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PED-EM-L  May 2000

PED-EM-L May 2000

Subject:

Evidence-based medicine under siege!

From:

Jeffrey Mann <[log in to unmask]>

Reply-To:

Jeffrey Mann <[log in to unmask]>

Date:

Sun, 21 May 2000 08:58:02 -0400

Content-Type:

text/plain

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Parts/Attachments

text/plain (67 lines)

About 2 months ago, I published the first soapbox piece on my website -
a piece called "Evidence-based medicine under siege!" - in which I drew
your attention to two articles in the lay press that commented upon the
corrupting influence of changing cultural patterns in the USA on the
quality of evidence-based scientific research. Now, I see that even the
NEJM has felt the need to enter the fray and there are two articles in
this week's issue of the NEJM on the same subject.

I have posted inbuilt hyperlinks, that will take you directly to those
two NEJM articles, in my "Evidence-based medicine under siege!" piece in
the soapbox section of my website at:-
http://emguidemaps.homestead.com/JeffMannEMguidemaps.html.

In the one article "Is academic medicine for sale", Marcia Angell writes
"researchers serve as consultants to companies whose products they are
studying, join advisory boards and speaker's bureaus, enter into patent
and royalty arrangements, agree to be the listed authors of articles
ghost-written by interested companies, promote drugs and devices at
company-sponsored symposiums, and allow themselves to be plied with
expensive gifts and trips to luxurious setttings. Many also have equity
interest in the companies."

I think that we need to do something about this problem before it gets
totally out-of-control. I think that it needs a multi-pronged approach.
First of all (on a personal level), I think that every physician should
refuse to receive any gifts/meals from any pharmaceutical
representative. Secondly, I think that pharmaceutical companies should
be barred from coming into any hospital to promote their wares. Thirdly,
I think that all physicians should refuse to attend any conference or
symposium that is sponsored by a pharmaceutical company if there is too
close a relationship between the subject matter and the company's
products. Fourthly, I think that the AAEM and ACEP need to develop
watchdog committees to oversee this entire phenomenon to ensure that
medical researchers, who serve the for-profit drug industry at the
expense of neutral scientific endeavour, are publically identified and
socially ostracised. I also think that specific measures should be
undertaken to prohibit certain financial ties between medical
researchers and drug companies - especially equity-interests, and any
income from patent royalties and speaking arrangements. Fifthly, I think
that the AAEM and ACEP should tackle this issue politically and they
should encourage the legislative branch of our government to amend the
Bayh-Dole Act that encouraged academic institutions (supported by
federal grants) to patent and licence new products developed by their
faculty members. I also think that the 1997 Balanced Budget Act (that
resulted in a financial shortfall for academic hospitals) should be
amended so that academic centers do not have to make deals with
pharmaceutical companies to make up for the financial shortfall. I also
think that academic institutions should have much stricter rules to
ensure that their faculty members do not do extensive work for the drug
industry at the expense of their committment to their school's
educational mission. Finally, I think that we need to have much tighter
oversight of contract-research organizations (CROs) and site-management
organizations (SMOs) to ensure that they are not too lax in their
ethical and scientific standards of behaviour. I also think that we
should actively promote the idea of academic institutions developing
their own research networks with community physicians thereby taking the
drug-trial entrepeneurs, who are motivated by profit, out-of-the-loop.

What do you think? Do you think that this is a 'big' problem and how do
you think that this matter should be addressed?

Jeff.

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html

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