The Canadian Medical Marveller is now News Editor at Mad In America. I am editing the daily “In the News” and “Around the Web” features. To go to the Mad In America website, click here. If you’d like to subscribe to the RSS Feed for Mad In America click here, or click the RSS Feed button at the top of the home page on the Mad In America website.
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Considering that it’s been reported globally for many years that pharmaceutical drugs –particularly the widely popular, often prescribed, marginally helpful kinds — are polluting water bodies at significant levels and affecting amphibian health and fish behaviours, it’s as much disturbing as it is encouraging that the European Commission has finally started “watching” three particular drugs.
For the first time, the European Commission (EC) has included pharmaceutical compounds in a list of chemicals thought to pose a risk to the safety of surface water.
The EC made the announcement as it added 12 new substances to its priority list of 33 known pollutants in the latest amendment to the 2000 Water Framework Directive, which governs how river, lake and coastal waters are monitored and how emissions into them controlled across the EU.
An article by Andreas Laupacis in HealthyDebate.ca reviews conflicts of interest with respect to government and contract health services researchers, and raises some provocative issues not often discussed even amongst COI watchdogs:
For example, Evidencenetwork.ca, a web site that provides journalists and others with access to “non-partisan health policy experts and evidence” removed me from their list of experts because I received about $15,000 per year for work I did for three pharmaceutical companies (being a member of Data Monitoring Committees and providing advice about the design of clinical trials). However, my guess is that they would not have seen any significant conflict of interest with my previous role as CEO of the Institute for Clinical Evaluative Sciences (a health services research institute that receives millions of dollars of funding from the government of Ontario), even though the personal payment I received from public provincial funds was much greater than what I received from pharma, and when I was CEO I had a clear interest in not criticising the Ontario government publicly about their health policies, because government support was essential for the survival of ICES.
HealthyDebate.ca has an overview of some of the findings, issues and concerns with respect to big pharma’s influence on doctors written by family physician Ritika Goel.
So it makes sense why the companies would do this, but why would doctors not resist these practices? In 2007, a national survey of doctors in the US found that 94% had some form of relationship with the drug industry. While 28% reported directly receiving payment for consulting, lecturing or enrolling patients in a study, a striking 78% reported receiving drug samples and 83% reported receiving food in their workplaces.
When considering the impact of these relationships, two-thirds of medical school department chairs in the US felt a relationship with the industry had no impact on professional activities (and almost two-thirds reported having such a relationship).
The Toronto Star reports on a study that found University of Toronto medical school students are being routinely misled about the enormous influence of pharmaceutical companies on their educational programs.
As Canada’s opioid addiction epidemic took root, students at one of the country’s most prestigious medical schools were receiving “potentially dangerous information” about the use of these drugs, a new study claims.
The lectures were supported by the pharmaceutical companies that market opioids in Canada, the guest lecturer was a member of the speakers’ bureau of the pharmaceutical companies and a free reference book, published by one of the drug firms, was distributed free.
But these conflicts of interest were not fully disclosed to students…
A new study published in PLOS One looks at pharmaceutical industry activities and influences on universities in Canada and conflict of interest policies in Canadian medical schools, and finds COI policies “Too Few, Too Weak.” Lead author Adrienne Shnier is tracking ensuing media coverage on her website. The Toronto Star has published a story on it:
With “restrictive” policies in all but three categories, Western University was ranked No. 1.
In more than half of all schools, however, the researchers found that policies were either “permissive” or nonexistent in most categories. The worst offender was the recently established Northern Ontario School of Medicine (NOSM) in Sudbury, followed by the University of Alberta and Queen’s University.
“Most people don’t expect that the biggest schools in the country and the most influential schools in the country actually scored some of the lowest (scores),” said Shnier. “That’s problematic . . . because when you see a diploma on the wall in a physician’s office from one of these reputable schools, you expect that they’ve received a balanced education.”
David Hutton of the Parkland Institute has done an analysis of whistleblower legislation along with recommendations, with a focus on Alberta in particular. Looking at the important health findings that have come from whistleblower protections and incentives in the U.S. that have led to successful lawsuits, we obviously desperately need similar protections here in Canada.
