Pharma-funded Research

On August 20, 2014, Psychiatry Advisor published an article on its website.  The article was written by Leslie Citrome, MD, a professor of psychiatry at New York Medical College in Valhalla, NY, and a member of the Board of Directors of the American Society of Clinical Psychopharmacology.  The article is called Is Bias Against Pharma-Funded Research Fair?  This is an interesting title, because bias, by its very definition, is unfair.  So the very wording of the question begs the question – which strikes me as unfair.  But let’s put that aside. 

Dr. Citrome begins by introducing the term “pharmaism” (anti-pharma prejudice).  He tells us that:

“Pharmaism includes the implicit belief that people associated with pharmaceutical companies are more likely to be intellectually and morally dishonest than others.”

He provides two examples of pharmaism:

The fact that medical journals insist on independent statistical analyses of research submitted by pharmaceutical companies.

“…the lay media singling out health-care professionals who earn money by contracting with pharmaceutical companies for professional services…”

Dr. Citrome predicts, with apparent misgivings, that the media’s activities in this area will increase when the Physician Payments Sunshine Act’s provisions take effect on September 30.

So, as you can see, the article is off to a good start.  Medical journals that insist on independent statistical analyses of pharma-conducted research are displaying prejudice against pharmaceutical companies.  And we even have a name for this prejudice – “pharmaism,” akin, presumably to racism.

But, wait!  There’s an important difference.  Racism refers to prejudice or discrimination against another person, or group, based solely on race or skin color.  But medical journals that insist on independent statistical analyses of pharma-conducted research are basing this policy decision on the fact that, in a compellingly large proportion of cases in the past, the statistical analyses of pharma-funded research was flawed.  And, by an extraordinary coincidence, was always flawed in a direction favorable to the company!

What Dr. Citrome is trying to do is rescue both pharma and the psychiatrists who accepted their largesse, from the consequences of their venality.  Psychiatry maintained its corrupt relationship with pharma for decades.  The dynamics were simple.  Pharma provided the money; psychiatry provided the fraudulent research, the medical licenses, and the prescription pads.

But now the hoax has been exposed, and corrective measures have been taken.  And Dr. Citrome is crying:  foul!  You people are just pharmaists!  A nice piece of spin, which, incidentally, in prison populations is called “flip the script”.

To find a psychiatrist using a ploy that is popular among prison inmates is not all that surprising to me.  But, you see, I’m a pharmaist – so what can you expect?

Incidentally, the term pharmaism was actually coined by Dr. Citrome, himself, and James Karagianis, MD.  Here’s a quote from the June 2014 issue of The International Journal of Clinical Practice editorial Pharmaism: a tale of two perspectives, by L. Citrome, et al.

“The term ‘pharmaism’ (or ‘pharmism’) has been used informally by two of us (JK and LC) and we were both surprised and pleased that another person has used it in an editorial…and to the best of our knowledge, marks 2013 as the year that this word has first been used in a scholarly publication.”

So Dr. Citrome and Dr. Karagianis are clearly pleased with themselves for this lexicological invention, and, presumably, with the verbal chicanery that it entails.  Or perhaps they’re blinded by truthism, a prejudicial aversion to facing facts.

Incidentally, Dr. Citrome’s and Dr. Karagianis’s full definition of pharmaism is given in the IJCP document quoted earlier.  Here it is – read carefully:

Pharmaism, definition

1

: a belief that being associated with a pharmaceutical company is the primary determinant of human traits and capacities regarding scientific discourse and that not being associated with a pharmaceutical company produces an inherent superiority regarding moral and intellectual standing free from bias

2

: prejudice or discrimination

This is doctoral level spin, without a doubt.  They begin with the notion that many people are distrustful of pharma-funded/conducted research.  They convert this distrust, which incidentally is well-deserved, into a prejudice, and – and this is the rabbit in the hat – they give it a name and a definition.  But note how the phenomenon of warranted distrust has morphed into something truly obnoxious by the simple expedient of inventing a word and a definition to go with it.  Warranted and appropriate distrust has now become a belief,

“…that being associated with pharma is the primary determinant of human traits and capacities regards scientific discourse…”

Has anyone on this side of the debate said this, or anything even remotely like this?  What we do say is that pharma influence and money has in the past corrupted a great many psychiatrists, in both academia and clinical practice, and that it is prudent to be cautious and skeptical of pharma-funded research and advertizing.  Note that Drs. Citrome and Karagianis don’t dispute this.  Instead, they create this inane caricature of our position, and critique that, as if it reflected the position on this side of the issue.

And the second part of the definition is even worse:

“…not being associated with a pharmaceutical company produces an inherent superiority regarding moral and intellectual standing free from bias”

Again, has anyone said this, or even suggested it?  Certainly pharma’s deep pockets, and their willingness to spread largesse, has created an environment in which a great many psychiatrists have been corrupted.  But the notion that a lack of contact with pharma will produce the opposite result is simply absurd.

