Discussion in 'Other Health News and Research' started by MeSci, May 31, 2015.
Interesting piece from May 14th:
Thanks for posting this, MeSci. It's a fascinating read.
So, is the gist of this piece that doctors, by virtue of their intelligence and inherent integrity, should be granted exclusionary status from the moral traps that conflicts of interest - potentially - introduce to the broader population? That by virtue of what they do, and who they are, they generally are protected from the need for any regulatory oversight, because they are just that morally good, and intellectually gifted enough to think through - and rise above - most ethical failings to which the average individual is susceptible?
Then for clinicians and medical researchers, it's not so much "Greed is Good", as it is "Greed is not Relevant"?
I suspect there might be some that would take issue with this position.
'the extent to which physicians’ primary and secondary interests actually conflict, under what circumstances, and at what cost are unknown'
Only to someone with no contact with reality. The way my colleagues' behaviour was influenced by commercial kickbacks was plain for all to see. If you did not take the kickbacks you had to eat alone in a kebab shop the nights of conferences because you had no invitation to the expensive restaurants where everyone else was getting plastered on free booze. Things were perhaps at their worst in the 1970s but different sorts of commercial involvement still have a huge impact on what people say and do. I think it is a pity that NEJM should do an article of this sort. What would be the motivation for being, or pretending to be, an ostrich...
It seems that Dr Rosenbaum is a clear and thorough thinker. But a little disingenuous. It's true that decision making by Dr's is prone to a variety of bias. The problem is: the type of bias in question that matters -- financial conflict of interest is quite different from the other types.
Too fatigued to say any more at the moment. . .
I checked the disclosure form for the author, and there appeared to be nothing untoward.
I used to be rather bemused and amused when I was a hospital telephonist and people were talking about 'drug lunches'. Having no idea what these were, I had images of people sitting around a table saying "Another hash cake, nurse?" and "Could you pass the heroin, please?"
The sharp-suited drug rep was always lurking around at such times, and I gradually realised what it was about.
But this article in the Washington Post has some interesting info about industry funding, and mentions the NEJM.
Funding for the journal itself includes "advertising, subscriptions and other revenue."
Advertising presumably includes that from the drugs industry. And what might 'other revenue' be?
reminds of the not so uncommon attitude often seen in medicine. someone points out a problem:
reaction: let's write an eloquent piece with a lot random talk, throw in a few facts, pretend that you look at both sides of the argument. then suggest how wonderful everything is and leave things as they were and have always been.
So I'm guessing the first ME/CFS article to be published in the NEJM in decades will be that written drug company scientists...
Except that the Phase III Norwegian study will be hard for NEJM to refuse if it comes out positive.
But who would want to publish in the NEJM given their attitude? That's all I'm suggesting.
If you were a footballer would you say you didn't want to win the world cup because of Sepp Blatter? Or if a mountaineer that you wouldn't climb Everest because you can't get a decent cup of tea at basecamp? At a Department of Medicine Annual Dinner I happened to have the front page of my NEJM proofs in my pocket and slipped it across the table to the chief. He just gave me a broad grin, and passed it to the person on his left, but as the A4 sheet travelled along the refectory table I could feel myself getting six feet taller than everyone else, one by one. The editorial policy of NEJM may be suspect but it is still recognised by the community as the toughest journal to get into and altruism has its limits for all of us.
We need to break the cycle.
The "it must be true because it was published in Nature" joke is becoming increasingly prevalent, so why not other 'top' journals too?
One of the "experts" answering questions for several days regarding ME/CFS on the online talkhealth/NHS Q&A actually used that argument to insist PACE was accurate and trustworthy Sadly, that was far from the most outrageous thing said by the NHS psychobabblers, and only made it to #10 in my article: http://phoenixrising.me/archives/18487
Just read another NEJM article about medicine and pharma and was struck by its defence of the latter's involvement. Then I remembered this article and thought - I wonder - could it be the same author? It is.
Some comments on this series of articles:
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