The head of the U.S. Center for Disease Control is issuing a public plea for doctors to stop prescribing so many painkillers so often unnecessarily for relatively minor aches, because addictions and fatal overdoses are going up dramatically. A Los Angeles Times article reports:
Dr. Tom Frieden, director of the U.S. Centers for Disease Control and Prevention, said that doctors are relying on these powerful drugs to treat chronic pain when physical therapy, exercise and other remedies would be safer and in many cases more effective.
“These are dangerous medications, and they should be reserved for situations like severe cancer pain,” Frieden said in his most forceful statement yet on the use of narcotic painkillers. “In many other situations, the risks far outweigh the benefits. Prescribing an opiate may be condemning a patient to lifelong addiction and life-threatening complications.”
Global TV News has released an encore presentation of its investigation into how antidepressants got into the marketplace despite glaring flaws in evidence that they even worked, and their terrible side effects.
Just discovered an interesting website, “Retraction Watch,’ that reports on studies, professors and medical researchers caught faking data, falsifying conclusions and fudging numbers at such a scale that the studies have been retracted, or the doctors fired etc. You can find other interesting sources of information on the CMM “Links” page.
The work of Peter Doshi and Cochrane Collaboration lead Dr. Tom Jefferson is reviewed in this New York Times article. It provides some enlightening information about the past 10 years of efforts to get drug companies to make trial data public. The hidden battle over whether the Tamiflu vaccine for flu actually works or not is particularly interesting reading.
The Canadian Health Coalition has posted videos of the proceedings of the conference Rethinking Drug Coverage: Time for Universal Pharmacare?
Paul Webster provides a good overview in the Vancouver Observer of the BC liberal government’s gutting of public-service drug research and analysis in the province, including this admission from Premier Christy Clark about axing the Therapeutics Initiative:
Unplugging the Therapeutics Initiative, the premier suggested, was in keeping with her commitment to “a businesslike manner” in running the government. “We are managing the costs of drugs as best we can,” she insisted in language verging on doublespeak. “Since I have been Premier, we have lowered the cost of generic drugs for seniors. And we have done that by working hard with the pharmacies that provide those drugs.”
But the need to control drug costs has to be balanced with “respecting the private sector,” she explained. The attack on the teams that audit drug safety and spending, she seemed to want people to believe, was necessary in “supporting an economy that is growing, that is going to pay for the things we need.”
Clark appeared to be suggesting the TI was being sacrificed to appease private interests.
In 2005, there was a widely-publicized global effort by the world’s leading medical journals to try to rein in conflicts of interest that were polluting medical studies. Since that time, we’ve seen a steady erosion of that noble effort, mainly because so few studies could actually meet the new, stricter conflict of interest guidelines, and consequently the journals had little to publish. It has become like a long-running, mutual game of “chicken” between the drug industry and the journals. The latest development is the Journal of the American Medical Association’s decision to drop all requirements that clinical studies undergo independent statistical analysis prior to publication. The JAMA editorial states that their policy has been “perceived by some in academia and industry as creating barriers to publication of important trial results.” (CMM note: Er, wasn’t that what the policy was supposed to do?) Accordingly, the JAMA editorial continues, “JAMA will evaluate and consider for publication clinical trials that are analyzed by statisticians employed by or contracted by the study sponsor, without requiring independent statistical analysis by an academic biostatistician.”
Focus magazine has published the Canadian Medical Marveller’s investigation into the activities of drug company sales representatives in Victoria, British Columbia, Canada. What did we find? Seems like things may not be different in Canada as in the U.S., except that Canada isn’t regulating or prosecuting drug companies as much for breaking the law — or indeed monitoring at all.
An excellent analysis on PharmaWatch Canada critically explores the past 10 years of strengthening relationships between various public and private bodies to create an expanding “medico-security-industrial complex,” particularly through the use of expanding mental health laws.
