Drug firms turn to private doctors for promotion
Filed under: Conflicts of interest, Hot Health Headline
Pharmaceutical companies are turning to doctors in private practice to promote their products as universities have developed conflict-of-interest policies that limit their doctors’ activities, according to the latest report from John Fauber of the Milwaukee Journal Sentinel.
Fauber, who has been covering conflicts of interest in medical research for more than a year, reports that “So much money is at stake that in January one academic doctor resigned his job at Harvard rather than give up his speaking income.”
Medical schools can restrict doctors who work for them from advocating particular drugs and can require that they inform patients of their ties to drug companies, but private physicians have no such obligations.
In previous articles, Fauber has reported on University of Wisconsin doctors who were making six-figure sums from drug and medical firms by serving as consultants or doing promotional speeches.
Critics say the talks can be biased and contribute to spiraling health care costs by promoting the use of expensive brand-name drugs over generics. The practice, according to critics, also leads to more non-approved and potentially harmful use of those drugs, so-called off-label prescribing.
Journal editor linked to spinal implant royalties
Filed under: Conflicts of interest, Hot Health Headline
John Fauber of the Milwaukee Journal Sentinel continues his coverage of conflicts of interest in medical research and journals with a look at journal editors. First, Fauber lays out the case in question:
- For seven years, a University of Wisconsin orthopedic surgeon (university bio | hospital bio) has been editor-in-chief of the Journal of Spinal Disorders & Techniques.
- During that time, he’s received more than $20 million in patent royalties thanks to spinal implants sold by Medtronic.
- Also during that time, an average of more than one Medtronic-related article appeared in each issue of the journal, most of them positive. Some were even co-authored by the editor/surgeon himself and related to the implant for which he gets royalties.
- Despite these coincidences, the journal never disclosed the potential conflict of interest.
Fauber then goes on to explore why journal editors aren’t mentioned more often in conflict-of-interest scandals, and then to explain exactly why those editors hold the sort of power that makes these conflicts particularly distressing. As Fauber explains, editors of medical journals can accept or reject manuscripts of studies involving drugs or devices - something that can make or break the product.
They can send a study out to peer reviewers who may be sympathetic to a particular drug or device by virtue of their own financial relationships with the companies that make those products. They can give authors more leeway to say positive things about a drug. They can turn down studies that say bad things about the product of a company they get money from.
The author of “On The Take: How Medicine’s Complicity with Big Business Can Endanger Your Health
Earlier coverage:
- Wis. researchers didn’t disclose conflicts to journals
- U. of Wisconsin conflict of interest policy gutted
- Wyeth paid university for ghostwritten articles
- University’s ties to testosterone therapy questioned
- Drug companies aim to sway docs through classes
- Wyeth-funded course promoted hormone therapy
- Academic docs collect money from manufacturers
Report focuses on researchers’ conflicts of interest
Filed under: Conflicts of interest, Government, Studies
There are vulnerabilities in how financial conflicts of interest are handled by NIH-funded researchers, according to a report (PDF, 46 pages) released today by the Department of Health and Human Services’ Office of the Inspector General. Among the findings:
- 90 percent of the grantee institutions rely solely on the researchers’ discretion to determine which financial interests are required to be reported
- because nearly half of the grantee institutions do not require researchers to provide specific amounts of equity or compensation on their financial disclosure forms, specific financial interests of NIH-funded researchers are often unknown
- grantee institutions do not routinely verify the information submitted by researchers about their financial interests
- some grantee institutions lack documentation to support their oversight of financial conflicts of interest
- the majority of grantee institutions do not have policies and procedures that address subgrantee compliance with federal regulations regarding financial conflicts of interest
- conflicts were not reported by grantee institutions to NIH in a consistent format
- grantee institutions are not required to report to NIH any financial interests that they have with outside companies
The inspector general’s review focused on the 41 grantee institutions that submitted financial conflict-of-interest reports to NIH in fiscal year 2006.
The review found that the most common financial conflict of interest is equity ownership (including stock and stock options) in companies in which the researchers’ financial interests could significantly affect the grant research.
Other financial conflicts of interest among researchers involved inventing technology, consulting, or holding positions with outside companies. To manage financial conflicts of interest, grantee institutions often require researchers to disclose conflicts in research publications; however, grantee institutions rarely reduce or eliminate financial conflicts of interest.
The report includes a number of recommendations – that it has previously recommended – to improve the reporting of financial conflicts of interest.
