, audio and presentation files relevant to drug promotion.

If you would like to post a file, please contact: .(JavaScript must be enabled to view this email address)


New Videos:
A new epidemic
Having trouble getting out of bed in the morning....feeling unmotivated at work? You may have Motivational Deficiency Disorder. A short video about this new epidemic by investigative journalist Miranda Burne is now available to all in the Documentaries section of our Gallery at this link.

Pharma insider
PharmedOut have posted two videos on YouTube of Douglas Melnick, a former pharma insider, telling Adriane Fugh-Berman about drug promotion techniques. See: Pharma Insider Part 1 and Pharma Insider Part 2


HS International News: The dilemma for young doctors created by pharma funding of education
In the September 2007 issue Portuguese GP registrar, Tiago Villanueva, discusses the difficult dilemma for young doctors created when the government does not fund education adequately but they can access education funded by industry. See: Pharma money: the least common denominator

In the October issue young Australian GP academic Geoff Spurling expresses different views about that dilemma. See: A response to Tiago Villanueva


Consumers International's Marketing Overdose campaign
Marketing Overdose is a new campaign organised by Consumers International.
The aim is to expose examples of irresponsible drug marketing and campaign for effective rules and regulations to ensure doctors and the public have access to independent, accurate and up-to-date information.

The campaign website has a report titled Drugs, doctors and dinners (1.5 Mb pdf file) highlighting irresponsible drug marketing to doctors in developing countries. This report is based on a larger report produced for Consumers International by Healthy Skepticism.


HS management group re-elected
At our Annual General Meeting on 1 November our management group was re-elected unopposed:
The management group is:
Dr Heather Carter (General practice) Adelaide, Australia
A/Prof Jon Jureidini (Child psychiatry) Adelaide, Australia
Prof Joel Lexchin (Emergency Medicine and Health Policy) Toronto, Canada
Dr Dee Mangin (General Practice) Christchurch, New Zealand
Dr Peter Mansfield (General practice) Willunga, Australia
Ms Joana Ramos (Social Work and Health Policy) Seattle, USA
Ms Melissa Raven (Public Health) Adelaide, Australia
Mr Jörg Schaaber (Sociology and Journalism) Bielefeld, Germany
Dr Agnés Vitry (Pharmacy) Adelaide, Australia
 

 

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Update 2007-08-22

International News
The July 2007 issue is a review by David P. Ellis of John Watkins’ new book Healing schizophrenia: using medication wisely.
Visit: this link


AdWatch
The August 2007 issue was written in response to a subscriber’s comments regarding the March 2007 AdWatch about GlaxoSmithKline’s advertising of rosiglitazone (Avandia) in Australia.
Visit: this link


A new service from Healthy Skepticism: HS Headlines
The new HS Headlines email newsletter is now available for our Paid Subscribers and Members only. This almost daily service provides links to articles we have just added to the Healthy Skepticism library. Many will have been published less than 48 hours before.

To receive HS Headlines, tick the relevant box at the bottom of [PREFERENCES] then click "Update".


Who gets what from Healthy Skepticism?
The main services now provided by Healthy Skepticism now include:

Everyone who has internet access can visit the HS website including our library which now has over 11,000 references relevant to drug promotion.

Free subscribers also receive Healthy Skepticism Updates about once a month.

Paid subscribers and Members can opt to receive HS Headlines.

Members can opt to be on our HSmembers email discussion list and access the Members Only areas of our Fora. Our management group is elected from and by our members.

Additional services are being developed and will be announced later this year.

Healthy Skepticism founder will tour Europe, Nth America and New Zealand in 2008
Peter Mansfield will visit Europe, Nth America and New Zealand sometime around April, May or June 2008. If you would like him to visit you please contact him.

 

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Update 2007-07-20

HS Int News
Two new Healthy Skepticism International News issues have now been added to our website.

