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Reports Detail More Drug Industry Ties to Medical Societies

Recommendations made by two medical societies give at least the appearance of a conflict of interest.

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At the Heart Rhythm Society convention in San Francisco in early May, key cards to hotel rooms were sponsored by St. Jude Medical at the price of $45,000-$70,000. Other news outlets have since chimed in to report on apparent conflict-of-interest issues involving medical societies. (Photo by Robert Durell for ProPublica)

As we reported earlier this month, there are often deep financial ties between professional medical societies and the drug and medical device industries. This week, other news outlets chimed in, detailing how recommendations made by two medical societies raise at least the appearance of a conflict of interest.

Professional groups represent physicians in specialized areas of medicine. They are responsible for writing the guidelines that those physicians use to decide on treatments and care. The organizations also lobby for the interests of their members. But recent reports question whether some of the groups' recommendations are in the best interests of patients or are tainted by industry support.

The National Lipid Association, for example, has been working on recommendations for the screening and treatment of a group of genetic disorders that can lead to premature coronary artery disease. It turns out the development of those recommendations was supported by $112,500 in grants from six drug companies that stand to profit from the results, according to the website Cardiobrief. Many societies explicitly ban such funding for guideline writing because of the appearance of conflict.

The association told Cardiobrief that the grants were among various sources of funding for the development of the guidelines, but it did not specify what percentage of the funds came from drug companies. The Lipid Association hasn't responded to our request for comment, but it gave the following response to Cardiobrief (the genetic disorder is known as familial hypercholesterolemia, or FH):

"The [National Lipid Association] maintained full control over the planning, content, quality, scientific integrity, implementation, and evaluation of the FH conference and resulting recommendations, as well as the FH public education campaign. All related activities are free from commercial influence and bias."

The guidelines recommend increased screening of children as young as 2, which one expert said would be excessive. One of the companies that sponsored the guidelines -- and that has a drug in the pipeline for the condition -- has been quick to promote the association's new recommendations. Aegerion Pharmaceuticals obtained early copies, apparently as a result of a publishing mistake, and sent them to physicians with an accompanying message, saying, "These publications illustrate the need for wide-spread screening and early diagnosis and treatment of FH."

In another recent case, reported by BNET, the U.K.'s Royal National Institute of Blind People came out against the use of a cheap alternative for treating a type of macular degeneration. The institute, as it happens, has long received support from Novartis, the U.K. marketer of Lucentis, which is 40 times more expensive than an alternative drug. Researchers at the National Institutes of Health recently found that a much-cheaper drug, the cancer treatment Avastin, is just as effective, though it is not formally approved for treating macular degeneration. (In the United States, both Lucentis and Avastin are marketed by Genentech.)

But the Royal Institute criticized the British government for encouraging the use of the cheaper Avastin, saying, "Safety should not be compromised by cost." In written comments to ProPublica, the organization elaborated on its position, saying, "There is still insufficient data to draw firm conclusions on the comparative safety of these drugs."

BNET details a number of financial ties between Novartis and the institute, including a recent grant worth more than $500,000. The institute pointed out that the grant, which Novartis issued this year, is a tiny percentage of the organization's funding, representing about 1 percent of all donations received last year.

"We have relationships with a number of companies whilst always maintaining our independence," an institute spokeswoman said via email.

Novartis told us it works with many organizations to support education and raising awareness for different medical conditions and that all financial support they provide is compliant with industry guidelines. The money does not buy influence, the company said.

"How patient groups choose to spend funding provided by Novartis is entirely their decision," the company wrote in an email.

As we reported earlier this month, financial links between these professional societies and the drug and device industries are a widespread concern. The Heart Rhythm Society got nearly half of its $16 million in donations last year from companies that make drugs and devices used to control abnormal heart rhythms. The Society for Cardiac Angiography and Interventions took in $4.7 million, more than half of its total receipts in 2009, from drug and device manufacturers.

As we put it then:

Professional groups such as the Heart Rhythm Society are a logical target for the makers of drugs and medical devices. They set national guidelines for patient treatments, lobby Congress about Medicare reimbursement issues, research funding and disease awareness, and are important sources of treatment information for the public.

The groups say the industry money helps them provide better education and that their members develop better treatments. They say they have guidelines to ensure the money doesn't buy influence.

But as our nifty interactive graphic shows, it does buy -- or at least get your name on -- just about everything else, including tens of thousands of dollars for coffee cup sleeves at the annual conference, $15,000 for goodie bags, or as much as $70,000 to get your name on hotel key cards.

