ARE OUR LEADING PEDIATRICIANS DRUG INDUSTRY SHILLS?
- From: rpautrey2 <rpautrey2@xxxxxxxxx>
- Date: Sun, 27 Jul 2008 11:23:17 -0700 (PDT)
Article:ARE OUR LEADING PEDIATRICIANS DRUG INDUSTRY SHILLS?:/c/a/
2008/07/12/IN7G11L6TL.DTL
ARE OUR LEADING PEDIATRICIANS DRUG INDUSTRY SHILLS?
Lawrence Diller
Sunday, July 13, 2008
Most parents have never heard of him, but Joseph Biederman of Harvard
may be the United States' most influential doctor when it comes to
determining whether their children are normal or mentally ill.
In 1996, for example, Biederman suggested that drugs like Ritalin
might serve 10 percent of American kids for Attention Deficit
Hyperactivity Disorder. By 2004, one in nine 11-year-old boys was
taking the drug. Biederman and his team also are more responsible than
anyone for a child bipolar epidemic sweeping America (and no other
country) that has 2-year-olds on three or four psychiatric drugs.
The science of children's psychiatric medications is so primitive and
Biederman's influence so great that when he merely mentions a drug
during a presentation, tens of thousands of children within a year or
two will end up taking that drug, or combination of drugs. This
happens in the absence of a drug trial of any kind - instead, the
decision is based upon word of mouth among the 7,000 child
psychiatrists in America.
That's why Iowa Sen. Charles Grassley's recent revelation that
Biederman did not declare $1.6 million in drug company consulting fees
is so important, scary and tragic. If true, this scandal is yet one
more stake in the heart of American academic medicine's credibility
with frontline doctors like me - and more importantly, with the
parents of the patients I deal with every day.
American medicine, with psychiatry the most culpable, has fallen back
to a time more than 100 years ago when doctor credibility was
tantamount to the promotion of patent medicine. Subsequent reforms
severed ties between medical school doctors and the drug industry -
and for decades there was a much more ethical balance between the
industry and physicians.
Now once again, drug company money is corrupting medical practice and
the maintenance of our country's health. In a market economy, both
doctors and the companies are motivated by profit. However, doctors'
Hippocratic oath and their personal/professional relationships with
their patients attenuate the most crass aspects of a fee-for-service
system.
In contrast, drug companies owe primary responsibility to their
shareholders. Of course these companies must operate within legal
business and Food and Drug Administration restraints, but the drive to
push such rules to the limit is implicit in any business.
Such a strategy isn't always beneficial when our children's health is
affected.
The Fortune 500 drug companies, by their sheer economic clout, have
become the single most dominant influence in our health care system.
The ambiguities of children's mental health and illness make child
psychiatry the most vulnerable branch of medicine open to such
influence.
In this climate, drug company research money, professional medical
education and direct advertisements to parents tilt families and
doctors to biologically brain-based solutions, rather than nondrug
(e.g., parenting and education) approaches.
That's why we're seeing famous (or infamous) Newsweek cover boys like
Max, a 10-year-old who has taken 38 psychiatric medications in his
short, unhappy life.
Research funding must be directed to the needs of patients and their
doctors - not to the bottom line of stockholders. Drug companies can
still make money, but it's ethically immoral when stockholder profits
trump children's health needs (as in the cover-up of negative studies
of antidepressants in children).
More money must be directed toward head-to-head competition between
existing generics and the new products, and toward more studies
comparing nondrug or combination approaches to drug-only interventions
for children's problems.
Drug company funding of medical research is not going to end - nor
should it entirely stop. Yet a new set of federal rules dictating the
transparency and direction of such funding is desperately needed to
redress a dangerously corrupt system. It's not enough to simply have
doctors more explicitly report their incomes from drug companies,
though it is a very useful first step.
I remember about six years ago when I read a major article by the
Biederman team on the advantages of a non-Ritalin drug pathway for
ADHD. On the same day, much to my dismay, I also heard him give a
speech - for a Wall Street audience - promoting a new drug by Eli
Lilly called Strattera.
Although Strattera turned out to be a bust both clinically and
commercially for ADHD, I was still shaken that such a prominent
researcher could be so brazen with his potential conflict of interest
appearance.
The $1.6 million that Biederman didn't declare is only a small
fraction of the full amount of research funding that his clinic
receives from nearly a dozen companies that pay for not only the cost
of running studies but also the salaries of the doctors involved.
Virtually all doctors who receive drug company money say they are not
influenced, but every independent study examining the effects of such
money says they are.
The leadership of Harvard's psychiatry department is strangely silent
or even defends Biederman. These are good men with solid reputations
both in drug and nondrug aspects of treatment. Yet they know that
their psychiatry department would not exist were it not for drug
company money - considering the withdrawal of federal research dollars
over the past 25 years and the meager reimbursements that
psychiatrists receive for their services from insurance companies and
Medi-Cal.
Sens. Grassley, a Republican, and Herbert Kohl, a Wisconsin Democrat,
have introduced the Physician Payments Sunshine Act, which will
require more vigorous reporting and enforcement on payments (anything
more than $500) received by doctors from drug companies.
But in addition, we need laws to have the federal government, along
with the major academic research centers, coordinate and direct the
use of drug company money in medical research. This is not pie-in-the
sky wishing. Such reform was precisely what the doctors of 100 years
ago accomplished in this country.
Lawrence Diller, M.D., practices behavioral-developmental pediatrics
in Walnut Creek and is on the clinical faculty of UCSF. He is the
author of "The Last Normal Child" (Praeger, 2006). Contact us at
insight@xxxxxxxxxxxxxxxx
http://sfgate.com/cgi-bin/article.cgi?f=/c/a/2008/07/13/IN7G11L6TL.DTL
This article appeared on page G - 2 of the San Francisco Chronicle
© 2008 Hearst Communications Inc.
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2008/07/12/IN7G11L6TL.DTL
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