Wednesday, October 22, 2008

Psychiatrist Recounts a Wyeth Snow Job

In 2004, Dr. Steven Reidbord, who was at that time the medical director of the mental health clinic at California Pacific Medical Center, had a Wyeth coming-of-age experience (read about my own adventures here). As he details in his interesting new blog, Dr. Reidbord was approached by his own hospital's Community Health Resource Center to give a talk to the public about depression. This was part of an event called "GOAL" (Go on and Live!), and would feature Delta Burke, an actress best known for a role on the TV show "Designing Women."

Dr. Reidbord, assuming that this was a community initiative and not a drug company-sponsored event, initially agreed to give the talk, but when he received the flyer advertising the program, he noticed a phrase that sounded suspiciously Wyeth-crafted: "... it is possible to virtually eliminate the emotional and physical symptoms of depression and go on and live." Recall that the Effexor XR campaign emphasized remission as the goal of treatment, because their studies found that the drug slightly outperformed SSRIs only when remission was used as the outcome statistic.

Dr. Reidbord investigated the event further, and found that it had been organized by a public relations firm,
Porter Novelli, and that the website created to promote the event was copyrighted (surpise, surprise) by Wyeth.

I won't steal anymore of Dr. Reidbord's thunder, but I will give you the sneak preview that this story also involves that Zelig of industry-funded research, Charles Nemeroff.

Congratulations on a great new blog, Dr. Reidbord, and welcome to the Wyeth Refugee Club!

12 comments:

Steven Reidbord MD said...

Thanks for your kind words, and for welcoming me into the "club." You do fine and admirable work raising these issues for the profession and the public. Cheers, SR

Supremacy Claus said...

Ed Silverman did this:

http://www.pharmalot.com/2008/10/pharmalot-pharmalittle-a-little-speech/

He failed to reveal the speaking fee, and any other consideration granted, including pens, sandwiches, or memo pads.

Dan failed to post his fee for the Wired article.

These fees and sandwiches may cause bias and are relevant to the credibility of these bloggers.

Supremacy Claus said...

See this announcement.

http://www.raps.org/personifyebusiness/MemberCenter/Chapters/RAPSNewYorkNewJerseyChapter/tabid/617/Default.aspx

It seems Ed also likely got a free meal out of his speaking engagement at this group. They profit from greater regulation of industry. They are rewarding Ed for his excellent work documenting industry problems that regulation can remedy, increasing the market for their services.

He may be characterized as a thought leader and a promotional speaker for greater industry regulation. For the purpose of transparency, I request that all fees, free meals, pens, pads, and other swag he received be listed on the website and on his blog.

Daniel Carlat, M.D. said...

Supremacy,

You are getting almost as paranoid about other people's motivations as I am. Please don't use me as a role model!

Actually, RAPS, the organization Ed is speaking for, is composed mainly of drug company executives. They are interested in his take on the pharmaceutical industry because it will help them avoid problems with regulatory authorities, thereby increasing the profits of their companies.

Maybe you still want to know Ed's speaking fee, but I seriously doubt that any reader of his blog could imagine him being a thought leader for less regulation of the pharmaceutical industry.

Regarding my Wired article, I was paid $7000 to write it, fairly meager considering that I spent hundreds of hours in researching and writing it, including one trip to California and another to New York. However, I fail to see how this kind of disclosure is related to the disclosure we should require of physicians speaking for drug companies. In the latter case, there are clear, competing interests, between the needs of physicians in the audience to learn accurate information and the needs of drug companies to sell more product, regardless of accuracy. A hired gun is caught in a moral tug of war between these interests, always calculating how honest he or she should be in discussing the sponsor's drug.

In the case of Wired, there is a confluence of interests. The readers subscribe in order to read cutting edge information on science, and the publisher must provide this in order to maintain its readership. The writer may have his own personal biases (as I certainly did), but they are not related to being paid a fee to write the article. In other words, now that you know I was paid $7000 to write about Amen and his use of functional neuroimaging, how, exactly, should this discredit me? Where's the conflict?

Supremacy Claus said...