We also reported that Heart Rhythm Society tip sheets tout the effectiveness of some medical devices without mentioning dangerous side-effects. The sheets are posted on the society's website and are meant to help patients research options for treatment. But the sheet for one defibrillator, for example, says the device is 99 percent effective while failing to mention that it can deliver unnecessary and painful jolts. The makers of these devices are among the society's biggest funders.

As the Cleveland Clinic's Dr. Steven Nissen told us, "What you're exploring here is the subtle ways in which the companies and professional societies become partners and -- wittingly or unwittingly -- physicians become agents on behalf of the interests of the sponsoring company."

I believe that it is quite apparent from any Patient’s perspective, one that has actually seen it for themselves that when we are sitting in the waiting rooms of some of the Physician’s offices, patiently so to speak , waiting for our appointments/to be called back,  then walks in a nicely dressed Pharmaceutical Representative with lunch, i.e. pizzas, sandwich trays etc. and called back ahead of us to speak with the Physician,  while we are still sitting in the waiting room ,  that this is common practice.  Now, this is on such a smaller level than you are speaking of and no, all doctors do not fall prey to this type of salesmanship but if they are promised percs then of course I am sure some of them accept.  Pushing the very pharmaceuticals for the companies that they are accepting gifts from . I have very good physicians that have never fallen prey to this type of behavior but I have seen it throughout my long medical history. I mean, really, isn’t this what goes on in all aspects of medicine, It has become such a business, rather than the physicians that used to go into medicine to actually uphold their oath “First do no harm”. Now it seems it is first, lets see if you have insurance, secondly, lets try this medication, even if they know that it has severe side effects, as long as they prescribe and get their percs, dare I say vacations?? paid.

Dr.Stephen R.Keister

May 20, 2011, 12:45 p.m.

Please note my article in the current Rag Blog…

I am entirely on board with ProPublica and as a retired 90 year old retired rheumatologist, member of Physicians For A National Health Program, appreciate your excellent reporting.

The two major vet associations are also included in the same scheme.

Our pets and animals are all being subjected to unnecessary vaccines!

Sandy Gottstein

May 20, 2011, 5:49 p.m.

Here are letters between the vaccine manufacturers and the American Academy of Pediatrics, revealed during “discovery”, that demonstrate clear conflict of interest.  http://bit.ly/gBpV3e

What don’t we know about this cozy relationship, but should?

This is what happens when there is no handle on out of control drug manufacturers.  I can’t totally blame doctors for this practice, as I know a few who actually try to “heal” people.  Pharmaceuticals are a business, plain and simple.  They will always do what they can get away with to ensure there products are utilized by doctors.  There influence is way too much in our healthcare system.  When you look at the actual numbers of people who are addicted to prescription medication, how can anyone think differently…

K Patrick McDonald

May 21, 2011, 2:01 a.m.

We Americans have developed no habit more inherently insane, than forcibly drugging an entire population of healthy people.

The legal drug cartels chum poisons out at an astonishing rate; the FDA approves them; and our otherwise ethical doctors become the most rabid drug pushers the world has ever known.

The pharmaceutical giants, for their part - GlaxoSmithKline, Pfizer, Eli Lilly and Schering-Plough - have stolen more taxpayer money than any known criminal organization, accounting for more than half of all federal financial penalties since 1990, paying $10.5 billion in fines collectively. The two largest criminal penalties ever assessed by the U.S. government against anybody. were against Lilly (1/2 Billion) and Pfizer ($1.2 Billion), just in the last two years.

And exhibiting an idiocy of Olympian proportions, we allow then continue business as usual. Why on earth would anybody else with a finger in the pie, even bother to remain honest?

Having morphed into the monsters of the Midway, the legal drug cartels have amassed an army 80,000 strong to overpower physician doubt – a well-equipped battalion of ground troops armed with the deadliest, most effective weapons known to mankind – spray-on tans & the world’s greatest legs. They have their banter down so well they effectively lecture physicians on what the new diseases ought to be.

More often than not, our doctors buy the spin, hook, line & sinker.

We now live in a true “tail-wagging-the-dog” society, where “you might get sick” has become the disease de jour.

And we are not merely poisoning our animals and ourselves. We are poisoning our food and our water and our soil. Where else could it possibly end up?

How long before the human race discovers – wonder of wonders – that the “process” itself is far more devastating than the diseases?

Well, we never really got to the weird science punch-line anyway. At least, not until the very, very end of the Twilight Zone.

