Pharma-scolds tee off on drug industry

"The nation's most influential medical advisory group" - the Institute of Medicine (IOM) - recently released a "scolding" report demanding doctors and medical schools "end a number of long-accepted relationships and practices that create conflicts of interest, threaten the integrity of their missions and their reputations, and put public trust in jeopardy."

Its release coincided with swine flu's headline-grabbing global uptick.

One of us is a member of IOM and not proud of this report. It's the predictable, dysfunctional, response of academic health centers and other medical organizations to anti-commercial inquisitions promoted by critics, demagogue politicians and the news media - a species we designate collectively as "pharma-scolds."

An enormously complex, granular and nuanced collaborative interface between industry and medicine has provided physicians with powerful and effective tools yielding the awe-inspiring miracle of increased longevity and life quality.

In view of this progress and given the enormous stakes, only rigorous, detailed evidence reviewed by competent analysts should ever justify radically re-engineering the "long-accepted relationships and practices" of this fruitful collaboration.

The pharma-scold agenda, however, imperially eschews such common sense, preferring to address this practical topic abstractly as "ethics and professionalism."

Counting money and profits as inherently evil, the pharma-scold movement initially targeted and banned common industry marketing tools, too trivial to defend, e.g., pens, notepads, tote bags, provided at continuing medical education venues.

From this trinket toehold, pharma-scolds now seek greater gains, demanding medicine reject most commercial support of its professional meetings and industry-subsidized medical education. Next up: Sanitizing patient advocacy groups of commercial influence.

The 300-plus-page IOM report mirrors these goals in its voluminous pharma-scold writings chattering away about conflicts of interest. This literature, informing other groups' policy recommendations, reiterates and excoriates an astonishingly small list of adverse outcomes that pale by orders of magnitude compared to the beneficial effect of commercial contributions to medicine, especially given no evidence supports that, on balance, industry marketing hurts patient care or increases medical costs.

Indeed, the report openly admits no data exists to justify heavy-handed regulation - but recommends it anyway. To obfuscate this lack of hard evidence and eye-poppingly positive risk-benefit ratio, the report resorts to speculation about what damages conflict of interest might inflict, speculation that has failed to materialize in fact. It also overemphasizes harmless activities pharma-scolds don't like - such as conflict of interest disclosure lapses.

As if this isn't bad enough, this IOM exercise surpasses all others, in that, written by and for pharma-scolds, it effectively calls for a welfare stimulus program of pharma-scold management and research.

Not surprising, considering a third of the 17 IOM committee members were ethics and policy entrepreneurs with a public track record opposing industry influence in medicine, some of whom make their living solely by describing and managing conflicts of interest; none were current industry employees; and industry experience is almost non-existent.

By contrast, no sensible medical center would define how best to treat patients with, say, heart disease by using a team packed with bureaucrats rather than physicians or researchers specializing in cardiology.

Praising the self-serving report, IOM President Harvey Fineberg, formerly a distinguished public health scholar, justified its severe conclusions, saying, "Every week, some breach some failure is reported in the press" - suggesting Fineberg's been in Washington too long to differentiate news reporting from scientific evidence.

Curiously, contemporaneous with the report's release, IOM recycled a decades-old analysis of the last swine flu scare and how administrative reaction caused more harm than good. Ironically, the co-author of the analysis, titled "The Swine Flu Affair: Decision-Making on a Slippery Disease," was none other than IOM President Harvey Fineberg.

Dr Stossel is American Cancer Society Professor of Medicine at Harvard, Member of the Institute of Medicine, and Senior Fellow of the Manhattan Institute for Policy Research. Ms. Kendall, a writer and commentator, served as Special Assistant to the Assistant Secretary for Health, U.S. Department of Health and Human Services, 1989-1993.