Articles Posted in Conflicts of Interest

Barry_Goldwater_photo1962muskieThey’re crazy, right? Or maybe they have a “personality disorder.” Our current political season is raising the issue about how wise it is for commentators and the rest of us to put labels on politicians we don’t like  in terms of their mental health.

Susan Molchan, a psychiatrist in the Washington, D.C.-area, provides a thought-provoking commentary on this topic at Healthnewsreview.org, the excellent watchdog site for hype and misinformation about health-related matters. She argues that, barring a careful, expert, and actual diagnosis of a patient, it can be destructive to the public dialogue and stigmatizing to those with true mental health afflictions, for the media, in particular, to speculate about public figures’ mental disorder.

Many of these pieces, of course, focus on a polarizing current candidate−and she provides examples of his coverage with commentators’ theorizing. Others could be added, such as: this column in which its author analogizes her own negative health experiences on to the candidate; or this piece−which drew attention because its author also happens to be a psychiatrist.

Operating_theatreIf the time in a doctor’s office or the hospital isn’t  frightening enough already for most patients, some recent publications by MDs in prominent, peer-reviewed medical journals may ramp up that anxiety to new heights: Just who is skulking around, with institutional blessing, when you’re getting your medical care? And what role are these official-looking people playing?

A tip of the hat to Morning Rounds, the daily newsletter from the health news site Stat, for pointing out a newly published study on PLOS One that details how sales people for surgical device makers conduct themselves when they are routinely allowed into operating rooms. They are gowned, often wear badges like hospital staff, and they consult with the surgical team, as doctors allow. They bring laser pens that they use to point out instruments and anatomical features. They never touch patients or handle any part of the surgery.

But, the study notes that the sales reps:

headsupfootballAs a former president used to say with finger pointed and head cocked: Well, there they go again. That same angry but resigned tone should be applied to the National Football League, and its dissembling use of data. The NFL keeps damaging its own reputation as it seeks to persuade the public that it recognizes the major, lasting health damage that head injuries inflict, and that the league is doing something about it−especially when it comes to kids who idolize the game and its athletes.

The New York Times has caught yet another instance of league officials’ duplicity, and summed it up well in its Page One headline: N.F.L.-Backed Youth Program Says It Reduced Concussions. The Data Disagrees.

To dwell on the details is only to get enraged by league officials’ attempts to play fast and loose with data, research, and supposed evidence−and to the detriment of kids. The Times drills down on Head’s Up, the NFL’s flagship initiative to educate kids, parents, coaches, and schools on protecting football players from the risks of head trauma, especially concussions. As the paper reports:

Doctors who sexually abuse their patients too often get away with it because of weak oversight, sympathetic regulators, and their capacity to move around to elude punishment, a new investigation has found.

The Atlanta Journal Constitution says it spent months, scrutinized more than 100,000 medical board disciplinary orders from across the nation, and found too many disturbing instances where perverse physicians harmed patients but escaped punishment or received only a slap on the wrist.

Stacks_of_moneyBig Pharma is not just  whistling Dixie, as Southern, for-profit hospitals lead the nation in rolling out the welcome mat so doctors can take meals, consulting, and promotional payments from drug and medical device companies, an investigation shows.

Pro Publica, the Pulitzer Prize-winning investigative site, has put up its latest findings from its multi-year tracking of which doctors at which hospitals across the country report, as they are legally required to, to federal authorities that they have taken the blandishments of Big Pharma or medical device-makers.

Docs scooped in the most green from these providers in the Garden State: Pro Publica found almost 8 in 10 MDs in New Jersey−where many in Big Pharma have their headquarters−took such pay in 2014. Almost 8 in 10 physicians in Louisiana, Mississippi, Florida, South Carolina and Alabama took the money.

$20 billA primary care physician in the United States receives an average, total, annual compensation of roughly $195,000, and likely will take in more than $6.5 million over a lifetime of practice. Ask most Americans and that’s a respectable, and deserved, income.

Which makes it all the more eyebrow-raising that a leading journal,  JAMA Internal Medicine, published a study that finds that Big Pharma can sway doctors’ drug prescribing practices for about the cost of a large pizza and a few sodas, roughly $20.

Just to be clear, this scrutiny involved more than 275,000 MDs, and more than 65,000 payments over four medications. The research doesn’t purport to demonstrate cause-and-effect but shows a troubling correlation.

FDA logoCongressional overseers of the federal agency that regulates drugs and medical devices have gotten red-flag warnings about problems at the Food and Drug Administration, including: two separate calls for improvements from lawmakers’ top watchdog; and an eyebrow-raising corruption case brought against an agency official by U.S. prosecutors and securities enforcement authorities.

As Stat, the health news site, has reported, the Government Accountability Office has criticized the FDA in reports, saying the regulatory agency has failed to plan how it will keep up with rapid advancements in medical science. Stat observes of the studies by GAO, Congress’ watchdog:

One report notes that the FDA lacks goals, targets, and time frames for keeping up with scientific advances—and also fails to track the money it spends on these efforts. The other finds fault with the FDA’s strategic plan, which is supposed to speed approvals of drugs and devices, especially combination medical products, such as heart stents that also deliver blood thinners to prevent clots.

NFL-vector-logosWhat’s $30 million among friends? When the National Football League offered in 2012 to provide that sum to support concussion research by the National Institutes of Health, the conventional wisdom held that the sports powerhouse was finally coming around. The league basked in public praise for taking a more progressive approach to its challenges with deadly, debilitating head injuries.

But a congressional panel has found the NFL’s magnanimity was a sham. Instead, pro football sought to strip $16 million of its funding from the NIH when the agency wanted to bring in Dr. Robert Stern, a Boston University researcher who has been a major critic of the league.

The NFL, instead, tried to lateral its gift to members of its own committee on brain injuries.  As for these “experts,” the New York Times reports:

nihclincenterFederal officials have decided to sweep out the executive ranks at the flagship hospital of the National Institutes of Health in Bethesda, this after a blue-chip investigating committee rebuked the institution and declared that research concerns there had wrongly taken precedence over patient safety.

Initial reports about the NIH Clinical Center, as I wrote recently, had suggested that systemic changes were required at the venerated and sprawling facility, particularly after disturbing reports surfaced about neglect and unsanitary conditions in its pharmacy operations. Officials first spoke just of creating a new, external oversight body, and an office to monitor quality and safety concerns.

But, as the Washington Post since has reported, the NIH’s chief has decided to “replace the hospital’s longtime leadership with a new management team with experience in oversight and patient safety, similar to the top structure of most hospitals. He is recruiting for three new positions: a chief executive, a chief operating officer and a chief medical officer. … [He] wants all three to be physicians, and he wants them in place by the end of the year.”

oxycontinOxyContin in two decades not only has become a highly profitable, exceedingly popular prescription, it also has become one of the nation’s most abused painkillers─for a crucial reason, the Los Angeles Times says. The paper investigated and found that the drug’s maker wrongly has promoted the medication as having a 12-hour effectiveness─twice that of generic medications.

That isn’t so. It wears off for many much sooner, leaving them with intense cravings and excruciating withdrawal symptoms. This leads to addictive abuse of the drug, the paper says.  The Times reports:

More than half of long-term OxyContin users are on doses that public health officials consider dangerously high. … Over the last 20 years, more than 7 million Americans have abused OxyContin, [which] is widely blamed for setting off the nation’s prescription opioid epidemic, which has claimed more than 190,000 lives from overdoses involving OxyContin and other painkillers since 1999.

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