A local FOX Atlanta show, you can see me and read about it here.

Reported By: Beth Galvin | Edited By: Leigha Baugham

Nearly 20 percent of American doctors get paid by drug companies to be consultants or speakers, and in some cases, they’re making quite a lot of money. So does that influence the decisions your doctor makes about your care?

Doctors earn money by giving professional talks to their peers about the latest research and the practice is pretty common.

For years it’s been unclear how much money physicians were actually earning for these speeches. Now, three major drug companies are going public revealing who is on their payrolls and how much money they’re making.

On Eli Lilly’s website, the company lists faculty on the drug company’s payrolls, including educators, advisors and contractors.

Nearly 200 Georgia doctors are on the list and they pulled in over $2.2 million dollars last year.

Some of Georgia’s highest paid physicians on the list are Emory urologist Dr. Muta Issa, who earned $ 91,000 from GlaxoSmithKline. Atlanta endocrinologist Dr. David Robertson cashed in over $78,000 from Eli Lilly and Roswell psychiatrist Dr. Michael Banov banked over $68,000 from Eli Lilly.

Some healthcare providers are earning much more by working for several companies at the same time.

“It’s common, that people who are very active, can make several hundred thousand dollars or more,” said Emory psychiatrist, Dr. Doug Bremner.

“We don’t sell medications. We simply educate physicians about data, and they make their own mind up,” said Dr. Banov.

Dr. Banov, a private practice psychiatrist, was paid over $68,000 by Eli Lilly. The Roswell doctor said he gives speeches for about five companies with competing medications.

“I think my patients welcome the fact they have a doctor who is meeting other doctors, actively involved in research, actively communicating with other physicians, someone who’s on top of the game,” Dr. Banov said.

Dr. Banov said the drug company, not him, creates the materials used in his speeches, and he also said there’s a reason for that. “We are only able to present the data. We’re not able to present our personal opinions, our personal preferences, how we use the medication off label, any of that. So we’re held to a very tight standard by the FDA.”

Emory’s Dr. Bremner said he thought paying doctors to speak for drug makers was a bad idea. Bremner said he used to do it, until he got a wakeup call about six years ago.

“I was going out to give a talk and the sales, the marketing guy like, slapped me on the back and said, ‘Go on out there and sell some,’ I’m not going to say the name of the drug. ‘Sell some of that drug,’” said Dr. Bremner.

Dr. Bremner said he worried that even the most independent doctor can get hooked on all that extra cash coming in. “Doctors are human, and once you get into this routine of making outside income, you become dependent on it.”

When asked how receiving money from the drug companies could from influencing how a doctor treats a patient, Dr. Banov said, “When I close that door, and I’m with a patient, my 100 percent interest is in getting that patient better.”

Last fall, Emory University’s School of Medicine banned staffers from making promotional talks for drug companies after congressional investigators accused the school’s chief of psychiatry, Dr. Charles Nemeroff of failing to report to the university over a million dollars he got from pharmaceutical and medical device manufacturers.

Dr. Nemeroff resigned his chairmanship, and has since left the school.

Another Emory staffer, urologist Dr. Issa listed his earnings as $91,000 in the first three months of 2009 from GlaxoSmithKline. Dr. Issa declined to comment on this story. A school spokesperson said Dr. Issa left the speaker’s bureau when Emory changed its policies.

Atlanta diabetes specialist Dr. David Robertson, who earned $78,000 for giving 47 promotional talks for Eli Lilly, said he only speaks about medications he actually prescribes.

“I think a presentation a physician makes should represent their own practice,” said Dr. Robertson. The doctor did admit that some physicians spend too much time promoting too many products. “That’s bad for everyone. That’s bad for the pharmaceutical companies, that’s bad for physicians as a profession and that’s bad probably for physicians as recipients of information because they become mistrustful.”

So are public lists like this a good thing?

Doctors on both sides say yes.

“I think it’s gotten to the point where the public is looking at it for what it is and they’re saying, ‘What’s going on here?’” said Dr. Bremner.

“Why not let the public know? There is nothing to hide. There is no shame. We’re not doing anything illegal,” said Dr. Banov. “I think it’s terrific. [It] should be completely open.”