But back to the Psychiatry Advisor article.  Dr. Citrome concedes that:

“Some of the attitudes behind pharmaism have origins in the sins of the past. This includes the deliberate withholding of data, questionable promotional tactics, and rewarding high-volume prescribers. Despite substantial changes in how pharmaceutical companies do business, there is much in the way of lingering suspicion that deceptive practices continue unabated.”

Let’s take a look at that last sentence and the embedded link.  Despite “substantial changes in how pharmaceutical companies do business” there is still suspicion of deception.

I suggest that most people reading this would presume that the “changes” mentioned were of the cleaning-up-one’s-act variety.  And, I further suggest that most people on opening the link would expect to find some account of this clean-up, e.g. publishing the results of all trials, rather than cherry picking those with favorable outcomes, making all relevant data available to outside scrutiny, etc…

But actually, this is not the case.  The link is to a brief article in HealthDay News titled Pharma Sales Reps Finding Access to Physicians Increasingly Difficult (author unnamed).  The gist of the article is that according to a report from ZS Associates, a New York-based marketing consulting firm, there has been a steady decline in drug reps’ access to physicians.  The only changes on the part of pharmaceutical reps mentioned in the article is greater reliance on  “digital communication channels.” Rather than on face-to-face visits, which were the norm in the past.

In particular, there is nothing in the article that might be expected to allay the lingering suspicion concerning pharma-funded research.

So what Dr. Citrome has done is imply that pharma has cleaned house, pretended to provide a supporting reference, and then directed criticism at us pharmaists for retaining – in typically bigoted fashion – our lingering suspicions concerning the integrity of pharma researchers and those psychiatrists who sup at the same table.

And then the Crown Jewel:

“Separating the facts from the rhetoric takes some effort…”

Dr. Citrome, that is, indeed, the case!

He then refers us to “…an excellent summary of the issues…”  This links to an article by Thomas Stossel, MD, et al in the June issue of The International Journal of Clinical Practice, After 20 years, industry critics bury skeptics, despite empirical vacuum.  Dr. Stossel is a professor of clinical medicine at Harvard, and a division director at Brigham and Women’s Hospital.

Here’s the conclusion section of that article, quoted in full:

“As this review reveals, the conflict of interest movement has failed to substantiate its central claim that interactions between physicians, researchers and the medical products industry cause physicians to make clinical decisions which are adverse to the best interests of their patients. After 20 years of impugning the motives of industry and demeaning the professional judgment of physicians, the instigators have failed to produce solid evidence of harm commensurate with their extravagant allegations. At the same time, they have diverted resources away from more worthwhile pursuits, such as basic and applied medical research, clinical care and medical education towards onerous compliance exercises and obtrusive laws and regulations. They have propagated an availability cascade that projects the superficially plausible message that the medical products industry is coopting patient care by corrupting physicians and researchers. Perhaps worst of all, they have made it respectable to ignore the epistemological foundations of medical science, diverting attention away from the scientific merit of the information presented and focusing it instead on the identity and motives of those who present the information.”

A full critique of this article would take us too far afield, but the essential points of the piece are:

  1. The conflict-of-interest (COI) movement has not proven that physician ties to industry have actually harmed patients.
  2. The COI movement has created an environment where information is judged more by the motives of the presenter than by its actual merits.

It’s an interesting, if one-sided, article.  Note  some of the language in the conclusion:

  • the “instigators” [in the COI movement];
  • their “extravagant allegations”;
  • “onerous” compliance “exercises”;
  • “obtrusive” laws and regulations;
  • the “superficially plausible” message.

And the image of the COI movement “diverting attention away from the scientific merit of the information presented” is a far cry from the reality – at least in the psychiatric field –where an eminent researcher at a prestigious university is actually on record as promising a pharmaceutical company a positive result for their drug if they would pony up at least $700,000 for a center on pediatric bipolar disorder at Harvard’s Massachusetts General Hospital.

And incidentally, according to an Editorial in Endocrine Practice, November/December 2009:

“Dr. Stossel is a founder and director of, consultant to, and owns stock options in Critical Biologics Corporation to which his employer, Brigham & Women’s Hospital, has licensed his inventions; he is a director of and owns stock options in Velico Medical Corporation to which Brigham & Women’s Hospital has also licensed his inventions; he currently serves as a consultant to Pfizer.”

But getting back to our psychiatrist, Dr. Citrome, it is clear that he loves the article and he finishes with an upbeat quote:

“Consulting for and collaborating with industry to facilitate the development of new treatments, informing practitioners about new treatments, assisting in conducting clinical trials are all activities that can ultimately benefit patients.”

