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Sunday, September 22, 2024

Diagnosis: Greed

Here’s a NY Times editorial that caught my eye and as author Judith Warner says, it’s a break from the financial crisis, in spite of the title.  This may best be classified as a political post. I think Judith’s right that the story is a "product of legislative and cultural changes," not unlike the story of the collapse of the banking system.

As an aside, Paul Krugman Wins Economics Nobel! — I’ve found his articles particularly helpful in understanding the credit crisis and financial meltdown…  Thank you Paul and congratulations!  

Diagnosis: Greed 

By Judith Warner

Excerpt:  "For a break from the news of the financial meltdown, The Times on Saturday offered a page one story about Dr. Charles B. Nemeroff, a prominent psychiatrist at Emory University, who violated federal research rules regarding conflicts of interest and made millions of dollars consulting for the pharmaceutical industry.

Yet the story of Nemeroff, who earned $2.8 million in fees from 2000 to 2007, and had at one point consulted for 21 drug and device companies simultaneously, wasn’t really a departure from the news of the week – or of this whole benighted era – at all.

It was, rather, yet another iteration of the ever-unfolding saga of greed and how the deregulation of absolutely everything has brought our country to this painful season of reckoning. Because Nemeroff’s story – which is hardly unique – belongs uniquely to this time in our nation’s history.

It is a product of legislative and cultural changes that have altered the practice of medicine, the work of research universities and the relationship between those universities and industry. And it is marked, like so much of what’s gone off the rails in our era, by the failure of our government to step in to protect citizens...

Nemeroff’s case, which has many twists and turns involving allegations of conflicts of interest and nondisclosure of payments going back over the years, is only the latest to issue from the office of Senator Charles E. Grassley...

And these cases are, of course, only the tip of the iceberg. Conflicts of interest between the pharmaceutical industry and prominent research physicians now “permeate the clinical research enterprise,” writes Dr. Marcia Angell, author of the 2004 book, “The Truth About the Drug Companies,” in the Sept. 3 issue of The Journal of the American Medical Association. 

Scientists in government agencies aren’t above suspicion, either: Angell cites a study of 200 government panels that issued practice guidelines, which found that more than a third of the authors had some financial interest in drugs they recommended. And “perhaps most importantly,” she writes, many members of 16 standing committees that advise the Food and Drug Administration on drug approvals also have financial ties to drug companies. “Although these individuals are supposed to recuse themselves from participating in decisions about drugs made by specific companies with which they have a financial relationship, that requirement is frequently waived by F.D.A. authorities,” Angell writes.

Universities have all kinds of conflict-of-interest rules too, of course, as do the National Institutes of Health, which hand out grant money to researchers. But the federal government counts on universities and researchers to police themselves, and I think we know all too well from recent events on Wall Street where self-regulation leads.

The upshot: No one can be trusted. “Not only do the researchers have the complete conflicts of interests, but the medical schools and the universities do too,” Angell told me this week in a telephone interview…

How did all this happen?

It’s a familiar story: About three decades ago, it became possible to make serious money as a university researcher…

That changed in the early 1980s with the passage of legislation that allowed universities to patent their publicly funded research results and then grant exclusive licenses to pharmaceutical companies. The public-private wall came down. The universities received royalties on the drugs, and the royalties were split between the researchers and the departments. Start-up companies were spun off and sold. University researchers became, essentially, partners to industry.

The change wasn’t just structural, however. There was a cultural shift, a kind of boundary melt.

“Greed became respectable,” Angell, a professor of global health and social medicine at Harvard Medical School and the former editor in chief of The New England Journal of Medicine, recalled. “There used to be a sort of tension between doing well and doing good for medical researchers"…

…On Wall Street, change had to come via catastrophe. Let’s hope it won’t take a disaster to bring sense back to medicine."

My comment:  Results are already being felt by patients and the difference between the meltdown on Wall St. and the negative effects on medical care is not as readily apparent, because cause and effect is much harder to prove in a medical setting.  But, personally, I believe the disaster is here.  – Ilene

 

 

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