PAXIL: Athlete Wrongly Given Pacemaker for Paxil-Induced Heart Malfunction – FL

NOTE FROM Ann Blake-Tracy (

Although Paul’s case is an older case I have only this week found my copy
of excellent this article so had not been able to send it out before now,
but feel it is extremely important to include in our database. Others need to be
aware of the effects of SSRI antidepressants upon the heart, even in those who
are in excellent physical condition. I would encourage you to read the entire
article as it is full of very important information of drug approvals, financial
ties between drug companies and the FDA, Paxil withdrawal effects, the common
ignorance of doctors about these adverse effects and their unwillingness to
admit them even in the face of glaring evidence.
His “abnormal” heart rhythms come from having the benign “athletic
heart syndrome,” a sign of a super heart. The original fainting was probably due
to taking Paxil; the later problems were likely due to withdrawal from it.
Even with this confirmation, Paul had to go to more than 20 doctors
before he found one who would remove the pacemaker. Paul is recovering from his
ordeal; he is able to walk a mile now, although previously he could run 50.

The Science
of Deceit

by Burton Goldberg

The mainstream media
regularly reports on the “dangers” of “unproven” herbal remedies and
supplements. But what is the reported number of people who have died from using
herbs and supplements? According to the FDA, between 1993 and 1998, federal,
state and local agencies reported a total of 184 deaths, most of which were
associated with weight loss formulas. Compare that to the reported number of
people who die in hospitals because of the side effects of properly prescribed
pharmaceutical drugs: more than 100,000, every year. You can add to that the
number of patients killed in hospitals because of “medical errors”: another
100,000 or so. Those statistics are from the Journal of the American Medical
Association (JAMA). This means that the ordained guardians of our health kill as
many people every week as died in the September 11 terrorist attacks.

And that number only includes people who died in hospitals. A 1998
JAMA article estimated that more than 2 million people require hospitalization
every year because of the adverse side effects of drugs. Moreover, it is widely
conceded that the number of adverse reactions and fatalities attributable to
prescription drugs is actually many times the number

Statistics aside, let’s put a face on what I’m
talking about. Paul Domb is the son of a dear friend of mine. Two years ago,
Paul was a 41-year-old endurance athlete who had run thousands of road races,
hundreds of triathlons and other world-class endurance events. Paul had
regularly trained twice a day for 20 years to stay in competitive shape, so it
was hard for him to understand why he should begin to experience anxiety and
panic attacks. He went to a psychologist who, after a few sessions, recommended
that Paul take the antidepressant drug Paxil. Paul was reluctant, but his
anxiety was affecting his work in corporate real estate, so he started taking a
daily dose of 20 mg.

About three weeks later, Paul was set to begin
an early morning swim when he felt his heart suddenly speed up. For the first
time in his life, he felt faint and lost consciousness. He fell backward,
crashing onto a metal pool chair. He revived after several seconds, and felt
ready to continue his workout, but his training partner convinced him to take it
easy and go home. Paul related the incident to his wife, who insisted he go to
the hospital for an examination.

At the hospital, he underwent an
extensive battery of tests. They took Paul’s medical history, asking what
medications he was on, and took brain scans, electrocardiograms and various
other tests. Paul’s electrocardiogram measuring his heartbeat rhythms showed an
unusual pattern. A cardiologist specializing in heart rhythms was called in. He
told Paul that he needed to put a catheter up Paul’s groin to stimulate the

heart in an effort to reproduce the earlier arrhythmia. Paul refused, but the
physician told him that a previous patient with the same symptoms who refused
the test died soon after. Scared into it, Paul took the test. Afterward, the
doctor came back with the bad news: Paul had a rare disorder called Brugada
Syndrome. Without having a pacemaker/defibrillator inserted, he was told, his
heart could suddenly stop and he could drop dead at any moment.

There was worse news: The disease was genetic and the possibility
existed that Paul’s 5-year-old daughter had the same condition and could die at
any time.

Paul had the pacemaker inserted. Unfortunately, his
doctors did not take into account that he was a competitive athlete, and they
set the parameters of the pacemaker wrong. Whenever Paul went to sleep, his

heart rate dropped below “standard,” and the device would rapidly pace his
heart. Paul was unable to get more than two hours of sleep at a time. Although
the doctors eventually reset his pacemaker, that was just the beginning of what
became almost six months of physical and emotional hell. He was nauseated, but
vomiting brought no relief. He frequently had convulsions. Electric shocks would
shoot through his body 30 or 40 times a day, sometimes violent enough to cause
him to fall. He started having recurring thoughts of suicide ‹or violence
toward others. And through it all he was tortured by the fear that his daughter
was going to die because of the genes he had passed on to her. Paul traveled the
country, seeking an answer, but no doctor could help him. So Paul buried himself
in research, trying to find a solution to his problems. And then one day he
happened to catch the TV news show 20/20. On it were people describing exactly
the same symptoms as he had, only they didn’t have Brugada Syndrome ‹they were
suffering side effects of trying to withdraw from Paxil.