DISCUSSION

The most notable feature of Dr. Citrome’s article is the fact that it got written at all.  Psychiatry’s corrupt relationship with pharma has been a dominant feature of the profession for the past 40 years.  It is a legacy of the most profound shame and ignominy, which psychiatry made no attempt to correct, until outsiders such as Senator Chuck Grassley, of Iowa, who is probably a pharmaist, began to expose these practices.  Pharma-psychiatry corruption was widespread, and existed in both academia and in clinical practice.  Deliberately tainted pharma research was promoted, not just in professional circles, but also to the general public.  Tawdry pharma adverts in psychiatric journals and in the general media promoted the chemical imbalance lie, and turned dangerous psychiatric drugs into blockbuster products.  For instance, between 1997 and 2007, the number of Americans taking neuroleptic drugs increased from 2.2 million to 3.9 million, bringing the promise of brain shrinkage, tardive dyskinesia, akathisia, and an assortment of other adverse effects to an additional 1.7 million people!  Most of this increase was the result of cooperative psychiatric researchers “discovering” new uses for these products, especially among children and older people.

As in so many areas, psychiatry has no answers to the criticisms it faces. So it resorts to spin; in this case, vilifying the conflict-of-interest movement.

For decades, psychiatry went unchallenged.  Those few of us who drew attention to the spuriousness of its concepts, and the destructiveness of its “treatments” and its corrupt ties to pharma, were marginalized and ridiculed.  We were parodied, and asked if we also believed in witches!

Psychiatry had the backing of pharma dollars, and seemed unassailable.  They neither listened to, nor cared about, voices of dissent.  Theirs was the arrogance of the true believers, and they had the pharmaceutical cash register receipts to prove that they were correct.

Then something happened.  The bubble burst.  The scales fell from the eyes. The Emperor’s nudity was recognized, and psychiatry has no response other than spin. And that’s what we’re seeing in Dr. Citrome’s article:  the COI movement is doing more harm than good!

And, incidentally, at the end of the article, the disclosure states:

“In the past 36 months, Citrome has engaged in collaborative research with, or received consulting or speaking fees, from: Alexza, Alkermes, AstraZeneca, Avanir, Bristol-Myers Squibb, Eli Lilly, Forest, Forum, Genentech, Janssen, Jazz, Lundbeck, Merck, Medivation, Mylan, Novartis, Noven, Otsuka, Pfizer, Reckitt Benckiser, Reviva, Shire, Sunovion, Takeda, Teva and Valeant.”

And just to make my epistemological position clear, I do recognize that a person could have all these ties with pharma and still be objective on these issues.  That’s logic 101.  But I also recognize that there are strong incentives not to bite the hand that feeds us.  That’s psychology 101.  Actually, it isn’t even that.  It’s just common sense.

 

  • Anonymous

    I don’t see “pharmaism” entering widespread usage. It sounds ridiculous, this term they’ve allegedly coined. I hope you keep us up to date on what comes of this Sunshine Act and whether it makes much of a difference. Thank you. Prodigious output this week as usual. The amazing stamina on you Hickey. Amazing.

  • Gary Sidley

    Dr Citrome’s article would be hilarious if it wasn’t for the fact that the unholy alliance between pharmaceutical companies and psychiatry had damaged many innocent victims. His outrage at the unfairness of it all is a bit like a convicted serial killer complaining that other people are now wary of him.

  • Steve Spiegel

    This is another articulate article; thank you again. I do believe that “pharmacism” will become common usage as a defense against increasing attacks against the alliance of psychiatry and the pharmaceutical industry. I did not realize that criticism of this alliance had made much impact; it is inspiring to see psychiatrists playing the victim card.

  • mikristsan

    We probably need some seroquel, thorazine, geodon, or ECT, or maybe something stronger to help treat our pharmaism for the rest of our lives. It’s doubtful there’s a cure though.

  • cledwyn bastardo

    Good article.

    If the article you refer to were a colon, it would rupture from the amount of excrement in it. If it were a ship, it would capsize from the sheer weight of bullshit in it.

    I can just see the writer penning it, his posture bowed under the weight of his gargantuan head, so much so that if it expands to even greater dimensions, his spine will crumble under its weight.

    Organized psychiatry is quite content to wallow in its own filth and corruption, and clearly has little interest in reforming itself. Indeed to do so would be a truly Augean task, given all the filth that has accumulated over the years.

    Anonymous is right that it would seem too absurd a term to pass into conventional usage, but that absurdity will wear off over time once habit has cast its spell. Forcing ostensible “treatments” upon a person would have seemed absurd to an age unaccustomed to its example, but now that it is enshrined in law and custom, and habit has worked its spell, what really occasions disbelief among the broad masses is that anyone would question its supposed validity and necessity. What’s wrong with forcing people neurotoxins into people’s bodies, people are heard to say. Maybe one day it will seem absurd if the state proposes raping sexually-frustrated people on the grounds of a supposed libidinous illness and the violence it occasions, but not for long, I can assure you.