Fox’s Stossel to appear at Ark. health-care forums
Filed under: Conflicts of interest, Health care reform, Health journalism
While plenty of people are paying attention to the Obama administration’s assertions that Fox News is “ideologically predisposed against Obama and his agenda,” fewer have noticed that the host of a new show on Fox Business will appear at town hall meetings in Arkansas sponsored by Americans for Prosperity to “discuss the dangers of government-forced health care.”
John Stossel, until recently co-host of ABC’s 20/20, will appear at three events on Thursday with the organization’s president, Tim Phillips; AFP Texas director Peggy Venable and a small business owner “to debate solutions and discuss the dangers of government-forced health care,” according to a press release from AFP that bills Stossel as a “veteran journalist.”
John Stossel
Americans for Prosperity’s “Patients First” project advocates against “a costly, government-defined plan paid for by American taxpayers.”
According to Fox, Stossel’s new show “will feature in-depth reports on domestic and international libertarian issues and will debut during the fourth quarter of this year in FBN’s primetime lineup. Stossel and a panel of experts will explore a wide range of topics including civil liberties, the business of health care and Social Security.” Stossel also will make regular appearances on Fox News as well.
This is not the first time Stossel has made appearances at the group’s forums.
Feds take Columbia to task over decade-old study
Filed under: Conflicts of interest, Health data, Hospitals, Hot Health Headline, Nursing, Pharmaceuticals, Studies, Tools
The run of intriguing health journalism from the Huffington Post Investigative Fund continues this week, as Jeanne Lenzer and Shannon Brownlee look at the federal government’s entrance into an internal conflict at Columbia University’s medical center over the legality and morality of a heart-related study that took place from 1999 to 2001, one in which some experts say it was “virtually guaranteed” that some patients would suffer hemorrhaging.
Columbia has already conducted three internal investigations on the matter. Now, the federal government has asked for a full account of what happened to the study’s participants and ordered that Columbia write a letter to the study’s participants and disclose the “true nature” of what some contend was a deceptive study.
NOTE: In addition to the story itself, the reporters have posted a selection of key documents online.
Lenzer and Brownlee explain that the study went wrong when participants (some of whom were “Spanish-speaking patients who lived in low-income neighborhoods near the hospital”) “were not told that they could be given high doses of the fluids or that they faced a risk of serious bleeding.” Then, despite protests from hospital doctors that patients hadn’t been informed of what were serious possible health risks, the local Institutional Review Board allowed the study to continue. This was followed by years of internal fighting, and finally capped by the HHS’ Office of Human Research Protections entrance into the fray.
U. of Wisconsin conflict of interest policy gutted
Filed under: Conflicts of interest, Health data, Hot Health Headline
The Milwaukee Journal-Sentinel’s John Fauber reports that the University of Wisconsin’s proposed conflict-of-interest rules have been heavily watered down with the addition of an exception for doctors, including orthopedic surgeons, who implant devices. This is also a group of doctors who tend to bring in significant amounts of money for the university and thus tend to be rather influential.
Fauber:
After getting pressure from orthopedic surgeons, medical school and UW Medical Foundation officials amended the policy to allow doctors to make presentations for medical-device companies, provided they are paid no more than $500 an hour plus food, transportation and lodging.
In recent years, some of the most egregious ethical violations in the medical field, including allegations of kickbacks and extravagant payments, have involved orthopedic surgeons and companies that make implantable devices.
How extremists orchestrated health care hooliganism
Filed under: Health care reform, Hot Health Headline
Tim Dickinson, writing for Rolling Stone, amassed a neat little pile of documents that enable him to make a solid case that the supposedly spontaneous town hall protests were in fact carefully orchestrated by a number of political and interest groups.
An extensive excerpt of his piece is available online, it focuses on the groups that Dickinson says made up the coalition behind the hooliganism. Some highlights, taken largely from Dickinson’s text:
- Top Republican legislators worked with the organizers “not only to block health care reform but to bankrupt President Obama’s political capital before he could move on to other key items on his agenda, including curbing climate change and expanding labor rights.”
- The basic script was written by Frank Luntz, who “rose to fame in 1994 as pollster for Newt Gingrich’s Contract With America, and crafted the Republican playbook on global warming.” Dickinson posted the full text of Luntz’ memo laying out Republican buzzwords and strategy, it’s a great read full of familiar phrases.
- Americans for Prosperity, the ringleader of the hooligan-based efforts, “is a front group for oil billionaires David and Charles Koch, co-owners of the world’s largest private oil and gas conglomerate.” Its efforts are led by Tim Phillips, who “served as a strategic consultant to George W. Bush in 2000 and reputedly took part in the smear campaign in South Carolina that portrayed John McCain’s adopted daughter as his mulatto love child.” According to Dickinson, their health care rabble rousing has paid off: “AFP now boasts 700,000 members and chapters in 24 states.”