Paul could
hardly believe it. His doctor had told him to stop taking Paxil before his heart
surgery. Paul started studying Paxil, and what he found shocked and enraged him.
He discovered an astounding pattern of apparently deliberate deception by
SmithKline Beecham (now called GlaxoSmithKline), the manufacturer of Paxil,
withholding information on the dangers of this drug from the FDA and the medical
community. In June 2001, GlaxoSmithKline lost a lawsuit when a Wyoming jury
awarded $6.4 million to the family of a man who killed three relatives and
himself after taking the antidepressant. The verdict was based on the company’s
failure to sufficiently warn doctors and patients that the effects of the drug
could include violence. It has since come to light that 20% of patients
worldwide who were prescribed Paxil for depression stopped taking it because of
suffering adverse effects. And effects of withdrawal include intense insomnia;
vertigo; electric shocks; profuse night sweats; nausea; extreme confusion;
intense fear of losing sanity; and thoughts of suicide and homicide. A class
action filed in San Diego, representing thousands of victims of Paxil is

Paul then went to an expert: Pedro Brugada, the physician
son of Dr. Ramon Brugada, for whom the condition is named. Brugada the younger
looked at all of Paul’s records and told him that he didn’t have Brugada
Syndrome. Other experts concurred. Paul was told that the hospital’s original
procedure to reproduce arrhythmia “would’ve brought a horse down.” His
“abnormal” heart rhythms come from having the benign “athletic heart syndrome,”
a sign of a super heart. The original fainting was probably due to taking Paxil;
the later problems were likely due to withdrawal from it.

Even with
this confirmation, Paul had to go to more than 20 doctors before he found one
who would remove the pacemaker. Paul is recovering from his ordeal; he is able
to walk a mile now, although previously he could run 50. Despite off-the-record
confirmations of incompetence and negligence in Paul’s misdiagnosis and
treatment, not one physician would sign a letter to that effect, or agree to
testify on his behalf. Now, multiply Paul’s story by thousands, by millions,
every year, and you can understand my anger over sensationalistic headlines
about the “dangers” of taking herbs like St. John’s wort.

Here are
some truths about the “scientific” testing of pharmaceutical drugs that you
probably are not aware of. Did you know that the research information contained
in the Physicians’ Desk Reference  (the pharmaceutical bible used by M.D.s
)is supplied by the drug manufacturers themselves? Did you know that the FDA
approves drugs not by actually doing the testing, but simply by reviewing
studies submitted by the drug manufacturers? Did you know that a drug
manufacturer needs to submit only two studies showing satisfactory results to
get a drug approved by the FDA‹even if there are even more studies showing the
drug causes adverse reactions in an unacceptably high number of cases?

Did you know that most of the articles discussing the efficacy of
drugs that are published in medical journals are studies paid for by the drug
manufacturer? And that often, as the New York Times reported last summer, the
academic scientists listed as lead authors are often just “window dressing, to
lend credibility to papers that are really the work of drug companies. The
academic scientists’ main role in such studies is to recruit patients and
administer experimental treatments. The scientists or their universities are
paid for this work.”

And did you know that a study conducted by USA
Today found that more than half of the experts hired to advise the government on
the safety and effectiveness of medicine had a direct financial interest in the
drug or topic were asked to evaluate? An analysis of financial conflicts of
interest at 159 FDA advisory committee meetings from January 1, 1998, through
June 30, 2000, found that at 92% of the meetings, at least one member had a
financial conflict of interest, while at 55% of meetings, half or more of the
FDA advisers had conflicts of interest. These conflicts included helping a
pharmaceutical company develop a medicine, then serving on an FDA advisory
committee that judges the drug.

You may not know that a significant
portion of your tax dollars earmarked for healthcare goes to research on
patentable drugs that make billions of dollars for drug companies. The
government should fund research into nontoxic, non-patentable remedies at a much
higher level than it is presently doing. This situation again points out the
need for political action, for campaign reform. For 2001, the budget for the
National Institutes of Health was $20 billion. This amount could be doubled by
2003. Approximately 83% of this is spent on research performed outside the NIH.
This is serious money, and most of it goes to developing patentable drugs.