May 2007 Vol 25 No 5
Is it insulting to suggest that health professionals are influenced by drug promotion?
By Peter R Mansfield
One of the most important barriers to healthy skepticism about drug promotion is the belief that to suggest that health professionals are influenced is to insult them. Some arguments for overcoming that barrier are presented in this issue. Peter has found these arguments to be effective for use in presentations to health professionals.

April 2007 Vol 25 No 4
Regulation of Homeopathic Products
By Ken Harvey
Ken questions whether companies are misusing the regulations that govern homeopathic products in Australia in order to market pharmacologically inactive substances labelled as DHEA, HGH and melatonin.


Call for papers
If you  have written, or would like to write, a paper relevant to misleading drug promotion and would like to have it published in Healthy Skepticism International News, please contact: .(JavaScript must be enabled to view this email address)


Special thanks to Judy Norsigian
We thank Judy for her article "Misleading Ads and How They Hurt Us" published by The Women's Media Center (USA) on 25 May 2007. We usually get one or two new subscribers every day but there has been a surge of new subscribers since Judy's article was published.
See: www.womensmediacenter.com/ex/052207.html


Who is Sebastian?
For technical reasons to do with spam filters etc from now on Healthy Skepticism Updates will come to you from: .(JavaScript must be enabled to view this email address)
Sebastian is named in honour of one of the pioneers of moderate skepticism: Sebastian Castellio 1515–1563. Please don't send emails to: .(JavaScript must be enabled to view this email address)
If you want to contact us please use one of the addresses given below:

 

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Update 2007-07-03

Two new publications by Healthy Skepticism have been added to the web-site:

Is consumer health information by drug companies trustworthy? The most recent AdWatch ( http://healthyskepticism.org/global/adwatch/issue/au2007-06 ), which analyses an advertorial by Pfizer published in the Australian edition of the Readers Digest in March 2007, suggests not. This advertorial is presented as consumer information on arthritis but hardly hides its main aim: half of the brochure promotes Cox-2 inhibitors, which include Pfizer’s Celebrex® (celecoxib), in a country where direct-to-consumer advertising of prescription medications is illegal.

In the latest edition of Healthy Skepticism International News ( http://healthyskepticism.org/global/news/int/hsin07-06 ), Gregory Pawelski writes about the conflicts of interest inherent in the US Chemotherapy Concession, from the experience of supporting his wife as she struggled with ovarian cancer.

Also of interest is a documentary launched on June 18 called “PERx: Prescribing Evidence-Based Therapies” and the accompanying interactive website ( http://www.perxinfo.org ). Developed by Elissa Ladd, Clinical Assistant Professor at the MGH Institute of Health Professions, with filmaker, consumer advocate, and former drug rep Kathleen Slattery-Moschkau, PERx illustrates how pharmaceutical industry influence affects the prescribing behaviors of clinicians, emphasizes the ethical implications of these practices and offers strategies to enhance evidence-based practice.

 

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Update 2007-05-31

What is the difference between free subscribers, paid subscribers and members?
There are 3 main groups who receive Healthy Skepticism Updates:
1. Free subscribers
2. Paid subscribers whose payments provide the core funding for Healthy Skepticism.
3. Members who are paid or honorary subscribers who state that they support our aims (see below) and have been nominated by 2 other members. HS members own the association and elect the management group. You are welcome to apply for membership even if you don’t know any current members to nominate you. We will find a way to get to know you so we can. One way is for us to read your curriculum vitae.


HS members’ discussion list
Some of the things we do don’t work, others do. Last year we set up a web discussion forum for our members. There have been very few contributions to that forum. By contrast one of the most successful things we have done this year is set up an email discussion list for our members. The feedback from members is that many are finding the list very helpful.

If you are not receiving HSmembers emails, that is because you are one of many who are not currently a member or one of very few members who have opted out.

If you are interested in becoming a HS member please contact: .(JavaScript must be enabled to view this email address)


New video: "Drug Reps Talk Shop"
PharmedOut's new video, "Drug Reps Talk Shop", is now available at:
http://pharmedout.org.
The video features two drug sales reps talking about how they use prescribing data and samples to influence what drugs physicians give to patients. Here's a quote about the real purpose of samples: "first one's free, then you pay, then you're hooked."