So far, GlaxoSmithKline, Eli Lilly and Merck have published online lists of who’s on their payroll. Pfizer will be doing the same this spring.

Related Links: statements and public registries for Eli Lilly, Merck (also see here) and

GlaxoSmithKline (also see here).

Complete statement from Emory University School of Medicine regarding its new Conflict of Interest policy.

“In June of 2009, Emory’s School of Medicine adopted a comprehensive new policy governing faculty relationships with industry. The policy meets the recommendations of the Association of American Medical Colleges, the Association of American Universities, and the Institute of Medicine. Professors Issa, Pacifici, and Schulman are respected faculty members who are in compliance with that policy. Dr. Nemeroff resigned his position at Emory in fall of 2009 to become chair of psychiatry at another medical school.”

Having read the Open Letter to Dr. J Douglas Bremner of Emory University published on September 12, 2009 by Dr. David Gorski in Science-Based Medicine Blog in defense of Dr. Peter Lipson’s criticism of Dr Bremner I was immediately brought back to three articles all published in the 1999 medical literature.

One was by Dr Elliot Fisher from Dartmouth who was among the very first to dare to ask the basic question about “more possibly being worse” in US bio-medicine in JAMA. The second and third articles were from Dr Larry Dossey who then edited The Journal of Alternative and Complementary Medicine who wrote eloquently about intolerance among bio-medical scientists toward even considering Alternative Medicine. (see references below)

I would ask Drs Gorski and Lipson if an iconoclast like Dr Bremner might be serving a valuable role as gadfly to an entrenched failing status quo in bio-medicine who have made the mistake of deifying science? I would posit that the very essence of science is always and incessantly asking the question- “is it possible that I may be wrong?”. And I strongly support the return of narrative- the patient’s individual story- to the practice of medicine. The incomparable Sir William Osler, one of my heros in medicine, knew that well.

I believe that of all the determinants of successful US bio-medicine medicine going forward that a strong dose of humility is in very tall order.

To make progress our egos must die first- a basic psychiatric principle. It is much better and much more important to be tolerant and kind than to be right.

I support Dr Doug Bremner’s role as a colorful and passionate iconoclast. We need more like him.

Dr.Rick Lippin
Southampton,Pa
http://medicalcrises.blogspot.com

Ref-

-Fisher ES, Welch HG. Avoiding the unintended consequences
of growth in medical care: how might more be worse? JAMA 1999;
281:446-53.11.

— Dossey, Larry‘You people’: intolerance and alternative medicine. 1999;5(2):12-
17,109-112

Those who have been following this blog know that last month I was told to remove the name of my university from this blog and then a few days ago my university backtracked and said I could use the name (not the letterhead, which I never disputed). The incident attracted the attention of the American Association of University Professors (AAUP) and the Foundation for Individual Rights in Education (FIRE) who wrote a followup article on it here after the reversal of the decision as well as abel pharmboy on scienceblogs. There was also a humorous post by Margaret Soltan on University Diaries, who follows university politics, here, where she wrote a limerick (she is an English professor I think, so that makes sense). My friends perform it below. That’s Billy Tauzin in the middle, head of PhRMA, with of course the always lovable lolcat:

After I wrote this post yesterday called “Motherhood is Not a Medical Disorder” about the Mother’s Act, which advocates for widespread screening of moms for post-partum depression (PPD), something I don’t think is a good idea because it medicalizes a normal stage of life, increases the chances that people will be but on antidepressant medications that they may not need and that may have side effects, and represents yet another intrusion into privacy, I got this response from John Grohol at psychcentral (”False Claims by Bremner”).

First he grumbles about my pointing out that the psychiatrist quoted in the Time article, Katherine Wisner, MD (you can follow the link to the Time article in yesterday’s post), was on the speakers bureau for Pfizer and Lilly (something not noted in the article but which I found on my own), makers of Zoloft and Prozac, respectively, which as a commenter pointed out are promoted as the two safest antidepressants for pregnant and lactating women. Being on a speaker’s bureau these days means giving “promotional talks”, which translates into working for the drug company to advertise to other doctors, and is relevant. In addition, the psychcentral website has paid ads, most of them for treatment (which includes medications), while this site has no ads. And don’t say I am trying to profit off my book, which now goes for a nickel on amazon.

