Healthcare (7) something is rotten (drugcompanies)

Senator Charles Grassley, not my favorite intellectual, is the ranking member of the Senate Finance Committee (we need help if the Republicans win a majority, even if Max Baucus, the current Democratic Chairman, is not very much more to the left of Gr.), and as such wrote a letter to 10 top medical schools asking what they do about professors who put their names to ghostwritten papers, in which the ghost is not Hamlet's father but a drug company (or its lobbying arm). The practice leads me to paraphrase Hamlet: "Frailty, thy name is 'greedy academic.'" The Senator has a point as is repeatedly indicated by testimony in suits by patients who suffer from breast cancer allegedly caused by the use of hormonal drugs that were made by two companies now owned by Pfizer. Large compensatory and punitive awards have been voted by juries in local courts, but Pfizer's stock is not suffering: the company will appeal (and in some instances has settled out of court). Yet thousands more suits are in the works. Even the 8th Circuit Court of Appeals, while overturning a $27 million award on technical grounds, said that there was enough evidence that Wyeth acted with disregard of possible injury and that a new trial could assess other punitive damages. The company, following a 2002 decision by the FDA, changed its advice on administering the drugs, but the recent punitive awards involved women who had taken the drugs for many years before warnings were placed on the packaging of the medicines. Not only did the latest jury, in Philadelphia hear testimony that Wyeth paid consultants and ghostwriters to play down concerns about breast cancer but also that one of the original makers did not study known risks.

The Senator, with appropriate modesty, often introduces himself as he begins a question with: "I am not a . . . , I'm only a farmer." Which, I hope, may be self- mockery for it looks like he is a full time politician and has been so for quite a while. Not one to cultivate the land and harvest crops with his own hands (I can see him being lampooned on Jon Stewart with his hands held out to receive the generous farm subsidies under various government programs that he helped create). Whatever honesty (or simplicity) traditional farmers may have had has, in his case, been grossly compromised by the machinations a long time politician engages in. Grassley's forte is investigating the financial sources of non-governmental, not for profit and tax free institutions, ostensibly to expose tax frauds, or in the present case to reveal undue, and mostly hidden, influence by drug companies. That's all to the good. Gifts by drug and health insurance companies to political campaigns are another source of tax evasion and undue influence. But I am wondering whether these laudatory inquiries of the Senator are not in fact aimed at undermining NGOs on principle, because they cannot easily be controlled. If that is the goal and if it was met with success, the American people would be "up the creek." The services provides by NGOs that favor progressive policies would not be there if the "small government, for the people can take care of themselves" that is the avowed aim of conservative (reactionary?) politicians, would be achieved. Never have all farmers (or the powerless) been able to take care of themselves and in the past American settler's took the land without pay or paid a small fee; today some survive on subsidies and many make their profit from them.

The question of accurately referring to sources in news articles or t.v. reports is obviously related to Grassley's concern. How can we be sure that the medical literature (or Professors of Medicine) are unbiased, if we are not informed about the funding of the research in question or the funding of institutions with NEUTRAL sounding names, but that maybe associated with academic departments at a great university that receives company funds for research or subsidies for professors? Or who is the source of a reporter who says: "My sources on Capitol Hill. . ."? Are they not too anonymous to be trusted not to further an agenda?

My questions are not a rhetorical, nor are they meant to rake muck for its own sake.
Last week the U.S. Preventative Services Task Force changed its own recommendations of seven years ago to limit the number of mammograms and raise the age from the current 40 years at which to begin them, suggesting also that women over 75 don't need them. The new Task force is made up by new members appointed during the previous Administration. The spokesman, Dr. Diana Petitti, Vice Chair, is not an oncologist or gynecologist but Professor of Biomedical Information The American Cancer Society and the American College (=Association) of Obstetricians and Gynecologists are not yet accepting the new guidelines but experts at university Med. Schools or Hospitals say they will apply the previous guidelines, even though they agree that mammograms are not perfect and may have emotional side effects. Actually the Chair of the previous Task Force admitted that the benefit of beginning mammograms at age 40 would be quite small and that even in older women the prevented only a small fraction of breast cancer deaths.

As a lay person, I wonder why mammograms (or other cancer screening tests) can't be made perfect. I'm thinking of the many x-rays I have had when radiation technology was in a more primitive state than today and, so far, without negative consequendes. Is it an example of that apparently all pervasive culture in the pharmaceutical and med-tech industry that assumes "minor risks" are worth taking until law suits make the FDA take action? Paying compensation must be cheaper than loosing the profits in the meantime. And how many companies go out of business as a result of such law suits? Certainly Philip Morris is surviving. And how many drug companies are doing all possible tests and waiting for un-fudged results before presenting a product for approval to the FDA?

[Addendum (Dec. 1): There is an item in today's NYT about a report presented at a Radiology Conference in Chicago on 11/30 which shows a statistical correlation between mammograms given to younger women at risk who developed cancer as a result of even low doses of radiation. But the American Cancer Society's Robert Smith questioned the methodology and rejected its recommendation that MRIs should be used instead, because an MRI may miss tumors that a mammogram may detect, and vice versa. He suggestes that for high risk women both screenings should be used.]

[Addendum 2, Jan. 27, 2010]. A propos radiation: The NYT is publishing the results of an in depth investigation of serious (really) problems with radiation procedures leading to awful health risks over a number of years (1-24 and 1-27, together some 5 pages of its print). They recalled several items on the French news in the last years of deaths from rediation in N.E. France that were caused by personnel that could not read the English instructions of a new American machine (why didn't the company provide French instructions?). In the NYT article unfamiliarity with ever new equipment is also a factor, but even when a screen signalled an overdose the technician did not react. A major problem appears to be lack of information about the various failures and resulting health risks, incl. in Veteran Hospitals that should have a national clearing house [I wrote about problems in the Phila. Veterans Hosp. in a previous Health Care blog].

Grassley should perhaps send his questions about ghostwriters (or financial contributions) to all his Congressional colleagues as well. It has been variously reported that remarks "revised for the record" of Members of both parties contained the same language which turned out to have been written by lobbyists for Genetech. How often is that kind of thing the case? It's not the same as people writing to their Representative or Senator at the request of a pressure group for or against a bill. There the staff will know and either add up the number of those coming from their constituency or state and they may even inform the "boss" if they judge them germane. But a reader of the Congressional Record is being misled by what is as much plagiarism as Professors giving their names to papers they did not write and in whose research they were not involved.