A recent article in the New York Times revealed that the
pharmaceutical industry spent $177 million on lobbying in 1999 and 2000: That’s
$50 million more than their nearest rival, the insurance industry. They employ
more lobbyists (625) than there are members of Congress ‹and more than half of
the lobbyists are former members of Congress, congressional staff members or
government employees.

This shows how important it is to get involved
politically, and work for campaign-finance reform. It’s also time for individual
physicians to take responsibility for their actions, and stop being pawns in the
economic games played by the drug and health insurance industries. Physicians
will change only if their patients demand it. Reform will only come from market
forces, which means you: how you spend your money on healthcare, and on
charitable and political donations. Get informed, take responsibility for your
own health, and choose your doctors and medicines wisely.

Sen. Grassley Investigates Lilly/WebMD link Reported by Washington Post

Dear Friends and Colleagues,

Freelance writer and
cartoonist Martha Rosenberg has worked diligently to reveal the conflict of
interest in many of the pharma/medical  situations.

rate this column. The rating buttons are at the top of the page after you click
on this link and are into the site. There is no
requirement to register or log-in so it should take only a few

Thank you.

Rosie Meysenburg

Grassley Investigates Lilly/WebMD link Reported by Washington

By Martha Rosenberg (about the
)     Page 1 of 2 page(s) Permalink

For OpEdNews: Martha Rosenberg – Writer

It is
not too hard to find evidence of links between WebMD and drug giant Eli

A 2002 article on the gigantic medical site about pain and
depression says “Lilly is a WebMD Partner,” and an advertising award in 2004
went to the FCB “client” Eli Lilly & Co./WebMD–not clients.

and skyscraper ads for Lilly‘s blockbuster antidepressant Cymbalta on WebMD‘s
home page never seemed to yield to other advertisers in 2009–and the Washington

Post reported Lilly and WebMD to be partners in 2000.

Now Sen. Charles
Grassley (R-Iowa), ranking Republican on the Senate Finance Committee, is
investigating financial ties between Lilly and WebMD Health Corp because of a

WebMD TV ad exhorting people to undergo a Lilly depression screening.

can joke about the need to tell people they are depressed–do people need to be
told they have a headache?–but pharma’s screening ruse to recruit new
patient pools for the volatile drugs among teens, adolescents and new mothers is
not funny.

3,500 news articles about antidepressant linked violence
appear on the web site,, including 700 murders, 200
murder-suicides, 51 school shooting incidents and 54 postpartum depression cases
since 1989.

In addition to WebMD, WebMD Health Corp. includes the web
sites Medscape, MedicineNet, eMedicine, eMedicine Health, RxList,,
and Original partners and investors says the Washington Post included
“Microsoft, DuPont, Rupert Murdoch’s News Corp. (and his Fox TV networks),
Silicon Graphics and Netscape founder Jim Clark, drug maker Eli Lilly, and EDS,
the computer services company founded by H. Ross Perot.”

Lilly is not the
only pharma company receiving unmarked product placement on WebMD.

summer, a video featured a woman patient confessing she was fearful of life
while a voice over said she needed treatment for “general anxiety disorder” and
the camera showed bottles of Forest Pharmaceuticals’ antidepressant
Lexapro moving down the manufacturer’s assembly line
. Get it? No disclaimer
on the video or “sponsored content” appeared.

Another unsponsored WebMD

video last summer urged people on antidepressants to remain on their therapy
“despite side effects” and a third suggested women concerned about cancer, heart
attack and stroke risks of postmenopausal hormone therapy should continue their
treatment at lowered doses. Hang in there, valued customers.

A search for
Wyeth (now Pfizer) antidepressant Effexor a few months ago on WebMD elicited a
JAMA study finding Effexor superior to other antidepressants by a Wyeth funded
second author, Graham Emslie, MD. Effexor was the drug Andrea Yates took when
she drowned her five children in 2001, a case found on

Questions about conflict of interest have surfaced at
WebMD‘s Medscape too which administers many of the lucrative drug company
sponsored continuing medical education [CME] courses in the US which doctors
must complete to keep their state licenses.

Last year psychiatrist Daniel
Carlat, MD–who recounts his adventures as a Wyeth paid Effexor promoter in the
New York Times magazine–writes that he received, as a member of Medscape, an
envelope with “a brochure from Forest Laboratories advertising Lexapro, and
nothing else. It was creepy, like Invasion of the Body Snatchers.”