Grohol further takes issue with my statement that women without a prior history of anxiety or depression are not at risk for PPD and therefore would not benefit from widespread screening. However in support of that he cites Ross et al 2009, claiming that history of abuse and alcohol or substance abuse are risk factors for PPD as well. However a perusal of Ross et al shows that a history of childhood abuse is not in fact a factor, rather only abuse during pregnancy. In addition, it is alcohol and substance abuse during pregnancy that is a risk factor, on the order of a pregnant woman drinking a six pack a day or actively abusing cocaine. That kind of substance abuse is a risk to the fetus, and needs to be stopped.

If you have a man beating his pregnant wife, or a woman snorting cocaine while pregnant, that it is a situation much more serious than PPD, and should be stopped. These extreme circumstances hardly justify mass screening for PPD.

I still say NO to the MOTHER’S ACT.

This recent article in Time Magazine discusses the Mother’s Act, legislation initiated in response to the story of Melanie Blocker-Stokes, who leaped to her death from her hotel room in Chicago three months after the birth of her daughter. Officially known as the Melanie Blocker-Stokes Post Partum Depression Research and Care Act, but referred to as the Mother’s Act, this legislation would require screening of all women post-partum for depression.

The problem with this is the attitude that being a mother is a risk factor for a psychiatric disorder. First of all, there is no evidence that women without a prior history of anxiety and depression have any increased risk of getting post partum depression. So to screen all moms as if giving birth is a risk factor for depression is ridiculous. And whenever you start screening the general population, you get into problems with over-identification of people and an increase in the number of people that go on antidepressants. I am opposed to mandatory screenings of the population, like Teenscreen, which are bonanzas for the pharmaceutical industry, but a major intrusion into the privacy and autonomy of American citizens. In the case of Melanie Blocker-Stokes, she had already been treated with multiple courses of psychotropic drugs and electro-convulsive therapy, so there is no reason to think that her life would have been saved by “screening”. This legislation is typical of much that comes out of an individual tragedy, that results in an intrusion into the personal lives of individuals and the further relinqueshment of individual freedoms to the government.

The article quotes psychiatrist Katherine Wisner MD as stating ”how can you be opposed to something that will help mothers?” But an examination of the fine print from one of her articles here shows that she is on speakers bureaus for Pfizer and Lilly, makers of Zoloft and Prozac, respectively. 

In it is quoted Amy Philo, a leader of the coalition against the Mother’s Act. Her experience was that after her baby choked on his vomit and needed emergency treatment, she became increasingly anxious about his health. Her doctor gave her Zoloft, telling her that it would make both her and her baby happier. After treatment with Zoloft, she started having alarming suicidal thoughts and thoughts about hurting her baby. When she weaned herself off of Zoloft she felt fine. This experience led her to start the United Non-Profits and Individuals for Truth and Ethics (UNITE), a coalition opposed to the Mother’s Act (click here to sign their petition). Time magazine recently corrected a statement that she had post-partum depression and developed thoughts of harm before taking Zoloft, which wasn’t true.

[update: read more on the debate that arose after this post here at Amy Philo's The Bitter Pill blog and my responses to John Grohol's attack on this post ("Bremner makes false claims...") here and here.]

Yep! For a nickel you can now get several years of research and the contents of hundreds of research articles read by someone who is not on the payroll of pharmaceutical companies. That would be in the form of a used copy of my book Before You Take That Pill, purchased on amazon.com. Or if you want a new book that might have an overstock mark you can pay $2.78.

You might want to do it fast though because with all of this free publicity the book has been getting lately it might go fast. At this point either the book, or me, will be going fast I think.

If this seems like gratuitous self promotion, that’s because, well, it is. If you aren’t interested in the book you might want to buy it as an act of solidarity since my university refused to issue a press release and otherwise squashed publicity and my local paper the Atlanta Journal Constitution refused to write about it even though I only said that drinking a sugar added beverage each day would make you gain five pounds a year, and didn’t actually use the word “soda” (OK, I said it).

Here is a recent amazon review from Carolyn, July 6, 2009 (no I don’t know her)

Now that every other commercial on television is urging us to “talk to your doctor about” and dispensing marketing disguised as bogus medical advice, we need objective information if we are to avoid the pitfalls of being over medicated for no good reason.

