Healthcare for all called an ethical issue

A professional association of U.S. bioethcists has come out in favour of President Barack Obama's plans to make public health insurance available to the 50 million Americans currently uninsured.

Collegiate bioethicists waded into the health-care reform debate Tuesday, declaring that "the current state of health care is unethical" and branding as false criticisms that congressional proposals would threaten patient choice or deny older Americans medical treatment.

"We felt we needed to speak up. The tenor of the debate has become quite strained and full of misinformation," said Jeffrey Kahn, president of the new, 60-member Association of Bioethics Program Directors. Kahn also heads the Center for Bioethics at the University of Minnesota.

"There is no morally defensible reason why some Americans get excellent medical care at costs they can afford and other Americans lose their homes or go into bankruptcy attempting to secure treatment for a seriously ill loved one," a statement from the group said.

"The current proposals being debated in Congress all go a long way toward making health care in America more just," it said. The group disputed what it called "the top three myths" about the proposals: that they would prevent individual control over health decisions, that costs would be cut by prohibiting costly treatments and that older people would be denied end-of-life care.

"This [end-of-life argument] may be the most pernicious myth of all," the statement said. Instead, a provision would pay doctors to spend time with dying patients and their families as they describe the care they want. The statement is on the group's website, www.bioethics directors.org.

The bioethcists have posted a fact sheet disputing the claims made by critics of the healthcare plan.

Letter calls for Lancet to be sold

A letter to the editor -- sparked by revleations in this blog, in The Scientist online and the American Journal of Bioethics blog -- calls on medical publishing company Elsevier to either divest of its respected journal The Lancet, or its pharmaceutical services division, which helps drug companies promote their products.

"Although the relationship between medical publishing and service to the pharmaceutical industry is not unique to Elsevier, we question the compatibility of these two roles," wrote Jon Jureidini, a psychiatry and paediatrics researcher at Australia's University of Adelaide, and Robyn Clothier, a staffer at the non-profit Healthy SKepticism, which Jureidini heads.

Elsevier wrote a response letter, saying specialty publications are okay as long as they come with full disclosure.

We believe that high standards for disclosure are appropriate and necessary to ensure that the purpose and sponsorship of any publication are clear to the reader, and we are confident the disclosure policies in place at Excerpta Medica meet this standard.

More medical conflicts revealed

Working with medical companies whose products they are supposed to be testing can make a doctor a millionaire, according to reports surfacing in the United States this summer. 

The latest revelations come from Minnesota, where documents released by the offices of Iowa Senator Charles Grassley show that University of Minnesota researcher Dr. David Polly billed Medtronic for reviewing one of its products at the request of a local non-profit group.  

Back in 2005, Dr. David Polly participated in a review of a new technology in spine surgery by an influential nonprofit group. After he concluded the work, the University of Minnesota expert submitted a bill for some of his time to Fridley-based Medtronic.

Four years later, leaders of the nonprofit group — the Bloomington-based Institute for Clinical Systems, or ICSI — say they wouldn't have let Polly participate in the review had they known about the billing arrangement. Technology reviews by ICSI are supposed to be impartial, they say, and a Medtronic device was among those being evaluated.

"I was shocked," said John Sakowski, the chief operating officer at ICSI, who learned of Polly's bill with the recent release of Polly's records by Sen. Charles Grassley, R-Iowa.

Although surprised, Sakowski said ICSI is not accusing Polly of wrongdoing in the matter. The nonprofit group didn't specifically ask whether the surgeon was billing an interested party for working on the review, and ICSI said the results generated by the group were solid — even with the apparent conflict of interest.

Medical ethicists say they have questions about how both ICSI and Polly acted during the episode, but they conclude that the moral of the story goes to a much broader point: Disclosure requirements throughout the health care industry have been woefully lacking.

"More independent control of financial relations is needed, clear conflict-of-interest rules are needed, and investigators have to receive proper education about conflicts of interest," said Trudo Lemmens, a medical ethicist at the University of Toronto. ...