Propaganda Conference
Strathclyde University in Glasgow is organising a conference on propaganda to take place on 7-9 September 2007.
See: http://gs.strath.ac.uk/content/view/240/130/
One of the key themes of the conference is disease mongering. Of particular interest, in the context of the conference overall, is the role of the media, including both mass and academic media, in disease mongering. The increasing involvement of patient groups in working with the pharmaceutical industry is of interest, as is the more general question of the regulation of industry activity, particularly in relation to drug promotion. The organisers are calling for abstracts to be submitted by 31 May.


Consumer International's World Conference
CI's World Congress 2007 will be in Sydney from 29 October - 1 November 2007.
See: www.consumersinternational.org
There will be a special session on The Ethics of Drug Promotion. Confirmed speakers for this session include Ray Moynihan (award winning health journalist) and Harvey Bale (International Federation of Pharmaceutical Manufacturers Associations).


Checking your occupation
We are keen to have correct records re everyone’s occupation so that we can send emails that are relevant to different occupational groups to all the right people but only the right people.

The illusion of invulnerability
On 5 May the British Medical Journal published arguments for and against patient groups accepting money from drug companies. The No case was written by Barbara Mintzes of the Therapeutics Initiative, Vancouver and Health Action International, Amsterdam. The Yes case was written by Alastair Kent of the Genetic Interest Group, London. The BMJ has published, as a letter to the editor, a shortened version of the following rapid response to Alastair Kent from Peter Mansfield.

Alastair Kent claims that “Patient groups are not naïve. They value their independence fiercely and are quite capable of spotting the strings that may be attached to funding.” Many doctors have similar overconfident beliefs about invulnerability to being misled by drug companies.<1> This illusion of invulnerability actually increases vulnerability.<2>

Drug companies sponsor patients’ groups as a way of promoting drugs to fulfill their legal requirement to maximize profits.<3> Drug companies can not influence all of the people all of the time but if their investments in any type of drug promotion do not achieve competitive returns on average they are ceased.<4> I don’t know of any examples of drug companies funding patient groups except for a limited time only when a relevant patent protected drug is being promoted.

In the 1840s doctors did not understand the risk of invisible microbes so were offended by the suggestion they should wash their hands. We are now going through a similar paradigm shift towards understanding the risk of invisible unintended bias from exposure to industry influence techniques. These techniques include manipulation of reciprocal obligation which can occur without our awareness.<5> Patient groups tend to reciprocate by lobbying governments to pay for overpriced drugs rather than lobbying the companies to reduce their prices.<6,7>

Funding for patient groups could be increased and the alleged problems with government funding reduced by abolishing patents to allow price competition and using the savings to fund research, education, health promotion and other activities of patients groups via competitive grants.<8>

1. Mansfield PR, Lexchin J, Wen LS, Grandori L, McCoy CP, Hoffman JR, Ramos J, Jureidini JN. Educating Health Professionals about Drug and Device Promotion: Advocates' Recommendations. PLoS Med 2006:3(11): e451
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371%2Fjournal.pmed.0030451
2. Sagarin BJ, Cialdini RB, Rice WE, Serna SB. Dispelling the illusion of invulnerability: the motivations and mechanisms of resistance to persuasion. J Pers Soc Psychol 2002 Sep ;83(3):526-41
3. Harnessing Patient Power: Strategies for speeding drug approval, building and retaining market share. Business Insights. 2004 Jan http://www.piribo.com/publications/regulation_policy/harnessing_patient_power.html
4. Garai PR. Advertising and Promotion of Drugs. In: Talalay P, Editor. Drugs in Our Society. Baltimore: John Hopkins Press; 1964. http://www.healthyskepticism.org/global/news/issue/hsin03-10
5. Dana J, Loewenstein G. A social science perspective on gifts to physicians from industry. JAMA 2003 Jul 9 ;290(2):252-5
6. Burton B. Drug companies told that sponsoring patients' groups might help win approval for their products. BMJ 2005 Dec 10 ;331(7529):1359
7. Ferner RE, McDowell SE. How NICE may be outflanked. BMJ 2006 May 27 ;332(7552):1268-71
8. Mansfield P. Industry-Sponsored Research: A More Comprehensive Alternative. PLoS Med 2006 ;3(10): e463
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030463