You can read this book cover to cover, as i did, even though i take no medication or you can look up the chapters that apply to you. here’s a perfect example: i sent the book to my 85 year old father to read. for some reason, he had been put on simvastatin. after reading the chapter on cholesterol lowering medication, he decided to stop taking it. when he told his cardiologist, the doctor said “i don’t know why you were ever on it to begin with!”

Obviously, another doctor had prescribed it a long time ago and no one was keeping track. so aside from helping to keep the country’s wildly out of control medical costs in check, my dad also noticed that a mysterious rash he had developed went away, in addition to muscle aches which he had attributed to his age.

He also quit his advair and has had no problems so far without it.

Now he is like any normal healthy 85 year old living in a country that doesn’t ram drugs down people’s throats to keep stock options soaring- he mows his own lawn, trims his hedges, treated his garage for termites and is getting ready to rehang all the windows in his house.

Yes, some people need drugs for short periods to fight infections and save their lives. but this chronic use of drugs for everything and forever is nonsense. we are certainly no healthier for it and certainly way poorer.

That a doctor was willing to examine his profession objectively and point out this very big weakness is something we must be grateful for.

Thank you, Dr Bremner

You’re welcome, hon.

Well it has been an interesting week. After word got out that I had been banned by my university from using their name on my blog with follow up actions, which was covered almost immediately by Inside Higher Education, there were quite a few comments on the internet. There were a number of comments about a double standard where others had used letterhead from the university to promote medications on behalf of drug companies, but they pounced on me for using it in a satirical piece, or where they pampered other authors with their own web sites and publicity but shunned me. BNET pharma speculated that their suppression of the press release of my book and subsequent squashing of publicity may have been a clever ploy (I think the word was “genius”) amongst the PR dept to create a conspiracy theory that would create even more publicity than a normal press release.

Actually the suppressed book release was over a year ago before they made the papers for too close ties to pharma. So it might have been a conspiracy, that actually wasn’t a conspiracy, that actually was a conspiracy. If that makes any sense.

But what was involved in the conspiracy probably wasn’t what he had in mind.

Gary Schwitzer showed interest in something that combines “academic freedom, double standards, and blog censorship.” Other comments are here and here and here, including one entitled “University Throws Doctor Under the Bus for Pharma Ties“. I liked that one, so here you go.

University throws doctor under the bus for pharma perks. That's Billy Tauzin, head of PhRMA lobbying group, at the wheel.

It’s getting a little tight down here.

On the actual questions of fact, the head of the American Association of University Professors offered his opinion in the Inside Higher Ed piece that the university absolutely had no right to block me from identifying myself as a member of that university. This seems in contradistinction from the “policy” of preventing the use of the name for “non-university” activities which could be construed as anything other than buying pencils on your university account. I mean alot of professors are writing blogs, writing books, speaking in public, making movies, whatever, and I think it really strikes a nerve to say that they cannot identify themselves as a university professor in the things they do, which is why this case has basically drawn national attention. As for the blog, I think many professors see their blogs as an extension of their professional life, and in fact it is an excellent way to quickly express ideas on newly breaking events in their field and get instant feedback. Not to mention twitter.

Amy Philo wrote the following about this situation: There is a case called Garcetti v. Ceballos involving government employees that limits the employee’s right to free speech if the speech is considered part of their official duties. Therefore if your university declares your blog ‘personal’ that would imply that you could not be retaliated against for whatever you write on the blog. On the other hand having you remove their name could be considered retaliation since it does relate to academic freedom. However, in Garcetti the Supreme Court said that their decision does not apply to scholars / academic freedom, implying that a professor would still have the First Amendment right to say whatever they wanted.

Statements made by public employees pursuant to their official duties are not protected by the First Amendment from employer discipline…

…The Court instead found a reason for limiting First Amendment protection to public statements made outside the scope of official duties “because that is the kind of activity engaged in by citizens who do not work for the government.

The Court also reserved for a future decision the issue of whether its analysis would apply in the same manner to a case involving speech related to scholarship or teaching.

Hat tip to Amy Philo [this does not represent legal advice]

Why the Drug Industry May Be Bad for Your Health, is available on Amazon last time we checked for $2.84.

