Friday, June 24, 2005

still more troublesome news about Big Pharma and cahoots

PLoS again has published an article ,which if its allegations are true, is more cause for concern about who the heck we can trust and what data about medications we can believe.The PloS article is a story of 5 whistleblowers including the outspoken Dr. David Graham who has 20 years of experience as as FDA safety officer . It includes the comments also a former drug rep who has written and directed a movie about drug detailing. The article is written by a freelance journalist from New York. Health Care Renewal has a recent posting also on the revelations of drug detailing and refers to a different sales rep than the one in the PLoS piece. Some of the accusations are the kind of thing I don't want to believe because it seriously calls into question the underlying data base from which I have drawn over the years to prescribe medications. Having some experience in the legal area as a expert witness and once as a plaintiff, I know that hearsay evidence is not at the top of the evidentiary food chain and often is not even considered by the court and at least some if not most of the material in the PLoS article is hearsay.
I believe if one wants more facts and figures a better and bigger source is the recently published book by former NEJM editor, Dr. Marcia Angel which received a very good review in the June 22, 2005 JAMA. The New York Review of Books offers a brief summary of some of Angel's main points.
The "cahoots" part of the title refers to comments of one of the whistleblowers in the PLoS article, Allen Jones, who was an investigator for the Pennslyvania Office of the Inspector General and his allegations that drug companies made payments to state officials to develop a medication treatment algorithm. BMJ has a recent article which alludes to the TMAP (Texas Medication Algorithm Project) and quotes Allen Jones , who asserts among other things-that this project was strongly influenced by Big Pharma, was exported to Pennsylvania where drug company money was also used to influence that program. The headline is attention getting: " Bush plans to screen whole US population for mental illness." The BMJ article discusses the Bush adminstration proposal to fund projects to screen for mental health problems using the TMAP as a model. Reference is to Bush's New Freedom Commission on Mental Health and the commission report can be found here.
The BMJ article refers to the controversy over alleged improper influence by drug companies on the choice of drugs used in the treatment algorithm and points out purported relationships between Lilly and the Bush family and administration. Supporting both the TMAP and national program is Dr. Darrel Regier, director of research at the American Psychiatric Association (APA). Not mentioned in the BMJ article is the larger issue which libertarians would quickly raise , namely should the government be involved in funding mental health screening at all. At the end of this we seem to be left with allegations and claims and a "he said-he said" situation which most of us would feel unable to sort out. Allegations regarding the influence of drug companies are more credible, however, since we have been enundated with account after account describing Big Pharma's role in manipulating medical research and the techniques used to promote their products.

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