Name: Brian
Email:
Bio: I'm a freelance science journalist in Washington, D.C.; I write for The Washington Post, U.S. News and World Report, and many other publications. Many of my articles appear in science and medical journals; they’re indexed by PubMed. Search on my name at PubMed. My email is bv{at}brianvastag.net.
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Live Radio
February 25th, 2010
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I discuss stem cell tourism with BBC superstar Matt McGrath. My yapping starts about halfway in. From Feb. 19, 2010, San Diego.
The Melting Snows of Kilimanjaro
November 3rd, 2009
Glacier remnant on Kilimanjaro
The snows of Kilimanjaro are rapidly disappearing and will be gone by 2033, predicts the most detailed analysis yet of the iconic glaciers gracing Africa’s highest peak.
”They’re being decapitated,” says study leader Lonnie Thompson. “In fact, they’re probably not really glaciers anymore. They’re remnants of another climate.”
Published in Nature. [Link]
Drug Companies Used Physician Education to Push Pills
October 20th, 2009A scientific journal recently commissioned this story from me, but after I reported and wrote it, the journal killed it. I think it’s an important story that serves the public good, so I’m posting it here to get it on the record. BV
Drug makers routinely exploited continuing education seminars as opportunities to market pills to doctors, company documents reveal.
Continuing medical education (CME) has exploded into a $2.3 billion business in the United States, with nearly half of the funds pouring in from drug and medical device manufacturers. Physicians must complete a certain number of CME courses each year to retain their medical licenses.
Today, the large pharmaceutical companies say their CME dollars support only independent education, with no input from the companies. But as recently as 2004, the documents show, marketing personnel played key roles in developing the seminars, treating CME as one element of their comprehensive sales plans.
“It is very clear…that continuing medical education has been used as marketing, and I think it continues to be,” said Allan Coukell, director of the Pew Prescription Project, which seeks to reduce or eliminate conflicts of interest in medicine.
For instance, GlaxoSmithKline’s “2003 Tactical Plan” – a marketing document – for their antidepressant Paxil lists $92 million in expenses, including $4.3 million for CME, $30 million for consumer advertising and $17.4 million for free samples. The plan includes “desired” CME topics, such as “anxiety symptoms/disorders in women” and “treating depression & anxiety in hispanic population.” The plan also proposes a “CME Tour” reaching 6,000 doctors, and provides detailed topics to be covered. The company prepared similar strategies for 1999 through 2004, according to the documents, which were uncovered by Senator Charles Grassley (R, Iowa), in his ongoing investigation of the drug industry.
A spokeswoman for GlaxoSmithKline, Mary Anne Rhyne, declined to answer questions regarding the documents.
Forest Laboratories, Inc., deployed similar strategies to push Lexapro, a Paxil competitor. One goal of the 2004 Lexapro plan: “More sponsorships of CME, increased level of speaker programs…and peer selling.” The plan includes $9 million for national and regional “CME symposia,” to be run by a for-profit company, CME Inc. Also included: $600,000 to pay for six “special reports,” to be labeled as CME: “A reporter from…CNS News, Psych Times, and the Journal of Clinical Psychiatry will be sent to cover key Lexapro data” at medical meetings, the document reads.
A third drugmaking enterprise, a partnership between Merck and Schering-Plough, dumped $64.5 million into CME courses on “cardiovascular risk management and/or cholesterol control and/or Vytorin” from 2004 through early 2008, a time when the companies were heavily promoting Vytorin, their soon-to-be-troubled anti-cholesterol pill. The funds were distributed in 1,930 individual payments to universities, professional societies and for-profit CME companies.
Companies improperly promoting products via CME may run afoul of the law, said Lewis Morris, the counsel to the inspector general of the Department of Health and Human Services. During a July hearing of the Senate Special Committee on Aging, chaired by Herbert Kohl (D, Wis.), Morris said, “A number of significant cases have involved allegations that funding for ‘educational support’ was a pretext for the payment of kickbacks” to physician-speakers who promoted off-label, or unapproved uses, of certain drugs. For instance, in 2004, Pfizer and Warner-Lambert paid the U.S. government $430 million to settle claims that the companies “corrupted the physician education process by fraudulently sponsoring ‘independent medical education’ events” on unapproved uses of Neurontin, an anti-epilepsy drug, Morris testified.