    What really bothers me about these kinds of psychiatrists, as well as organized psychiatry and the human race generally, is the way in which they are exploiting their position and the the superior resources they have at their disposal to do what Socrates described as the purpose of rhetoric; to wit, to make that which is bad seem good.

    This is why I am so cynical about human nature; because man is so eminently susceptible to power’s corrupting influence. Man is incapable of possessing power without it poisoning him and without lying to himself and everyone else about why it is he exercises it.

    When people come into conflict with others, we (as if by some inner compulsion to whose superior force our better nature yields) instinctively grab at anything we can use as a stick to beat our opponents with, as a lever to gain the ascendancy.

    A man is physically bigger than his opponent who is of diminutive stature. Without thinking, he uses this to his advantage if he comes face to face with him. I think most people understand this, yet this understanding does not extend to the many other ways in which men use their power to their own advantage, be it the power conferred by superiority of material resources, or the power conferred by position, and that comes with the support and admiration of your fellow men.

    One can see this in bureaucratically structured institutions, with superordinates abusing the power they have over their subordinates when conflict arises between them.

    The psychiatric ward is a veritable hothouse of conflict, and it should occasion no surprise that the staff regularly abuse their power against patients who they are at war with.

    People even use the very values of the times, and harness the spirit of the age, in their disputes with others. People take offense, for example, because in the current cultural climate, indignant utterances, allied to the identity of the person, possess a certain incantatory power, because of the magical effect they produce on the observer, who comes to see the demands of the bully as the pleas of the victim.

    This belief that certain people have a right to be protected from the words of others is being exploited left right and center. It has become the basis upon which various discriminations are being exercised by people who have usurped the standard of righteousness, and are now beating their enemies around the head with it. The sensitivities of certain precious others are being used as a justification for narrowing the scope of free speech and expression, or more correctly, the freedom of speech and expression of the people the precious ones hate, and whom they conceitedly assume are not entitled to offend them like they offend us. Truth is we all offend each other sometimes, be it through our words, opinions or actions.

    Righteousness has become little more than a front for evil.

    Some might say that the notion that power corrupts everyone has been empirically disproven, but the experiments done on this issue are mostly meaningless because they do not replicate the conditions within which power poisons its holder. In the right conditions power can be a means to noble ends, but under the wrong ones, at best rarely. Where there is variation is in the degree to which a man uses his power for base, self-serving, self-aggrandizing reasons.

    One reads articles like this and one has the picture of men exulting in the leverage their position brings to evade responsibility, like eternally unrepentant criminals. Fate will one day bring them down to the level of their victims and those they lord it over, though that brings little comfort given human society is largely the plaything of tyrants and fools from whose ranks replacements are always on hand when it so happens that one of their number dies.

  • Anonymous
  • Phil_Hickey

    Anonymous, thanks for the encouragement.

  • Phil_Hickey

    Gary,

    Thanks for coming in. Nice analogy.

  • Phil_Hickey

    Steve,

    Yes, they are definitely concerned enough to start hitting back.

  • Phil_Hickey

    mikristsan,

    I’m sure you’re right. No cure!

  • Phil_Hickey

    cledwyn,

    Thanks for coming in, and for the encouraging words.

  • Neo

    Just for fun I will engage in some name calling too. Pharmtisan: derived from the word partisan but applicable to those in the medical profession who blindly favor pharmaceutical products and medical devices.

    This conspiracy is much bigger than psychiatry. It exists throughout medicine. Medicine represents a failure of Adam Smith’s invisible hand. Naturally like most industry it is money driven but in medicine the complexity and the lack access to quality information has left consumers at a distinct disadvantage. Quality information has emerged but it is often countered by disinformation. Who do you believe?

    Find someone whose arguments are more substantive and less rhetorical. Someone like Hickey, not me. Find someone who does not have a financial interest in their viewpoint. Check and double check.

    To those who willfully push questionable drugs and devices on the unsuspecting public, beware. The Justice Department is getting more and more aggressive about treating manufacturers of drugs and medical devices as criminals. Recently they have been targeted physicians with connections with some of these companies. It appears the role of patsy has run it’s course and co-conspirator is the new term.

    There are many great physicians, great medications, and great medical devices, which have greatly improved the length and quality of our lives; however, Dwight Eisenhower’s farewell address is equally applicable to the medical industry. We must remain ever vigilant. Money corrupts.

    http://www.crainsdetroit.com/article/20140929/NEWS/140929842/open-payments-website-opens-tuesday-database-spotlights-physician#