Healthy Skepticism’s aims
1. Improving health by reducing harm from inappropriate, misleading or unethical marketing of health products or services, especially misleading pharmaceutical promotion.
2. Investigating and communicating about marketing practices.
3. Promoting healthy skepticism about marketing practices via advocacy, research and education.
4. Developing, supporting and evaluating initiatives to reduce harmful marketing practices, including reform of regulations and incentives.
5. Developing, implementing and evaluating educational strategies to improve health care decision making, including evaluation of drug promotion.
6. Supporting compassionate, appropriate, sustainable, evidence-based health care, provided according to need, for optimal health outcomes.
7. Providing practical opportunities to advance the aims of Healthy Skepticism Inc.

 

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Update 2007-04-25

TODAY IS A GLOBAL DAY OF ACTION RE ABBOTT'S BOYCOTT OF THAILAND
The Thai government has granted of a compulsory license for manufacture of lopinavir+ritonavir (sold by Abbott as Kaletra) Abbott has responded by withdrawing all of its current drugs awaiting registration and threatening to not register any new pharmaceutical products in Thailand.
You can read more at:
www.abbottsgreed.com/index.php?title=April_26:_Global_Day_of_Action
You can contribute to the day of action by sending an email to Abbott CEO Miles White via:
http://fightglobalaids.org/action/abbott.200703.php
If you contribute in another way please inform the Student Global AIDS Campaign at:
www.fightglobalaids.org/action/abbott.tellus.200704.php


HEALTHY SKEPTICISM INTERNATIONAL NEWS
March 2007 Vol 25 No 3
Letter from Novartis re litigation against India's refusal to grant a patent for imatinib (Glivec / Gleevec)
By: Peter R Mansfield and Joana Ramos
This issue includes an open letter from Novartis, published on request from that company. We also provide a summary of the context.
www.healthyskepticism.org/global/news/issue/hsin07-03


NOFREELUNCH DIRECTORY
The No Free Lunch Directory is a database of health care professionals who have pledged to accept no gifts from industry and to rely on non-promotional sources of information. At present, the directory only includes health professionals from the United States. NoFreeLunch intends to include the remainder of the globe in the near future.
The directory is searchable at:
http://nofreelunch.org/doctors.asp
Are you a health care professional who wants to be listed? If so make the pledge at:
http://nofreelunch.org/pledge.htm


MEDICINES ISSUES IN CENTRAL AMERICA
If you are working on, or interested in, medicines issues in Central America (regional and/or country-specific) including, but not limited to the following : access in general, role of Free Trade Agreements on access, rational use, promotion to prescribers and consumers, and pricing, please contact Joana Ramos of the HS Management Group directly in English or Spanish at: .(JavaScript must be enabled to view this email address). She will put you in touch with a Guatemalan physician/public health researcher interested in forming a network of like-minded people.


HEALTHY SKEPTICISM IS INTERNATIONAL
Healthy Skepticism is frequently described incorrectly as an Australian organisation. We are based in Australia but our focus and membership is international. We have people from 5 countries on our management group. Our 1,474 subscribers span 81 countries. The top ten countries (with numbers of subscribers) are:
Australia - 590
United States - 297
United Kingdom - 126
Canada - 63
Spain - 37
Sweden - 30
India - 30
Italy - 24
Brazil - 22
New Zealand - 22
France - 22
Germany - 19

 

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Update 2007-03-29

ADWATCH: GSK AVANDIA
Do not ADOPT rosiglitazone as first-line diabetes treatment.
www.healthyskepticism.org/global/adwatch/issue/au2007-03