Cue Rod Serling.

so pleased that others see as well…Thankyou to Dr. Stephen Keister, I will see your blog, and to all….  Bravo ,  K. Patrick McDonald…Wow !!!  It has all just become unbelievable…

In general I am leery of the large organizations that are running our country right now, I mean, if we take away the that good ole american feeling of patriotism and look at what is really happening, the conclusions require little speculation to come to. For example company X likes getting it’s huge special interest tax breaks each year so it supports the candidate that makes that a reality. Now, the fact that this now means in a tight budgetary year that educational programs like “Smart Start”  that do real good for thousands of children each year wont be funded. Do you think Company X cares? no of course not and if you think so I have some beautiful marsh property I’d like to sell you. However, Drug companies, I think sometimes deserve just the tiniest of breaks and here is why (I learned this from a Man that has impeccable credentials in the pharma industry, however, feel free to fact check this yourself.. i have…
Here we go, imagine a situation where I have on staff of my Big Pharma Company 10,000 of the brightest people in the world, that do nothing each day but try to understand the body in a better way and the interactions of various chemicals upon the body in an attempt to come up with the 1 drug in 9000 attempts that year that has the possibility of becoming commercially available via prescription to the general public.

Now Lets say I hit the Jackpot for the company that year and we find a new drug that if everything pans out MIGHT give a child with an incurable disease a chance at a normal life (this is not the norm, most drugs do far less but every once in a while a home run is hit). Now guess what that Big Pharma comany now needs to do to get this new wonder drug to market. here it is.

In 2003 it took about 800 million dollars and 15 years to bring a drug to market, today that estimate is almost 2 BILLION dollars and 20 + years.. why is it so much more expensive one might ask.. a number of reasons, but the biggest is costs of litigation in the event that a drug has a long term side effect that no one could have possibly predicted would occur. So now that dad with a 3 year old, in 2003 is told that his baby’s prognosis is (I love this one, not!) incompatible with life, but that there is a company that is running a trial right now that Might offer your child a chance. The Dad says of course, lets go, anything to save my Baby’s life. the child enters the study and 5 years later is running and playing and is a joy to that family.

Ok now it’s 20 years later and that child has a couple of issues one of which that makes her lose her hair every year on the first of january, another a bit more serious, but that prevents her from having children of her own.

Now lets cut to the sets of words that together in some semblance form the laws of this once great country.. and no i am not talking about the constitution or the bill of rights or anything that the framers did. I am talk about all that other @#$@ that gets bigger but not smaller and shows no sign of becoming anything that a citizen of good will ever be able to successfully navigate without a lawyer. Now just like anything else there are good lawyers that are good people and there are good lawyers that are bad people and there are bad lawyers that are good people and and bad lawyers that aren’t very nice people either. so you know the story, the family that was so happy 20 years ago sees and add on TV that describes them to a T, they call the lawyer forgetting that this child originally had a prognosis that was incompatible with life and that lawyer tell them that they are going litigating a class action lawsuit against the company that made their wonder drug and if there information meets the criteria, they stand to make thirty or fourty thousand dollars. the family says YAY, the Lawyer says YAY..,, and now because the suit that the company lost cost them 5 billion in payments (with 2.5 billion going straight to the lawyers). they say well we now have to make sure that 20 years after taking this drug that nobody ever loses their hair or becomes infertile, now guess what there is another dad that would love to be on this new study, but because of the new requirements the studies on human subjects wont begin for another 10 years.. the dad say but, but what I am to do? The doctor sits back in his chair looks at the weeping mother and father of this beautiful child and explains to them that their child has a condition which is incompatible with life.

Mark

Margaret Wilde

May 21, 2011, 5:30 p.m.

Thank you for this article.

I regard legal prescription drugs as far, far more harmful and dangerous than illegal drugs because they compromise the health of such vast numbers of people the world over.

Dr R RAMESH NAIK

May 22, 2011, 11:42 p.m.

Remedy is extremely simple!
First and foremost, Ban BRAND NAMES. USE ONLY GENERIC NAMES.
Secondly, withdraw tax breaks for so called research and development. When tax breaks are given, how intellectual property rights are given to the discoverer?
New discoveries then, becomes the property of the tax payers/ public property, and the cost- fixing of the newly discovered product comes under the authority of the public as the research has been done at the cost of tax payers money.

Once a well known Indian Computer CEO who stole his own companies funds said, “It was like riding a tiger, not knowing how to get off without being eaten” some how looks apt for the American economy, this is quite hard to digest when spending 70,000 dollars on keycards? could have fed poor children not in Africa but in America itself,

This article is part of an ongoing investigation:
Dollars for Doctors

Dollars for Doctors: How Industry Money Reaches Physicians

ProPublica is tracking the financial ties between doctors and medical companies.

The Story So Far

ProPublica is investigating the financial ties between the medical community and the drug and device industry. In October 2010, ProPublica compiled the list of payments that drug companies make to physicians and built a publicly searchable database so that patients could look up their doctors.

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