Rheumination

Vioxx Populi 2009

September 30, 2004. 

Do you remember where you were that day?  I do.  I was at my office peeling off another prescription of Vioxx when my mother called with news that the drug had been withdrawn from the market.You know the reason, increased cardiovascular mortality which they apparently only then discovered.  Since then, of course,  all sorts of dirt has been exposed about the drug, and in particular, the company that produced and marketed it.  What made it more disturbing was the fact that I prescribed it a lot, even took it myself.  I gave talks to other physicians and undoubtedly convinced them to do the same.  All my colleagues did the same.  We were all taken in. 

 So now, every September 30 I pause to review my relationship with pharma.  I'm not a pharma basher.  I can't imagine how brutal rheumatology as a specialty would be without the new biologics and the other miracles they produce. But they are business, and their business is influencing my prescribing pattern, nothing else.  Every high powered guest speaker they bring in, every CME conference they sponsor, and every lunch or logo-laden pen they offer is to increase sales.  Much is so obvious that we laugh at the thought that it would influence us.  But we know it can.  Surely no physician wanted to hurt anybody with Vioxx, but somehow physicians were involved at every level.  Doctors involved in the studies must have been aware of the cardiovascular concerns, yet few sounded the alarm. Others allowed their name to be put on company produced research, though they had nothing to do with the trials.  Clinicians are  given speakers fees to spread the word of what we thought was a good product.  Guest speakers we couldn't dream of attracting without drug company money show up, but what are the chances they have a contrary message. None of the chain of physicians involved had any ill intent yet we all went for the ride...and crash.  

So now on September 30th of each year I'll re-read the following articles:

Ghost Management:  How Much of the Medical Literature is Shaped Behind the Scenes by the Pharmaceutical Industry?  

Guest Authorship and Ghostwriting in Publications Related to Rofecoxib 

The ADVANTAGE Seeding Trial: A Review of Internal Documents

Medical Journals are an Extension of the Marketing Arm of  Pharmaceutical Companies

Then I'll visit the Scientific Misconduct Blog for a bit. (Not too long, that's just depressing)

And tomorrow, my skeptic battery recharged, I'll be a wiser rheumatologist.

This was a re-post of last year's vioxx populi.  Since then there has been more dirt uncovered, something which I think we'll have to get used to.  The articles listed are still worth reading and there are many more I could add, but to keep the reading of unpleasantness down to a bare minimum, I would simply suggest that you check out PLOS  which regularly publishes articles related to pharmaceutical underhandedness, and Pharmagossip, a highly entertaining blog which nevertheless brings to the fore the latest pharma missteps.

 

A New Era

Things are a bit different around here these days.  Yes, the fact that I am actually posting again is something different, but the real difference is that our service has gone all university.  Since the summer we now have regular housestaff following us around.  It's quite a change after nearly twenty years of talking to myself between service rounds.  There are pros and cons to having residents about, some expected, others not so much, but overall I am quite happy with their arrival.  

The major pro is having young smart inquisitive people around asking questions and keeping me on my toes.  Even demonstrating the physical exam is amusing.  I'm not sure that that thrill will last after showing the knee exam for the hundredth time, but for now it's all good.

The biggest con is the distance residents put between me and my patients.  My longstanding patients now see different housestaff with every visit.  They have to go through a much longer history and physical each visit and when I do come in, the visit is often shorter. New patients are even more difficult.  I never feel like I know the patient as well when someone else takes the initial history and many of the subsequent visits are also with residents, so I never catch up.  

But it's all new.  I'm sure I'll figure out the balance between patient care and medical student care.  Just hope my patients can hang in there until I do.