HEALTHY SKEPTICISM INTERNATIONAL NEWS
February 2007 Vol 25 No 2
What everyone needs to know about drug marketing. Part 3: Place, Promotion and Goals
By: Peter R Mansfield
This is the final part of a three part article about drug promotion.
www.healthyskepticism.org/global/news/issue/hsin07-02


MEDICINS SANS FRONTIERES PETITION: ASK NOVARTIS TO DROP CASE AGAINST INDIA
Novartis is taking the Indian government to court. If Novartis is successful in its challenge against the Indian government and its patent law, more medicines are likely to be patented in India, making it very difficult for generic producers to make affordable versions of them. This could affect millions of people around the world who depend on medicines produced in India. Please sign the petition:
http://web.archive.org/web/20090122074056/http://www.msf.org/petition_india/international.html *


RECOMMENDED WEBSITES
When we hear about relevant websites that are new or new to us we list them in our What’s New forum:
[obsolete URL deleted]

The best of the new websites include:

PharmedOut
An independent project run by physicians for physicians and other prescribers. The goal is to disseminate information about how pharmaceutical companies influence what we prescribe, to increase access to unbiased information about drugs, and to encourage physicians to choose pharma-free CME.
www.pharmedout.org

Hooked: Ethics, Medicine, and Pharma
Updates and Commentary related to the book “Hooked: Ethics, the medical profession and the pharmaceutical industry” by Howard Brody, MD, PhD ( Rowman and Littlefield, January, 2007 )
http://brodyhooked.blogspot.com

Pharmalot
Pharmalot’s self description is “a home for lively discussion about news and trends in the pharmaceutical industry. This blog is written by Ed Silverman, a veteran journalist for The Star-Ledger of New Jersey.
http://pharmalot.com

We will introduce more websites in a later issue of Healthy Skepticism Updates.

 

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Update 2007-03-19

You are one of 1,417 people on the mailing list for Healthy Skepticism Updates

CONTENTS
New web server
GSK internal documents
Healthy Skepticism International News
Recent publications


NEW WEB SERVER
We have moved our website to a new server but the address remains:
www.healthyskepticism.org If you have experienced technical problems
with our website, we apologize. We are trying to do a lot with
limited resources. We hope there will be less technical problems from
now on.


GSK INTERNAL DOCUMENTS
Jon Jureidini (HS Chair), Leemon McHenry (consultant to the Baum
Hedlund law firm) and Peter Mansfield (HS Director) have been
analyzing internal documents from GlaxoSmithKline regarding Study 329
of paroxetine for depressed adolescents. Our analysis has been
submitted to a medical journal. Meanwhile the documents and a list of
all known trials of newer antidepressants for depressed children and
adolescents are available at:
[obsolete URL deleted]


HEALTHY SKEPTICISM INTERNATIONAL NEWS
We are still catching up on posting Healthy Skepticism International
News issues. Issues dated December 2006 and January 2007 have now
been posted.

December 2006 Vol 24 No 12
What everyone needs to know about drug marketing. Part 1: Products.
By: Peter R Mansfield
This is first part of a 3 part article. This part focuses on
pharmaceutical products.

Go to: www.healthyskepticism.org//global/news/issue/hsin06-12

January 2007 Vol 25 No 1
What everyone needs to know about drug marketing. Part 2: Prices
By: Peter R Mansfield
This part will be easier to understand if you have read the first
part first.