The ghost of Adam Lanza has materialized into the allocation of one and a half billion dollars from the Obama administration for the identification of youth ‘at-risk’ for ‘mental illness’. Senator Al Franken of Minnesota, for example, is currently pushing The Mental Health in Schools Act, which would include the training of people who interact with children every day — “from bus drivers to principals” — to detect ‘signs’ of madness for early intervention.
Wrapped in commonsense and benevolence, there is something about psychic policing that smells like terror. As a practice to identify and intervene on threat before it arises, it moves like a mechanism of security and echoes with post-9/11 politics. It reminds me of the 2002 launch of the US New Freedom Commission on Mental Health. In his opening remarks, then-President George W. Bush invoked “soldiers in the armies of compassion” who were committed to “fighting evil” to “make America a welcoming place for people with disabilities”. The Commission went on to recommend TeenScreen – a program of “mental health check-ups” in schools for identifying and intervening on youth ‘at-risk’ for madness.
A collection of stunning statistics about the extent of prescription drug use in this press release from the Mayo Clinic about a forthcoming study:
Nearly 70 percent of Americans are on at least one prescription drug, and more than half take two, Mayo Clinic researchers say. Antibiotics, antidepressants and painkilling opioids are most commonly prescribed, their study found. Twenty percent of patients are on five or more prescription medications, according to the findings, published online in the journal Mayo Clinic Proceedings.
This British Medical Journal editorial presents a chilling, not-often-discussed view of how conflict of interest in medicine endangers even those of us with good doctors. The author recounts the story of how a group of doctors, all of whom had been bought off by the manufacturer of the drug alteplase, wrote a best-practices guideline for treating acute stroke with the drug alteplase. However, the body of scientific evidence, and most emergency room physicians, found the drug of little benefit and with very high risks. Nevertheless, doctors risk being sued for not following these now-established guidelines.
Meanwhile, emergency physicians find themselves in a difficult position. The guidelines represent the standard of care against which they will be judged in any claims of malpractice. And although the rules on conflict of interest may be tightening, the current standards of care across much of medicine originate with similarly biased guideline panels.
This New York Times article reports on findings that basic medical procedures around the U.S. consistently cost much, much more than in comparable countries, and that it’s this, rather than rising drug costs, that is accounting for much of the rise in health care costs. And it seems to be related to backroom negotiations between health care providers and insurance companies.
Americans pay, on average, about four times as much for a hip replacement as patients in Switzerland or France and more than three times as much for a Caesarean section as those in New Zealand or Britain. The average price for Nasonex, a common nasal spray for allergies, is $108 in the United States compared with $21 in Spain. The costs of hospital stays here are about triple those in other developed countries, even though they last no longer, according to a recent report by the Commonwealth Fund, a foundation that studies health policy.
While the United States medical system is famous for drugs costing hundreds of thousands of dollars and heroic care at the end of life, it turns out that a more significant factor in the nation’s $2.7 trillion annual health care bill may not be the use of extraordinary services, but the high price tag of ordinary ones.
This Journal of Social, Cultural and Political Protest case study of suppression tactics against a Canadian animal rights group is interesting reading, especially for the linkages it draws between AstraZeneca and Novartis pharmaceutical companies and their private security firms, local police and government, and state “counter-terrorism” operations. Here’s the abstract:
This article examines how policing, security, and intelligence agencies have networked with private agents in a campaign targeting Stop Huntingdon Animal Cruelty (SHAC) in Canada. SHAC is a network of autonomous groups that coordinate an international campaign to disrupt the animal testing corporation, Huntingdon Life Sciences. Unlike in the USA and the UK, where SHAC groups have been targeted by a series of extraordinary legislative initiatives that are coordinated at a national level, the campaign directed at SHAC-Canada has its root in the work of private detectives. Drawing from the results of Access to Information Act requests and interviews with SHAC members, we discuss how the preliminary surveillance conducted by private detectives facilitated a multi-scalar policing effort that includes a network of municipal, provincial, national, and international police–intelligence agencies. To enrich existing typologies of social movement repression, we emphasize the role that private security plays in monitoring activists and in providing information to public police. Our research suggests that public and private agencies involved in regulation of SHAC are networked through surveillance, engaging in information sharing that casts a wider net of suppression.