Tuesday, January 26, 2010

Dr. Lawrence DuBuske: Me, Myself, and I.R.I.N.E.

The "banality of evil" is a phrase coined by Hannah Arendt in 1963. She was referring to the theory that throughout history evils have been committed not by fanatics and outliers, but by ordinary people taking cues from their culture. While accepting money from drug companies for marketing is hardly “evil” in Arendt’s sense, modern academic medicine has also normalized behaviors which are morally unacceptable. Let’s call it the banality of greed.

Given this background, I was fairly nonplussed by the news in the
Boston Globe that Dr. Lawrence Dubuske resigned from Harvard’s Brigham and Women’s hospital so that he could stay on the drug company gravy train. The hospital's new policy forbids faculty members from giving promotional talks.

Dr. DuBuske made just shy of $100,000 in 3 months of speaking for GlaxoSmithKline (according to the company's physician registry), which implies a windfall of $400,000 a year if he kept up that pace. He also speaks for six
other companies, and consults for another six, so the chances are good that Dr. DuBuske clears $2 million a year as a hired gun. Is anybody really surprised that he would choose to stop seeing patients for one day a week in order to maintain his life style?

Out of curiosity, I looked into his background. On a superficial level, Dubuske’s career trajectory is a duplicate of that of many academic physicians over the last couple of decades. He got onto the fast track through a combination of his obvious intelligence and drug company partnerships. If you plug his name into
Pubmed, you’ll find an impressive 46 articles on various topics related to allergies and asthma.

Most of the articles are funded in one way or another by drug companies. For example, he did a clinical trial of Zyflo for Abbott in 1997, he studied Salmeterol for GlaxoSmithKline in 1999, and over more recent years he did several studies for Schering Plough on the antihistamines Claritin and Clarinex. One of his
papers, apparently ghost-written by Schering Plough, argued that not all antihistamines can cause cardiac arrhythmia,
especially not Claritin and Clarinex.

So far, pretty standard stuff--just Dr. DuBuske playing his small part in the larger permeation of medicine by the pharmaceutical industry.
But then we learn that Dr. DuBuske is the director of "IRINE" (Immunology Research Institute of New England) a non-profit organization that collaborates with doctors in Eastern Europe for research and education. At first glance, it sounds like an altruistic organization. A Harvard professor brings world class medical education to underfunded medical systems that have recently thrown off the yoke of Communism.

But digging into the web site, you start to get the unsettling impression that IRINE is no more than a global marketing vehicle for drug companies. For example, there is this long
list of cities around the world where IRINE has presented “symposia.” We're not talking just Warsaw and Lodz—over the last several years, Dubuske and his IRINE colleagues have presented symposia in Bangkok, Buenos Aires, Vancouver, Sydney, Munich, Paris, Amsterdam, Bucharest, and the list really does go on. At least some of these symposia, and probably all of them, were funded by drug companies—for example, Dubuske and his colleagues at IRINE were funded to speak in Barcelona by Allergy Therapeutics in 2008, and in Goteberg Sweden by ALTANA Pharma in 2007.

So what
is IRINE, anyway? Who founded it? Who really runs it? Where does it get all the money to run its dozens of international symposia?

Since IRINE is a non-profit, its tax returns are public. I looked them up on the web site Guidestar.org (it is free, but requires a one time registration to login). The most recent tax return, which you can view
here without logging in, is from 2007, and it lists Lawrence M. DuBuske as the "President and Director." There is "0" income and "0" expenses.

How do you travel to dozens of cities to give lectures without money being exchanged somewhere? Good question; I called IRINE to ask it. The contact page on the web site lists Ilona DuBuske (Dr. DuBuske's wife--there is a photo of the two of them on the IRINE site) as the "research administrative coordinator" and provides a phone number.

I called it and a woman answered "Hello?"

"Hi," I said, "I'm Dr. Carlat from the Carlat Psychiatry Blog and I have some questions about your organization."

I’m sorry I cannot answer any question, please don’t call this number.” And she hung up.

I then sent my questions to IRINE's email address but I have yet to receive a response.

I wondered if IRINE's global headquarters were at Dr. DuBuske's house, but IRINE's address is in Gardner Mass, while his home is listed in nearby Harvard Mass.

Best case scenario: IRINE is a mom and pop operation that operates out of a small office and does a lot of good work around the world, but keeps poor records and needs to improve its customer service. Worst case scenario: Only Dr. DuBuske knows for sure.


Sara said...

Great investigation! Greed sometimes knows no bounds. A good example of the ways in which pharmaceutical marketing is corrupting medical education.

Anonymous said...

lets throw off the yoke of capitalism. Patent monopolies are the real reason for the high price of drugs and thus the reason to market them in such deceptive ways.

Claudia M. Gold, MD said...

This is a fascinating and frightening view of the widespread influence of the pharmaceutical industry.
As a pediatrician on the front lines in a busy small town practice, I am horrified by the influence of the pharmaceutical industry on children's mental healthcare.