Go to: www.healthyskepticism.org/global/news/issue/hsin07-01


RECENT PUBLICATIONS
If you know of any publications relevant to drug promotion that are
not listed in our web library please inform: .(JavaScript must be enabled to view this email address)

Publications by Healthy Skepticism Members

Mansfield PR, Hoffman JR, Lexchin J.
Educating Health Professionals about Drug and Device Promotion:
Authors' Reply.
PLoS Med. 2007 Feb 27;4(2):e88
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040088

Harvey K.
Medicines Australia latest Code of Conduct Report
AusPharmList 2007 Feb 16
http://auspharmlist.net.au/post.php?postid=9292

Lexchin J.
A comparison of new drug availability in Canada and the United States
and potential therapeutic implications of differences.
Health Policy 2006 Dec;79(2-3):214-20
http://linkinghub.elsevier.com/retrieve/pii/S0168-8510(06)00003-0

Mansfield PR.
Doctors as lapdogs to drug firms: Independence may be most cost
effective way to improve health care.
BMJ 2006 Nov 25;333(7578):1121-2
www.bmj.com/cgi/content/full/333/7578/1121-c

Recent publications mentioning Healthy Skepticism

Pollard R.
Bitter pills
Sydney Morning Herald 2007 Feb 15
www.smh.com.au/news/world/bitter-pills/2007/02/14/1171405299899.html?page=fullpage#contentSwap2

Langley ZL
Antidote for Misleading Advertising: Healthy Skepticism Inc.
ShuffleBrain; 2007 Feb 11
www.indiana.edu/~pietsch/drugads.html

Fleg AN.
Introduction to pharmaceuticology
studentBMJ 2007;15:45-88
www.studentbmj.com/issues/07/02/life/78.php

 

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Update 2007-02-03

Notice: The URLs in this Update have been updated to be correct for our new website.

ADWATCH
December 2006
'Use the best first'. Moxafloxacin from Bayer (Italy)
This AdWatch issue provides an analysis by an Italian General Practitioner of a conference proceedings booklet funded by Bayer.

Go to: www.healthyskepticism.org/global/adwatch


HEALTHY SKEPTICISM INTERNATIONAL NEWS
November 2006 Vol 24 No 11
What are we doing to our children? / Do we have a prescription addiction?
By: Jerome Burne
Jerome Burne is a science and medical journalist interested in the gap between the ideals of science and the realities of commerce. The November 2006 HS Int News provides full versions of two of Jerome’s articles about treatment of children with psychiatric drugs.

Go to: www.healthyskepticism.org/global/news/int/hsin06-11


LIBRARY
Our main website library now lists over 8,300 publications relevant to drug promotion many with full text. New publications are being added almost every day by our new one hour per day employee: Robyn Clothier.

The best way to keep up with the latest publications is to visit our new improved What’s New page: www.healthyskepticism.org/global/new

The library home page is:
www.healthyskepticism.org/global/library
You can search the main library at:
www.healthyskepticism.org/global/library/search

If you know of a publication relevant to drug promotion that is not yet listed in our library please email .(JavaScript must be enabled to view this email address)

 

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Update 2006-11-23

UPDATES USUALLY ONCE A MONTH
Our aim is to send Healthy Skepticism Updates only about once a month because we know some people do not want more frequent emails from us. This is the third message this month. The increased frequency is temporary and arises because we are catching up after setting up a new email sending system.

If you want more contact with us, please contribute to our Fora: [obsolete URL deleted]


YOUR OCCUPATION AND LOCATION
It is useful for us to have accurate records of your occupation and location because sometimes we want to send messages that are interesting only for people in specific occupations or locations.

According to our database your location and occupation are:

Country: [COUNTRY]

Occupation: [OCCUPATION]

If applicable:
Medical specialty: [IF YOU ARE A DOCTOR]

Pharmacy Specialty: [IF YOU ARE A PHARMACIST]

Type of Student: [IF YOU ARE A STUDENT]

Second Occupation: [SECOND OCCUPATION]

If any of the above are incorrect, please use the link at the bottom of this page to correct our database.


 
HEALTHY SKEPTICISM INTERNATIONAL NEWS
October 2006 Vol 24 No 10
Don't judge a paper by its abstract
By: Peter Parry

Peter Parry is a consultant child & adolescent psychiatrist who became interested, perplexed and then troubled after closely comparing the abstract of a highly important paper to his clinical practice with the paper's own results in the body of its text. The paper in question "Fluoxetine, Cognitive-Behavioural Therapy and Their Combination for Adolescents with Depression - Treatment for Adolescents with Depression Study (TADS) Randomised Control Trial" highlights problems in current research and medical publication. Abstracts may reflect bias of the researchers or study sponsors and distort findings of the research.