- As an integral part of the effort, former House Majority Leader Dick Armey’s FreedomWorks has continued the legislator’s push against government-run medicine. Its goal, Dickinson reports, is to become “a grassroots juggernaut capable of going toe-to-toe with the unions, extreme enviros and the MoveOn.org’s of the world.”
- Conservatives for Patients’ Rights, another major player in the effort, is led by a former CEO of a hospital conglomerate who “now runs a chain of urgent-care clinics that serve uninsured Americans fearful of being bankrupted by hospital emergency-room visits” and would stand to lose a heap of money should the percentage of insured American rise.
As an interesting (if not particularly timely) side note, Dickinson also found that death panel pusher’s Betsy McCaughey’s notorious (and successful) attempt to derail Clinton-era health care reform was partly aided by tobacco companies that opposed the Clinton proposal to fund reform with taxes on their products.
Lieberman picks apart Baucus changes
In her latest post on CJR.org, AHCJ immediate past president Trudy Lieberman picks apart the Baucus bill, with a special focus on the Montana senator’s latest changes. Lieberman pays special attention to Baucus’ concessions, and takes care to point out exactly who benefits and how.
Her assessment of the bill’s provision insurers to vary rates based on age (within limits) is particularly incisive:
In exchange for issuing policies to sick people, insurers get to jack up premiums for older people, a kind of proxy for medical underwriting. Baucus essentially allows companies to charge older people more for their coverage. Initially, he wanted to charge them five times more than a younger person, but now he suggests letting them charge four times more. A 58-year-old, for example, who has lost employer coverage and is struggling to pay the premiums for an individual policy may not see that as much of a gift.
Project looks at high price of health care in Dallas
Filed under: Conflicts of interest, Health data, Hot Health Headline
In their “The Cost of Care” package, Dallas Morning News reporters seek to explain why, as Jim Landers says in the lead of a key story, one of the nation’s largest cities is “broken market where doctors, hospitals and other providers shower patients with services of diminishing value but staggering cost.”
The problems are clear: The Dartmouth Atlas ranks Dallas as the 13th priciest health market in the nation, while new Census data gives Texans the dubious honor of living in the least-insured state in the nation. The whys and hows of these issues are trickier, but the Morning News wades into the health spending morass.
Dallas sees no relief in health care expenses as competition drives up costs
Jim Landers explores the paradox that health care in the city is expensive because there’s so much competition, and considers the contributions marketing and medical records make to health care costs. The piece includes an interesting profile of CIGNA regional president David Toomey’s attempts to rein in costs in the area.
Robert Garrett and Jason Roberson explain how everybody pays the price for the area’s super-low insurance coverage rates, and put an exact cost estimate, both financial and human, on the price of a high uninsured population.
Doctor-owned hospitals a lucrative practice, though opinions split on benefits
Gary Jacobson’s weighs the costs and benefits, both economic and medical, of doctor-owned hospitals, which are more common in Dallas than any other major metropolitan area.
Medical imaging a growth industry, but some say unneeded scans increase expenses
Ryan McNeill assesses just how useful the high-speed, unregulated growth of medical imaging has been for patients, doctors, investors and other stakeholders.
Critics see home health care boom as wasteful, but others tout benefits
When you’re looking to explain growing costs, it makes sense to focus your efforts on growing sectors, and Gregg Jones does just that, looking at the fast-growing home health sector. He leads with Medicare fraud, but then shows just how much deeper and more complicated the cost equation of home health care can get.
Baucus plan takes on ’secret pricing’
Filed under: Health care reform, Hospitals, Hot Health Headline
The Associated Press’ Carla K. Johnson reports that a provision of Sen. Max Baucus’ health reform plan has brought attention to the “secret pricing” model that dominates in the health care system. According to Johnson, the Baucus bill would not only require hospitals to list standard charges for each procedure up front, it would also “require health plans to report how much of each dollar paid in premiums goes to items other than medical care.”
Maine and New Hampshire already provide online cost-comparison tools, and Johnson quotes a scientist at the Agency for Healthcare Research and Quality as saying such information “ought to be available on a more widespread basis.”
Related
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Health Journalism 2010, AHCJ's annual conference, features a world-class program with story ideas, sources, stronger reporting skills, chances to meet newsmakers and network with other journalists.
- Health and education: Covering these intersecting beats
- Reporting on the business of health care
- Health reporting resources for journalists on state and local government beats
- Shortened Lives: How location, lifestyle affect health
- Covering a complex story for the long haul
- Aging in the 21st Century: Presentations and tip sheets
- AHCJ calls for better information from Joint Commission Web site