Dan: I am a utilitarian (to the extreme) and a libertarian (in moderation). I oppose most transparency as a tool of pretextual, lawyer gotcha. Transparency is a Trojan Horse for oppression, like self-reporting in Stalin's time, followed by the firing squad for those self-reporting.

One of the maxims of legal remedy states, those who seek equity must come with clean hands.

Here are more cool maxims (not sarcastic, they are cool and most useful in any debate) from the Medieval court of equity:

http://en.wikipedia.org/wiki/Maxims_of_equity

See how many Grassley is violating.

Due to the nearly infinite number of bogus rules designed only for oppression by the lawyer profession, no one has clean hands. Ed's lack of transparency is just a silly gotcha, but no less silly than the doctor gotcha.

You have taken care of patients. Your life is heaven when they do well. It is hell when they do not. There is no bribe sufficient to have you act against the interest of your patients, because their interest is the same as yours. Effexor people could have paid you a $million, you would not leave a patient agitated on it for more than a day.

I was teasing you, and had no intention that you reveal a private fact. You are so earnest and moral, I have to choose my words more carefully.

The magazine's real purpose is not to inform people interested in high tech. It is to attract such people to tech ads. Let's say, your article said, there was no problem. (I had no disagreement with your article. You are a good and smart psychiatrist. I respect you as a clinician, whatever our policy dispute. And, you were fair enough to allow their rebuttal.) For $7000, would you have allowed editing by the employer to attract more readers? You could have said, no. They might have paid you. You would know, you would never work for them again, nor for anyone in their circle of magazine publishing. What if your fee were $100,000, would you allow editing to change the substance of the article? If yes, we are just haggling over price.

However, I know, no amount of money would have you fail a patient. That would be true of 95% of doctors. The other 5% should not be in medicine, and industry sponsorship is the least of their problems.

Anonymous said...

Supremacy Claus,

How long do you think it will take for Carlat to ban you for you consistent disruptive behavior and continuous non sequitors? My guess is that he will be a little more patient than Ed Silverman was, but less patient than other readers who are reading your comments.

Anonymous said...

Given the choice I think most patients would prefer the shrinks who think like Reidbord & Carlat than those who think like supremacy claus. I know I would. While I'm not opposed to docs depending upon big pharma for a large chunk of their income, I just don't want to be their patient. I do hope Grassley's efforts get all the drug companies to make their payments to physicians public.

Supremacy Claus said...

Anonymoous: As a general rule with exceptions, the way to choose a doctor is this.

The doctor who has seen the most patients with the same condition is the best doctor for you. It is not the one who is supercilious and refused a sandwich thinking it an irresistible corruption.

The experience criterion tells you, 1) the doctor has finished making his mistakes a 1000 patients ago; 2) enough patients did well that he got a lot of experience; 3) the wisdom of the crowd has endorsed the doctor.

Anonymous said...

Supremacy Claus, those are all good suggestions but I would add one more. Ethics. That matters to me.

Frankly I don't care how many in the crowd endorse a psychiatrist like Nemeroff or any of the others who have recently been in the news - I sure wouldn't want to be treated by them.

I learned the hard way that popular psychiatrist doesn't necessarily equal ethical psychiatrist.

therapyfirst said...

You know, after reading this guy Supremacy Claus these past 8 months, he is the guy rooting on everyone to jump off the cliff and then walking away with a smile on his face.

Sort of the kind of dialogue one would expect from the Joker character in "The Dark Knight"

Anarchy, buddy, you love it!

Anonymous said...

After the evil pharma empire has the capitalistic blood sucked out of it we can move on to nationalizing specialty physician compensation. If you believe in dismantling one business for "ethical" reasons you must believe in dismantling all business. These discussions are a driver leading us to more government intervention and loss of freedom. Stick to medicine. If you are not careful your utopian minds will come to learn that oppression is oppression. Supremacy Claus was right on in his view of what happened in Russia. We are on that path now. Be careful of what you preach.

Daniel Carlat, M.D. said...

Anon,

I'm not talking about getting rid of the pharmaceutical companies. Allow them to thrive. I want them to create more and better drugs. I just want them to market their products with integrity.