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Science Magazine is reporting about conflicts of interest in medicine that remind us it is a business!

You’ve heard reports that doctors are compensated, in many cases in the millions, by the very drug and device makers whose products they recommend.  It is almost impossible to take money from a manufacturer and not have a favorable opinion of the company and its products. That’s just human nature!

That has been reinforced many times by studies done at the University of North CarolinaYale Universitythe George Washington University and Harvard Medical School, among others.

They show that when doctors are paid by pharmaceutical companies, they’re more likely to prescribe drugs made by those companies.

Science Magazine in its July 2018 issue, peels back the conflicts that exist in the U.S. Food and Drug Administration expert panels. It is their job to review new devices and drugs that makers have poised ready to launch on the market.

Once the panel gives its okay, the FDA generally follows their recommendations.

FDA expert panels are made up of scientists, researchers and medical practitioners who are in a position to know, but also in a position to drive sales of any particular product. However, when cash is flashed in the form of consulting contracts, or speaking gigs, they often fail to apply their critical thinking skills.   

One hematologist-oncologist, Dr. Vinay Prasad, tells Science. “It’s in their best interest to play nice with these companies.”

How often do these conflicts occur?

Using disclosures posted by the Centers for Medicare & Medicaid Services from 2013 to 2016, 40 of 107 physician advisors received more than $10,000 in earnings or research support from pharmaceutical companies. Twenty-six received more than $100,000. Seven received more than $1 million.  

The top 17 earning advisors received support either in personal payments or research funding paid by the drug companies amounting to $26 million.

The FDA never disclosed many of the top committee members received funding from drug companies in years prior to serving.

Compare this to Europe.

The European Medicine Agency prohibits the appointment of advisory committee members who have had any financial relationship with pharmaceutical companies three years prior to being on a panel.

Carl Elliott, a medical ethicist at the University of Minnesota says, “Even in the best of circumstances, disclosure is a remarkably weak way of controlling conflicts of interest. A better way would simply be for the FDA to say, ‘We are not taking anybody with any kind of conflict on an advisory committee’.”

Taking a look at the mesh world, when a panel on morcellators was being convened, Dr. Andrew Brill was scheduled to be on the 2014 advisory panel. But Dr. Brill withdrew his name at the last minute. Turns out the San Francisco gynecologist received nearly $100,000 in consulting fees from Johnson & Johnson in 2013. The general cutoff that defines a conflict of interest is $50,000 under FDA guidelines.

J&J makes one brand of morcellator.

Dr. Brill however, did appear on the FDA’s 2011 panel convened to look at the safety of transvaginal mesh.  

How can you know if your doctor is in conflict with industry?

There are two ways. The Physician Payments Sunshine Act of 2010 requires manufacturers of drugs/devices to report payments to doctors and teaching hospitals. You can check that out on Open Payments and look up your doc on the Search Tools.

ProPublica, investigative journalism in the public interest, also has a database of payments to physicians.  Dollars for Docs is user friendly, easy to read and is based on data required under the Physician Payment Sunshine Act.

For example, look up Pelvic Organ Prolapse and see the top docs who received money from Boston Scientific in 2016—$3.4 million with Dr. Dennis Miller the top recipient at $1.16 million.

Dennis Miller is the father of the Pinnacle pelvic organ prolapse mesh implant.

Pinnacle, a pelvic mesh used to shore up a pelvic floor and organs, was found to be defective in this country and was recalled by the FDA.

Not to be deterred, Dr. Miller’s payments shown total more than $206- thousand from Boston Scientific as recently as December of last year and nearly $6 million in payments from Boston Scientific for royalty or licenses with the company.

That may not be a factor in deciding which doctor will provide your care, then again, it is information you might want to take into consideration about the objectivity of your medical provider.

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