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February 6, 2002
Study Says Clinical Guides Often Hide Ties of Doctors

[Fred A. Baughman Jr., MD:
Commentary. within brackets, by Fred A. Baughman Jr., MD

WASHINGTON, Feb. 5 -- A survey of medical experts who write guidelines for
treating conditions like heart disease, depression and diabetes has found
that nearly 9 out of 10 have financial ties to the pharmaceutical industry,
and the ties are almost never disclosed.

[Fred A. Baughman Jr., MD:
In biological psychiatry such guidelines, first and foremost, depict
the psychiatric "disorder" as a "disease" due to a "chemical imbalance",
needing "treatment with a "chemical balancer" from off the shelf of
their controlling partner, Big Pharma. See the "diagnostic" guideline of
the American Academy of Pediatrics for ADHD, followed, less than a year
later by their "treatment" guideline. Speak of betrayal by
professionals--there is to this day not an iota of legitimacy of ADHD as
a disease. This would take a demonstrable, objective abnormality,

It has long been known that contact with the pharmaceutical industry can
influence individual doctors' prescribing patterns and that financial
support from drug manufacturers can affect the course of academic research.

But the survey, a relatively small study conducted by a team from the
University of Toronto, is the first to document the extent to which the
industry may influence so-called clinical practice guidelines. These
voluntary guidelines, which are typically published in medical journals and
endorsed by medical societies, set standards that are followed by countless

"These clinical protocols should be seen by the public as unbiased," said
Sheldon Krimsky, a health policy expert at Tufts University who has written
extensively on financial conflicts of interest. "The fact that there is a
veil of secrecy over most of these does not bode well for a clinical
community which is trying to ensure trust in the public."

The survey, in this week's issue of The Journal of the American Medical
Association, sought the opinions of 192 medical experts who participated in
writing 44 sets of practice guidelines covering treatment for asthma,
coronary artery disease, depression, diabetes, high cholesterol, pneumonia
and other ailments.

[Fred A. Baughman Jr., MD:
of these "ailments", "depression" is never a disease having a
confirming, objective physical abnormality of the brain or body]

Of the 100 who responded, roughly 9 out of 10 had some type of financial
relationship with a drug manufacturer, including research financing and
speaking, travel or consulting fees. About 6 out of 10 had financial ties to
companies whose drugs were either considered or recommended in the
guidelines they wrote.

Eleven of the 44 practice guidelines were underwritten by pharmaceutical
companies and carried declarations stating so. But of the 44 guidelines,
just one reported a potential conflict of interest.

"That's a problem," said Dr. David Blumenthal, a health policy expert at
Harvard Medical School who has written about financial conflicts in the
medical profession. "This is just emblematic of the extensive, often
undisclosed relationships that exist between medical experts and
pharmaceutical companies."

[Fred A. Baughman Jr., MD:
Which thoroughly taints, pollutes, the medical mission of
physician, both those doing the deceiving and the deceived, the
practitioner, the front-line physician]

Financial conflicts of interest are the subject of intense debate in
medicine. Pharmaceutical companies often underwrite the cost of medical
conferences and hire prominent academic doctors to serve as speakers or to
lead symposiums at which the companies' drugs are discussed.

Proponents say the companies are helping to educate doctors. But critics
have complained that such financial relationships jeopardize the integrity
of scientific research. This week, more than two dozen prominent scientists
and doctors sent a letter to more than 200 scientific journals urging them
to strengthen their requirements for disclosing conflicts of interest.

Among those who signed is Dr. Marcia Angell, the former editor of The New
England Journal of Medicine. In an interview today, Dr. Angell said that
disclosing financial ties to industry was the least doctors could do and
added that in most cases, the ties should be simply severed.

[Fred A. Baughman Jr., MD:
Dr. Angell is among the few untainted voices from upon high in
medical academia. Her warnings are always to be heeded. Even the vaunted
New England Journal of Medicine has regularly had a hand in
"legitimizing" the fraudulent "disease"--ADHD. As does the Journal of
the American Medical Association--regularly, and the journal of the Am.
Acad. of Pediatrics--PEDIATRICS]

"Most consulting arrangements are simply a way for researchers to make money
and the industry to buy their good will," Dr. Angell said. "Researchers
serve on advisory boards and speakers' boards, and they travel around the
world, ostensibly to educational programs. But really, they are just
enriching themselves, and the drug companies retain influence over them to a
remarkable extent."

Others, including Dr. Allan S. Detsky, an author of the Toronto study, take
a less stringent view, arguing that conflicts should be made public and that
doctors should discuss them openly before writing guidelines.

"It's not possible to stamp this out," Dr. Detsky said. "The answer is to
sensitize people to accept that it's a problem."

[Fred A. Baughman Jr., MD:
It is outrageous of Detsky to suggest that the public can protect
themselves against a bought and paid for medical academia and entire
medical profession by their being sensitized to the problem. Just like
polluted rivers and streams, they will have to be cleaned up, but first
the origins of the pollution will have to be indentified and brought to
a halt.]

Only 7 percent of the doctors in the Toronto study said they believed that
their relationships with industry influenced their recommendations, although
19 percent said financial ties influenced the recommendations of their

[Fred A. Baughman Jr., MD:
How very convenient--for them]

A spokesman for the Pharmaceutical Research and Manufacturers Association,
an industry trade group, said today that the organization was not opposed to
doctors' disclosing their ties with industry.

But the spokesman, Jeff Trewhitt, said drug companies did not want to see
doctors with drug industry ties excluded from writing guidelines.

"Too many exclusions would mean not allowing some well-respected experts to
work on these important guidelines," Mr. Trewhitt said.

[Fred A. Baughman Jr., MD:
Industry had no say in such things through the 60s,70's and first
half of the 80's. See the attached article on the subject of Big
Pharma's control of the medical profession.]

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