Last week’s decision by my university to instruct me to remove the name of my university from this blog (which was done by a formal letter hand delivered by a courier) was actually the last in a string of events that to the uncritical eye might be seen as connected. The first was an attempt to block my involvement as an expert on the effects of the acne drug Accutane on depression and suicide, a drug which the manufacturer finally pulled off the market just last week because of its multiple toxicities. The second came in the form of attempting to quash publicity related to my book, an honest appraisal of the true risks and benefits of prescription medications, which, due to their effective anti-PR campaign, most of my colleagues at my university didn’t know I had written until just last week.

To whit, there was the unusual circumstance of no coverage in the local Atlanta Journal Constitution, which might be due to the fact that I said that cutting out carbonated beverages with added sugar could cut five pounds in weight per year from your midline, but I think it was more likely a collusion between our PR department and them, or at least the lack of enthusiasm didn’t help. I mean, who would expect that sad rag of a newspaper to do any real reporting, anyway.

In March of 2008 my book, Before You Take That Pill: Why The Drug Industry May Be Bad For Your Health was published by Avery/Penguin. Having a book published is sort of like giving birth to a child. There is all sorts of excitement leading up to it, etc. Part of the excitement is working with the public relations department of your university to come up with ways to pitch it to reviewers and getting it noticed, including writing the press release.

That is why I was justifiably disturbed when on publication day I scanned the internet looking for the press release and couldn’t find it. So I called the public relations person and asked where it was.

“We decided not to release it,” she said.

“Why not?” I asked.

“Because we felt that your publisher was doing a good enough job on that already.”

Well that was highly unusual for this university, who has a supercharged PR department. Most authors get press releases, their own web page for their book, the works. Besides, they had already written it. Why not go ahead and release it? I got the impression that they didn’t want PR for that book, they hoped it would be ignored, because they didn’t want to piss off the pharma industry.

Given how things have gone over the past year for their PR, I think they made a mistake in not issuing my press release. But hey, what do I know.

Anyway, here is the press release that was never… released (sniff, sniff)

The Missing Press Release

DRAFT COPY

[REDACTED] Health Sciences News

http://www.XXXXXX.edu

XXXXX, 2008

Medications Put to the Test in New Book by [REDACTED] Researcher and Author

Media contacts:

REDACTED, but the same who commented on this article.

ATLANTA J. Douglas Bremner, MD an [REDACTED] University researcher, was concerned about the way information was communicated about medications and supplements, so he decided to take action. After two years of doing his own research on hundreds of the most popular medications, he has written a book called “Before You Take that Pill,” which is scheduled to be released on February 28, 2008.

“You have the right to know the risks and benefits of the pills you take and to form an active partnership with your doctor to make decisions about what is right for you,” says Dr. Bremner.

“We all want to live as long as possible,” he continues. “If this book allows you to use medications safely and convinces you to change your diet and lifestyle to prevent disease, I will consider it a success.”

The book covers over 300 of the most commonly prescribed prescription drugs, the fifty top-selling prescription drugs, vitamins, and the best selling herbs and supplements. Also included in the book are drugs that are not used much any more but that are particularly unsafe and haven’t been taken off the market yet by the Food and Drug Administration (FDA).

Dr. Bremner says the U.S. is focused on developing newer drugs. But those drugs are more expensive and drive up health care costs and are not necessarily more effective than the older drugs. He says that pharmaceutical companies are not required to prove that new drugs are better and have fewer side effects than the older drugs they are claiming to replace.

In addition to that, vitamins and supplements and some medications can be avoided altogether if people are encouraged to stick with a healthy diet, exercise regularly and wash their hands to avoid infection.

“Despite the fact that Americans spend twice as much on health care as any other country in the world, we have some of the worst health care outcomes,” says Dr. Bremner. “In a survey of 13 industrialized nations, the United States was found to be the last in many health related measures, and overall was second to the last!”

Dr. Bremner read and analyzed journal articles, editorials, and drug research related to all the medications he describes in this book. Additionally, he reviewed investigative reporting about the safety of the drugs in credible publications such as the New York Times, and he consulted colleagues with specialties related to the medication he was researching.

Says Dr. Bremner “My goal in writing this book is to give patients all the information they need to be aware of the effects of the medications they are taking so that they can have knowledgeable conversations with their physicians, and make informed decisions together.”