Go to: www.healthyskepticism.org/global/news/int/hsin06-10

HEATHTY SKEPTICISM MANAGEMENT GROUP 2006-07

Executive:

Chair: Jon Jureidini, (Child Psychiatrist) Adelaide, Australia

Deputy Chair: Agnés Vitry (Pharmacy) Adelaide, Australia

Treasurer: Heather Carter (GP) Adelaide, Australia

Secretary and Director: Peter Mansfield (GP) Willunga, Australia

Other Management Group Members:

Dee Mangin (GP) Christchurch, New Zealand

Joana Ramos (Social Work) Seattle, USA

Joel Lexchin (Emergency Medicine and Health Policy) Toronto, Canada

Jörg Schaaber (Sociology and Journalism) Bielefeld, Germany

Melissa Raven (Public Health) Adelaide, Australia

We cover a wide range of disciplines, 4 continents (Joanna has many contacts in South America) and 5 languages: English, French, German, Portuguese, Spanish.

 

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Update 2006-11-09

THANK YOU !!!
We thank the 291 people who have corrected and updated their details in our database during the past 2 days. There were some errors created during the database transfer process eg. all the Australians were recorded as living in Argentina. If you have not done so yet, please use the link at the end of this message to check if our record for you needs to be corrected or updated.


RECENT PUBLICATIONS
PLOS Medicine has published today a set of recommendations for improving education for health professionals about pharmaceutical and device promotion. The recommendations were produced by an iterative E-mail discussion among representatives of four organizations: the American Medical Student Association, Healthy Skepticism Inc., No Free Lunch, and PharmAware.

Mansfield PR, Lexchin J, Wen LS, Grandori L, McCoy CP, et al. (2006) Educating Health Professionals about Drug and Device Promotion: Advocates' Recommendations. PLoS Med 3(11): e451
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371%2Fjournal.pmed.0030451
(You may need to repair this link before pasting it in your web browser.)

Also published recently:
Mansfield P (2006) Industry-Sponsored Research: A More Comprehensive Alternative. PLoS Med 3(10): e463
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030463


HELP OUR FRIENDS BY SENDING AN EMAIL
We have had a request for help from KILEN  - Consumer Institute and Association for Medicines and Health, Sweden because the new Swedish government has decided to stop the funding. KILEN will run out to funds and thus be forced to close in a few weeks.

KILEN ( http://www.kilen.org ) started in 1975 and is one of the oldest consumer-organisation focusing on helping people harmed by and/or dependent on medicines.
KILEN is also provides independent information about medicines including at seminars and conferences about patient safety.
KILEN is involved in many national and international projects including:
* Consumer reporting of adverse effects of drugs.
* Quality and safety of medicines - patient safety - in Newly Independent States.
* School-projects: To empower and educate children and youth about medicines.

I visited KILEN when I was in Stockholm in September and was very impressed.

You can help by sending an email to Goran Hagglund, Minister of Health, Sweden:
[email deleted]
with a copy to Lena Westin: [email deleted]
(NB the o in Goran and the a in Hagglund should have umlats but our email sender can not do umlats yet.)

For example I sent the following message today:

Dear Mr Hagglund,

I am writing to you on behalf of Healthy Skepticism Inc., an international organisation aiming to improve health by reducing harm from misleading drug promotion.

Please continue funding for KILEN (Consumer Institute and Association for Medicines and Health). KILEN's work on adverse drug reactions is has provided international leadership that is helping save lives and reduce harm around the world.

regards,

Dr Peter Mansfield
Director, Healthy Skepticism Inc
www.healthyskepticism.org
http://www.adelaide.edu.au/directory/peter.mansfield

 

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