Polly's bill for working on the ICSI review was just one of several hundred items in billing records released last month by Grassley. The senator has been probing the financial ties between doctors and medical companies for several years and has introduced federal legislation that would require more public disclosure.

The records released last month showed how Polly accumulated nearly $1.2 million in consulting bills to Medtronic between 2003 and 2007. Compared with the grand total, the bill for work at ICSI was a drop in the bucket.

It's not the first time Grassley's office has revealed payments to doctors and researchers. Last June, a Wisconsin newspaper used documents from his office to detail millions in payments to 11 doctors with the University of Wisconsin School of Medicine and Public Health.

Topping the list of those receiving large sums from medical companies was a group of UW orthopedic surgeons. They include:

• Paul Anderson, a professor of orthopedic surgery, who got $150,000 for eight days of work as a consultant from medical device-maker Medtronic. Anderson, who could not be reached for comment, also earned a UW salary of $755,000 in 2007.

• Ben Graf, an associate professor of orthopedic surgery, who got $770,000 in royalties from device company Smith & Nephew. Graf, who could not be reached for comment, also earned a UW salary of $591,000 in 2007.

• Clifford Tribus, an associate professor orthopedic surgery, who got $310,000 for 15 days of work as a speaker and consultant and from royalties from device company Stryker Spine. Tribus also earned a UW salary of $618,000 in 2007.

 

Wyeth hired ghostwriters to push HRT

Once again, a class action lawsuit has served to unveil the extent of ghostwriting in top medical journals.

In a story published this morning in the New York Times, drug giant Wyeth was found to have paid for more than two-doxen articles favourable to hormone replacement therapy over a seven-year period. For almost half that time, HRT was coming under scrutiny as independent tests linked the controversial treatment to breast cancer, hear disease and stroke.

Newly unveiled court documents show that ghostwriters paid by a pharmaceutical company played a major role in producing 26 scientific papers backing the use of hormone replacement therapy in women, suggesting that the level of hidden industry influence on medical literature is broader than previously known. 

The articles, published in medical journals between 1998 and 2005, emphasized the benefits and de-emphasized the risks of taking hormones to protect against maladies like aging skin, heart disease and dementia. That supposed medical consensus benefited Wyeth, the pharmaceutical company that paid a medical communications firm to draft the papers, as sales of its hormone drugs, called Premarin and Prempro, soared to nearly $2 billion in 2001.

But the seeming consensus fell apart in 2002 when a huge federal study on hormone therapy was stopped after researchers found that menopausal women who took certain hormones had an increased risk of invasive breast cancer, heart disease and stroke. A later study found that hormones increased the risk of dementia in older patients. 

The ghostwritten papers were typically review articles, in which an author weighs a large body of medical research and offers a bottom-line judgment about how to treat a particular ailment. The articles appeared in 18 medical journals, including The American Journal of Obstetrics and Gynecology and The International Journal of Cardiology. 

The articles did not disclose Wyeth’s role in initiating and paying for the work. Elsevier, the publisher of some of the journals, said it was disturbed by the allegations of ghostwriting and would investigate.

The documents on ghostwriting were uncovered by lawyers suing Wyeth and were made public after a request in court from PLoS Medicine, a medical journal from the Public Library of Science, and The New York Times.

A spokesman for Wyeth said that the articles were scientifically accurate and that pharmaceutical companies routinely hired medical writing companies to assist authors in drafting manuscripts.

The court documents provide a detailed paper trail showing how Wyeth contracted with a medical communications company to outline articles, draft them and then solicit top physicians to sign their names, even though many of the doctors contributed little or no writing. The documents suggest the practice went well beyond the case of Wyeth and hormone therapy, involving numerous drugs from other pharmaceutical companies.

The company hired to write the studies, as well as one of the academics credited for writing one of them, stood by the work.

In response to a query from a reporter, Michael Platt, the president of DesignWrite, wrote that the company “has not, and will not, participate in the publication of any material in which it does not have complete confidence in the scientific validity of the content, based upon the best available data.” 

The problem is, even if the science itself is not damaged by the connection to the company benefitting from it, its credibility can be.