Dr. Bremner is professor of Psychiatry and Radiology at [REDACTED] University School of Medicine, director of the [REDACTED]. Dr. Bremner performs research using brain imaging to look at the effects of medications on the brain and brain correlates of mental disorders. He is a board-certified psychiatrist and nuclear medicine physician and has authored or co-authored over 200 peer reviewed articles and book chapters and three books, including “Before You Take that Pill”.

Since that time phone calls to the PR department were efficiently written down and deposited in the trash can. It basically got no coverage in the regular media. But the good news about the cover up is that you can now buy a new copy for a dollar on amazon, or used for five cents. Enjoy!

Last week I posted some musings on among other topics academic freedom and I got quite a response to this topic. The question arises how much am I allowed to talk about and what can my university do to control what I write (last week my university announced that they don’t want me to put their name on this blog because of a complaint they got about a satirical letter I wrote on my blog saying that mental health blogger Phillip Dawdy should be allowed to smoke in his appartment because of his mental health condition). They claim that this blog is for “personal” use it was a violation of their policy to have me use their name or letterhead for personal use. Which raises some interesting questions

First off, is this blog really “personal”? I mean all of the topics relate to my field in some way, which is medicine, health, medications, and psychiatry. Even the “personal” posts about things like my childhood or my emotions relate to my field because, well, I am a psychiatrist for Christ’s sake. What they were worried about was getting sued by somebody because I wrote a sarcastic letter supporting Philip Dawdy’s right to smoke in his own home. Which seems weird that they wouldn’t want their name associated with me.

Which gets me to the next point. If I were to say something like, for example, they treat professors more like corporate employees than academics, would they have the right to take action against me for criticizing my employer? Or is that a violation of academic freedom?

Legally there isn’t a good basis for academic freedom. How safe you are depends on where you live and whether or not you have tenure. In the US there is specific legal concept of academic freedom as apart from the 1st amendment to the US constitution that gives you the right to free speech without being retaliated against. But that protects you from retaliation from the government. So for professors at private universities, they don’t necessarily have legal protection, unlike in Germany, where academic freedom is the law. If you don’t have tenure, they can let you go for any reason. If you do, they have to let you go for cause, meaning you have to do something really bad, I guess. Maybe some of the legal eagles out there could write in and say what that is.

Remember that professor from Colorado who wrote a paper calling the 9/11 victims “little Eichmans”? Turns out they dismissed him for plagiarism and research misconduct, not for what he said.

In general your protection as a professor is all about what is in your contract at your university, and ultimately the culture of your university. So if having divergent views and saying stuff that is out there (we never do that here… Naaa…) is accepted as part of the culture of the university, then you are on good ground. Oh, and also if for-cause tenure is part of your contract.

After word of this blog and the issue of removing the name from my university got around, it piqued the interest of the American Association of University Professors (AAUP), and ultimately Inside Higher Education. I would quote the title of the article, but it contains the name of my university, which I am not allowed to name here.

You see how awkward this gets.

And how absurd.

Sarah Goodwin, head of media relations at my university, was quoted as saying “if you read [his blog] over a long period of time, you can see comments he makes that may be of concern.” She also said the ban on use of the university name on blogs was “across the board”.

I mean, give me a break.

As the article points out, Mark Bauerlein, an English professor who blogs for the National Review online, and Drew Westen, who blogs for the Huffington Post (I used to write for them too but would be ashamed to be associated with that swill these days) both prominently display the name of our university on their blogs.

Both Bauerlein and Westen are politically correct and garner positive media information for my university. Both also get mentioned in press releases, from which I have been unceremoniously dropped since writing my book, which was labelled as “anti-pharma” but which as anyone who has actually read it knows is just an honest review of the published literature on the benefits and risk of medications.

If you consider Goodwin’s comments, it tells you that: 1) someone from my university has been reading my blog for a long time, and; 2) they have been considering whether or not the comments should be censured.

Which is more evidence that they are thinking more like a corporation than a university, where the free exchange of ideas, regardless of the perceived value or political correctness of those ideas, is held to the highest standard.

Things are really starting to get weird around here.

I don’t know, maybe I am just an idealist.

Or maybe I should move to Germany.