Health regulatory and advocacy groups are deliberately corrupted
arstechnica.com
arstechnica.com
I was the only person with my hand still up.
People really like to believe that they are above being influenced. People are wrong. It's OK, we just need to try to continue to redesign our medical system with that in mind.
Shaw: Madam, would you sleep with me for a million pounds?
Actress: My goodness, Well, I'd certainly think about it
Shaw: Would you sleep with me for a pound?
Actress: Certainly not! What kind of woman do you think I am?!
Shaw: Madam, we've already established that. Now we are haggling about the price.
It's OK, we just need to try to continue to redesign our medical system with that in mind.
"We"? "continue to redesign?" - I'd never question that health care is being constantly redesigned. But given that the present situation is product of the previous redesignings, would not you say that the "they (big pharma, etc)" redesigning to keep their profits and influence up has so-far outpaced, beaten "us" redesigning? That the continuing process is broken, that if "we" is patients or doctors or whoever is most concerned with patients' well-being, "we" have to get off our duffs and do something if we are going have even a modest expectation of positive outcomes here?
It talks about one Judge who had a tenant. The tenant brought his rent early one day and asked the Judge to rule for him in a dispute. The Judge refused the case, and referred him to someone else.
The Judge happened to hear part of the case, and immediately his thoughts turned to arguments on how he could help his tenant. The lesson being that even getting a payment that was already his, not even an extra gift, influenced him. And this was a very prestigious judge.
How much more so an actual gift to more ordinary people.
# "Ben Goldacre: Here’s the foreword to my new book, Bad Pharma (badscience.net)" ( 142 points )
http://www.badscience.net/2012/09/heres-the-intro-to-my-new-...
HN -> http://news.ycombinator.com/item?id=4569559
#2. "Something Doesn't Add Up: John Ioannidis and medical statistics (stanford.edu)" ( 49 points )
http://alumni.stanford.edu/get/page/magazine/article/?articl...
Any takers?
When I was in medical school and residency, it was a standard thing that lunches were all sponsored by pharma. These were usually nice catered meals brought in by some pharm rep. The price was at least listening to a sponsored (biased) speaker, or a five minute sales pitch. Sometimes an office's or deparment's prescribing numbers for a particular drug were actually tracked and discussed, as if we were in a sales meeting and we were or were not meeting the pharmaceutical reps quota for sales. Dinners were even more elaborate, commonly held at some swank restaurant, with a paid physician (shill) brought in to present "research" about that company's drugs.
My attendings were offered tickets to desirable sporting events, or paid travel to medical conferences that just happened to be in Tahiti. There was that wink and nudge: of course you would be using your own clinical judgment about the effectiveness of the drug being pushed. Of course the freebies had no effect on your judgement. Of course the published positive results reported at sponsored conferences and in sponsored journals constituted all the data and all the trials of that particular drug.
If you had qualms about big gifts or even meals, a pharma rep was always ready to give you a gift of the latest textbook (embossed with the name of a drug and/or pharma company) or maybe a sponsorship to the latest conference: after all, augmenting your education would only benefit your patients, right? What could possibly be wrong with that?
Physicians are increasingly and rightfully refusing to accept gifts of any kind from pharma. It was unethical then and remains unethical now. Many med schools and residencies have now rightfully banned pharma reps from any contact.
We need more and better regulation, not less.
Ask your doctor if he or she accepts gifts. If they do, or if you see product advertisements of any kind in the office (to include pens, notepads, pharma-labelled equipment, drug/product brochures), find yourself another doctor.
My pharm. class followed the typical academic exercise in memorizing information which was 80% useless to modern medical practice. The heavy focus on biochemistry and mechanisms of action were interesting but mostly irrelevant, because they didn't help us answer questions most relevant to clinical practice; we don't typically choose drug A over B because of a biochemical property, but because there's evidence that one works better than the other, is more cost effective, has a better response rate in a particular population, etc.
Shifting pharm. education to focus more on those types of things - how do we choose the right drug; how can we use evidence to critically choose when a new, more expensive drug, is actually better? Or marginally better but cost-effective? This type of teaching is relegated to one-off class' and side-topics. Its not center stage.
The methods of big Pharma can definitely be unethical, but I think the real problem is our physicians are fundamentally unprepared to ask the right questions and make the best decisions.
of course, that's assuming that the doctor and the pharmacist will be able to see each other's notes and that egos won't get in the way. but it's not like doctors don't alredy farm certain tasks out to specialists (eg radiologists for reading x-rays or neurologists for reading ct scans).
Doctors like the thought that they are evaluating each case based on first principles.
Right now there is: Dr. -> Urgent Care -> Emergency Room
We need something below Dr., for the really routine stuff. In some countries certain drugs are not over the counter, but are prescribed by pharmacists.
(Obviously there is a very important place for proper diagnosis. I'm talking about the really obvious stuff.)