The 2003 Paxil marketing documents show that GlaxoSmithKline planned to market the drug for an unapproved indication – pre-menstrual dysphoric disorder, or PMDD – 10 months before the FDA approved that specific use of the drug. The November 2, 2002 plan lists “anxiety symptoms in PMDD” as a “desired topic” of the CME seminars the company funded. But the FDA did not approve Paxil for PMDD until September 2, 2003. As Morris noted in his testimony, promoting an unapproved use of a drug is illegal under the Food, Drug, and Cosmetics Act.
Pfizer learned that lesson in a huge way last month when the Department of Justice announced the company had agreed to pay $2.3 billion – the largest criminal fine of any kind in U.S. history, according to the department – for illegally marketing several drugs, including its anti-inflammatory Bextra.
Murray Kopelow, chief executive of the Accreditation Council for Continuing Medical Education, which certifies CME providers, said his group tightened its rules in 2004. The rules now prohibit drug and device makers from directing educational content or even suggesting topics for courses. “We felt it necessary to define the bright line of what independence is,” he said.
Still, momentum is growing for an outright ban on industry-funded CME and a return to a system where physicians pay their own way, like lawyers and other professionals. The Institute of Medicine and the Association of American Medical Colleges support such a ban, and over the past two years, Stanford University, Memorial Sloan Kettering Cancer Center and the American Psychiatric Association have weaned themselves from the industry CME teat. Still, such funding comprises a critical slice of the budget pie for many professional groups. For example, the American Academy of Family Physicians, which claims 64,000 members, receives 8% of its operating budget from industry CME funds. President Ted Epperly said that AAFP follows ACCME guidelines and assiduously maintains a “firewall” between CME funding and content. “We believe this relationship can be managed,” he said. “It must be transparent and above board. You cannot have anybody telling you what the content ought to be, who the speaker ought to be.”
Where does Industry CME Money Go?
In 2008, drug and device companies spent $1.04 billion on continuing medical education in the U.S.
Where it went:
Hospitals: $39.5 m
Professional Societies: $202.5 m
Universities: $225.7m
For-Profit CME Companies: $463.4m
Other: $104 m
Source: Accreditation Council for Continuing Medical Education
A Curious Catastrophe in the Parrot World
September 16th, 2009
A Curious Catastrophe in the Parrot World
It’s CSI Parrot: Join me as I follow scientists tracking a virus that’s devastating captive-bred parrots. [Read Story]
5 Years After: Portugal’s Drug Decriminalization Policy Shows Positive Results
April 7th, 2009
In the face of a growing number of deaths and cases of HIV linked to drug abuse, the Portuguese government in 2001 tried a new tack to get a handle on the problem—it decriminalized the use and possession of heroin, cocaine, marijuana, LSD and other illicit street drugs. The theory: focusing on treatment and prevention instead of jailing users would decrease the number of deaths and infections. [READ STORY]
Published at ScientificAmerican.com.
The Beneficial Side of Prions
April 2nd, 2009
Prions, the mis-folded proteins best known for causing diseases such as bovine spongiform encephalopathy in cows, scrapie in sheep and Creutzfeldt–Jakob disease in humans, also help yeast survive and may even drive evolution. [READ STORY]
Published at Nature.com
Injections of Hope – Doctors Promote Offshore Shots but Some Patients Cry Foul
September 2nd, 2008
Patients are paying tens of thousands of dollars for stem cell treatments overseas, yet there’s little evidence the shots do any good. My reporting for the Washington Post turned up dozens of stem cell clinics and plenty of unhappy patients [Read Story]
Will We Soon Find Life in the Heavens?
July 24th, 2008
One of two cover stories I penned for the July 24, 2008, U.S. News and World Report checks in on the search for life out there, and finds a resurgence of scientific interest in listening for E.T. [Read Story]
How Did Life on Earth Get Started?
July 24th, 2008
One of two science cover stories I penned for the July 24, 2008 U.S. News & World Report, surveys the prevailing theories of how life began and peeks into a lab where scientists attempt to recreate the genesis event. [Read Story]
Foreign Clinics Lure Americans with Unproven Treatments
May 1st, 2008
As part of a U.S. News package on medical tourism, I cast a sharp eye on overseas stem cell treatments, which cost tens of thousands of dollars and carry little evidence of working. [Read Story]