Lilly is known for launching the SSRI antidepressant revolution with Prozac,
Cymbalta does much of the heavy lifting now with worldwide sales of $3.075
billion in 2009.

Many remember Cymbalta as the drug 19-year-old healthy
clinical volunteer Traci Johnson killed herself on, during trials on the Lilly

campus in 2004–soon after FDA investigations into suicide/antidepressant

Traci had no depression history said Rev. Joel Barnaby, a
spokesman for the Johnson family, who called Lilly‘s decision to proceed with
Cymbalta’s launch as scheduled “offensive” posturing.

Five others
suicides occurred during Cymbalta clinical trials, said the FDA and twice the
rate of suicide attempts were seen in women prescribed the drug for stress
urinary incontinence–also patients with no depression to blame.

remember Cymbalta as the drug Carol Anne Gotbaum, daughter-in-law of New York
City Public Advocate Betsy Gotbaum, was taking during her macabre death in
police custody at the Phoenix’s Sky Harbor airport in 2007.

But now Lilly
and WebMD are pushing Cymbalta for pain since it was approved for
fibromyalgia in 2008. “Across cultures, patients who complain of pain tend to be
depressed,” says the 2002 article which calls WebMD and Lilly partners, a
finding from a “huge international study by Prozac manufacturer Eli Lilly and

“Could your muscle aches be related to depression?” hawks WebMD

text under the heading, “Recognizing the Symptoms of Depression.” Next to it is
a picture of a depressed women with arrows pointing to the pain in her head and
neck, chest and stomach, arms and hands, legs and feet and of course

“Print out this symptom diary, and fill it out. Then take it to
your doctor to discuss what may be causing your symptoms.”

This content,
we’re told, is “selected and controlled by WebMD‘s editorial staff” but “funded
by Lilly USA.”

Martha Rosenberg is
columnist and cartoonist based in Chicago I

Lilly admits paying docs to peddle drugs – at what cost??

As part of a large government fine of $1.4 BILLION Eli Lilly, makers of Prozac, Cymbalta, Stratera, Cialis, etc. has begun to disclose payouts to doctors to peddle their wares/drugs. When you consider the long reaching damaging effects of that, you realize that the fine is nothing compared to the loss of lives that are the end result.
Let’s look at just a few facts:
1. The third leading cause of death in America is “properly prescribed (following FDA and AMA guidelines) prescription drugs. That does not count those taking these drugs “off label” or in higher amounts than recommended, etc., but only taking them as recommended by those who are suppose to know safest prescribing guidelines.

Eli Lilly and Co. paid Jacksonville-area doctors thousands of dollars as consultants to market drugs

Maker of Prozac and Cialis was forced to publish doctor names and compensation.

  • Story updated at 11:29 PM on Friday, Sep. 4, 2009

Drug companies routinely pay physicians as experts in the course of marketing their products. While legal, the practice is widely criticized as a conflict of interest that drives up drug costs.

One pharmaceutical company paid more than $76,000 to Jacksonville-area doctors and other medical providers in the first three months of this year.

That’s according to the first publicly released information to document the long-hidden financial ties between drug companies and doctors.

Eli Lilly and Co., the maker of Prozac, Cymbalta and Cialis, was forced to begin publishing the names and compensation of its paid consultants as part of a $1.4 billion settlement with the federal government last January.

Among the names that became public were those of several physicians practicing in the Jacksonville area. For the full story, including names of the physicians, see Sunday’s Business section of the Times-Union.


Wendell's picture

Dr.’s are as bad as politicians!

Submitted by Wendell on Fri. 9/4/2009 at 5:09 pmDr.’s are as bad as politicians!

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  • Dr’s Got To Make A Living Too

    Submitted by fearlessfan on Fri. 9/4/2009 at 9:05 pmYou shouldn’t blame the doctors, it’s the high dollar Pharmaceutical companies who are pushing the dough.   Anybody in their right mind would take it especially if its legal; too heck with ethics.

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  • It is all about ethics

    Submitted by rs471911 on Sat. 9/5/2009 at 10:50 am Recently I was in my doctor’s waiting room, 45 minutes past my scheduled appointment. During my wait I watched as 4 pharmaceutical reps, one after another, walked right in to see the doctor and peddle their drugs. The nurse said the doctor sees each rep personally. When I finally saw the doctor I asked if he saw more pharmaceutical reps or patients a day. He gets perks for prescribing their drugs. The scariest part was I heard him asking one of the reps for medical advice. He is no longer my doctor.

