Use of Educational Grants by Pharmaceutical Manufacturers

senate.jpg   This report has just been released by the United States Senate Committee on Finance. Here is the news release [April 25, 2007]:
Inquiry reveals educational grants as common business practice, but potential for abuse remains

From the executive summary:
Washington, DC – Senate Finance Committee Chairman Max Baucus (D-Mont.) and Ranking Republican Chuck Grassley (R-Iowa) today released results of a Committee inquiry into drug company grants to fund continuing education for medical providers. Baucus and Grassley launched their probe following allegations that drug companies were using educational grants for improper purposes, such as rewarding physicians for prescribing their drugs, influencing clinical practice guidelines and Medicaid formularies, or promoting drugs for uses that have not been approved by the FDA – an illegal practice called “off-label promotion.” Guidance on keeping education programs independent of drug company influence has been issued by numerous organizations, including the Accreditation Council for Continuing Medical Education (ACCME).
The report includes information from ACCME suggesting that some purportedly independent educational programs may still be influenced too much by their pharmaceutical sponsors. It appears that ACCME’s oversight of accredited CME providers is insufficient to guarantee the required independence. 
Download the full report

Following the script: How drug reps make friends and influence doctors

drugs.jpg    Just published in PLoS Medicine:

Fugh-Berman A, Ahari S (2007) Following the script: how drug reps make friends and influence doctors. PLoS Med 4(4): e150

Funding: This work was supported by a grant from the Attorney General Prescriber and Consumer Education Grant Program, created as part of a 2004 settlement between Warner-Lambert, a division of Pfizer, and the Attorneys General of 50 States and the District of Columbia, to settle allegations that Warner-Lambert conducted an unlawful marketing campaign for the drug Neurontin (gabapentin) that violated state consumer protection laws.

See Table 1. Tactics for Manipulating Physicians    Part 2 of the table

It’s my job to figure out what a physician’s price is. For some it’s dinner at the finest restaurants, for others it’s enough convincing data to let them prescribe confidently and for others it’s my attention and friendship…but at the most basic level, everything is for sale and everything is an exchange. —Shahram Ahari

Excerpt: In 2000, pharmaceutical companies spent more than 15.7 billion dollars on promoting prescription drugs in the United States. More than 4.8 billion dollars was spent on detailing, the one-on-one promotion of drugs to doctors by pharmaceutical sales representatives, commonly called drug reps. The average sales force expenditure for pharmaceutical companies is $875 million annually.

Unlike the door-to-door vendors of cosmetics and vacuum cleaners, drug reps do not sell their product directly to buyers. Consumers pay for prescription drugs, but physicians control access. Drug reps increase drug sales by influencing physicians, and they do so with finely titrated doses of friendship. This article, which grew out of conversations between a former drug rep (SA) and a physician who researches pharmaceutical marketing (AFB), reveals the strategies used by reps to manipulate physician prescribing.

Open Medicine

At long last, welcome to the first issue of Open Medicine, launched April 18, 2007. This new open access journal represents a milestone in the independence and academic freedom of medical research publishing. 
From the April 18 2007 edition of The Globe & Mail:

A new open-access general medical journal, published in Canada, is about to be born.
Editors of Open Medicine, a journal that won’t charge subscription fees and won’t run advertisements for medical devices or drugs, say they will go live online with the new publication on Wednesday.
The idea for the journal was conceived last year in the wake of the firing of the editor and deputy editor of the Canadian Medical Association Journal.
Dr. John Hoey and Anne Marie Todkill were fired by the CMAJ’s publisher in what is believed to have been a conflict over editorial independence between the journal and its owner, the Canadian Medical Association.  full story

Selected articles from the first issue:
Why Open Medicine? ;  Factors related to use of prostate cancer screening: The Alberta Tomorrow Project;  Rural medical students at urban medical schools: Too few and far between?;  Accuracy of administrative databases in identifying patients with hypertension;  A systematic review of studies comparing health outcomes in Canada and the United StatesDirect-to-consumer advertising and expenditure on prescription drugs: A comparison of experiences in the United States and CanadaThe joys and challenges of being an open access medical journal;  The media–medicine mix: quality concerns in medical reporting;  Decision-making in primary care: Does screening for peripheral arterial disease improve risk stratification for patients at intermediate coronary risk?;  Pharmaceutical ethics? [book review of Ethics and the Pharmaceutical Industry by] Jerome P Kassirer more

The Learning Healthcare System : IOM Workshop Summary

 lhs.jpg A summary of an Institute of Medicine workshop, The Learning Healthcare System, is the first  publication of the IOM Roundtable on Evidence-Based Medicine, and the first in a series that will focus on issues important to improving the development and application of evidence in healthcare decision making. The Roundtable serves as a neutral venue for cooperative work among key stakeholders on several dimensions: to help transform the availability and use of the best evidence for the collaborative health care choices of each patient and provider; to drive the process of discovery as a natural outgrowth of patient care; and, ultimately, to ensure innovation, quality, safety, and value in health care. — from the Web site

You can puchase this book or read it online at no cost.

Journal of Chiropractic Medicine

jcm.jpg  This journal is now published by Elsevier, and the June 2007 issue is now online, and the March issue is Open Access. Link to all issues,  now available by subscription.

From the March editorial by editor Claire Johnson:
For the past several years, the editorial staff has been working diligently to make continued and substantial improvements to the journal. For the year 2007, we welcome Elsevier as our new publisher. Joining with Elsevier brings many improvements to the journal including:
1.Indexing in Science Direct—allows broader access to our articles for journal readers and researchers [not in Science Direct yet]
2.New and updated Web site—provides easier access to current contents, a free table of contents service, and allows access to interesting articles in the back issues
3.Online manuscript submissions—increases ease of the submission process for authors, allowing them to track their submission throughout the entire process
Read the full editorial