Consider this story: this past week, a mother in my pediatric practice (details, as always, have been changed to protect my patients privacy) asked if I would increase the dose of her 13 year old daughter’s ADHD medication “so she would be nice all of the time.” She was perfectly serious, saying, “I know she’s capable of it, she can be so sweet.” When I told her that in my experience most 13 year old girls were not “always nice” to their parents, and that I might be worried about a child if she were, she became furious with me. She accused me of giving her daughter permission to be oppositional.

Later that day I opened the most recent issue of the Journal of Developmental and Behavioral Pediatrics. I found the following two page ad placed prominently on the inside cover.

“His ADHD symptoms can be disruptive, but there’s a great kid in there.
Now there’s a new way to help him out”
Below this writing is a photograph of a big green monster, with the head removed to reveal a sweet, smiling boy inside.

I am not pleased with this ad. Research in developmental psychology and neuroscience clearly shows that recognizing the meaning of a child’s behavior leads to healthy emotional development. In this case, my patient is working on becoming her own person and so, to leave the comfort and security of her mother’s embrace, she must sometimes actively run in the opposite direction. While certainly her mother does not need to condone her behavior, understanding and respecting her feelings will go a long way in helping her negotiate this difficult developmental stage.

But with the powerful pharmaceutical industry running ads indicating that any unpleasant behavior can be eliminated by a pill, it’s no wonder I have a hard time getting my message across.

Thank you for writing about this important subject.

Claudia M. Gold, MD

Doug Bremner said...

You are learning to write dialogue, Dr. Carlat! We are going to have to find you a literary agent! LOL!

Anonymous said...

Who is the mysterious psychiatrist from McLean mentioned in the Boston Globe article?

Joel Hassman, MD said...

I respectfully disagree with your comment that "accepting money from drug companies is hardly 'evil'", even if based on Hannah Arendt's terminology. My daughter once asked me a few years ago for a class project what my definition of evil was, and I felt I had a simple and applicable answer:

When one does whatever one wants, irregardless of the impact on others, and does not alter or modify the behaviors at all when there are negative or damaging consequences for others.

I think the question that begs to be asked by the general populace these days, when observing the growing percentage of psychiatrists who are beyond money focused in their alterations of standards of care, is when is the line between greed and evil crossed, as physicians are more recklessness, carelessness, and exhibit blantant disregard for consequences when dispensing medication like pez? I see it more and more as my travels in different venues in the profession accumulate.

So, as I have said to you in the past and now, being the mensch is respectful and gracious, but what does it get you in attempting to initiate change when you are dealing with people who have no souls to respond to decency and well intended efforts?

By the way, any comment to what Philip Dawdy wrote the other day at Furious Seasons? Obesity is to become a DSM 5 diagnosis? That, sir, is beyond offensive! That is greed and over diagnosing that redefines shameful.

Isn't greed considered one of the seven deadly sins per Christianity definitions? I'm Jewish, but find the list interesting in general.

Anonymous said...

On this:

"Dr. DuBuske made just shy of $100,000 in 3 months of speaking for GlaxoSmithKline (according to the company's physician registry)...so the chances are good that Dr. DuBuske clears $2 million a year "

I'm guessing the 2M is a gross underestimate. The company postings of fees paid to speakers and consultants do not include the money paid to speakers that has been laundered through their MECCs. And Dr Dubuske is likely involved with a boatload of those.

Nice article and great detective work on IRINE.

Gina Pera said...

Claudia, I'm sorry but you seem to have some very misguided attitudes about ADHD.

Perhaps you should start referring to someone who has taken the time to understand this condition, including why some of those ads are very much on target. This would be so much more professional than joining the scared-beyond-reason bandwagon about pharma ads.

Perhaps you also could have queried this mother further to see what she meant by "sweet" or "nice."
Perhaps the mother, too, has ADHD.

Or perhaps the child's behavior is worse than you realize, far beyond what is typical for the normal child going through adolescence. (By the way, I've never seen a double-blind, controlled study indicating the nature of "normal adolescence." Americans seem alone in the world in their attitude that it's normal and even desirable for teens to be disrespectful and rebellious.)

Lots of possibilities here, but you do not seem open to them. And that's a problem when you're ostensibly treating a child with ADHD.

Anonymous said...

Say what you will, Dr. Dubuske is a brilliant doctor who solved my sinus problems after years of suffering. He spent hours with me and my husband (another patient), that I'm sure were barely reimbursed by Blue Cross. How on earth are doctors at the Brigham supposed to support themselves on the tiny amounts being paid by insurance for 20 minute visits? When you see a doctor like him with other means of support, you can get world-class care. Otherwise, you're cattle.

Anonymous said...

You're just as bad posting this information. Please check facts before you follow though and post assumptions and lies. Every major PHRMA company has a cap for speaking. Dr. DuBuske has not made anywhere near $2 million, inclusive of all of his lines of income. Dr. DuBuske is a valuable educational resource, like it or not, that people demand to hear lecture. Quite honestly, the cost of prescription medications is more indicative of the cost of regulation and bringing products to market as opposed to marketing. To me, this sounds more like sour grapes than anything else. Dr. Carlat are you envious of Dr. DuBuske's success?