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  • I had the same thing happen to me six years ago///

    Submitted by Xenon on Sat. 9/5/2009 at 1:53 pmI also was waiting for a appointment for over 45 minutes and was shocked at the people walking in and out without signing in. Finally when i was checking out, three representatives were in the hallway laughing and talking with the Doctor and talking about a upcoming quail hunt, Montana hunting trip and a deep sea fishing trip at their expense, one female representative turned to me and handled me a pen, with pharmaceutical advertisement on it as i was trying to sign my check and said to me, “Just keep it, a sovernier.” Smiled perkily and turned back to the group and the Doctor.

    I have not been back since. I just wish integrity, honor, honesty and accountability would come back along with true patriotism for our country and it’s citizens. My age is showing…

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  • 5/31/2000 – Is Academic Medicine for Sale? – New England Jour of Med

    The New England Journal of Medicine
    May 18, 2000 — Vol. 342, No. 20

    Is Academic Medicine for Sale?

    by Marcia Angell, M.D., editor,

    In 1984 the Journal became the first of the major medical journals to
    require authors of original research articles to disclose any financial ties
    with companies that make products discussed in papers submitted to us. (1)
    We were aware that such ties were becoming fairly common, and we thought it
    reasonable to disclose them to readers.

    Although we came to this issue early, no one could have foreseen at the time
    just how ubiquitous and manifold such financial associations would become.
    The article by Keller et al. (2) in this issue of the Journal provides a
    striking example. The authors’ ties with companies that make antidepressant
    drugs were so extensive that it would have used too much space to disclose
    them fully in the Journal. We decided merely to summarize them and to
    provide the details on our Web site.

    Finding an editorialist to write about the article presented another
    problem. Our conflict-of-interest policy for editorialists, established in
    1990, (3) is stricter than that for authors of original research papers.
    Since editorialists do not provide data, but instead selectively review the
    literature and offer their judgments, we require that they have no important
    financial ties to companies that make products related to the issues they
    discuss. We do not believe disclosure is enough to deal with the problem of
    possible bias. This policy is analogous to the requirement that judges recuse
    themselves from hearing cases if they have financial ties to a litigant. Just
    as a judge’s disclosure would not be sufficiently reassuring to the other
    side in a court
    case, so we believe that a policy of caveat emptor is not enough for readers
    who depend on the opinion of editorialists.

    But as we spoke with research psychiatrists about writing an editorial
    on the treatment of depression, we found very few who did not have financial
    ties to drug companies that make antidepressants. (Fortunately, Dr. Jan
    Scott, who is eminently qualified to write the editorial, (4) met our
    standards with respect to conflicts of interest.) The problem is by no means
    unique to psychiatry. We routinely encounter similar difficulties in finding
    editorialists in other specialties, particularly those that involve the
    heavy use of expensive drugs and devices.

    In this editorial, I wish to discuss the extent to which academic
    medicine has become intertwined with the pharmaceutical and biotechnology
    industries, and the benefits and risks of this state of affairs.
    Bodenheimer, in his Health Policy Report elsewhere in this issue of the
    Journal, (5) provides a detailed view of an overlapping issue — the
    relations between clinical investigators and the pharmaceutical industry.

    The ties between clinical researchers and industry include not only
    grant support, but also a host of other financial arrangements.
    Researchers serve as consultants to companies whose products they are
    studying, join advisory boards and speakers’ bureaus, enter into patent and
    royalty arrangements, agree to be the listed authors of articles
    ghostwritten by interested companies, promote drugs and devices at
    company-sponsored symposiums, and allow themselves to be plied with expensive
    gifts and trips to luxurious settings. Many also have equity interest in the

    Although most medical schools have guidelines to regulate financial
    ties between their faculty members and industry, the rules are generally
    quite relaxed and are likely to become even more so. For some years, Harvard
    Medical School prided itself on having unusually strict guidelines. For
    example, Harvard has prohibited researchers from having more than $20,000
    worth of stock in companies whose products they are studying. (6) But now
    the medical school is in the process of softening its guidelines. Those
    reviewing the Harvard policy claim that the guidelines need to be modified
    to prevent the loss of star faculty members to other schools. The executive
    dean for academic programs was reported to say, “I’m not sure what will come
    of the proposal. But the impetus is to make sure our faculty has reasonable
    opportunities.” (7) Academic medical institutions are themselves growing
    increasingly beholden to industry. How can they justify rigorous
    conflict-of-interest policies for individual researchers when their own ties
    are so extensive? Some academic institutions have entered into partnerships
    with drug companies to set up research centers and teaching programs in which
    students and faculty members essentially carry out industry research. Both
    sides see great benefit in this arrangement. For financially struggling
    medical centers, it means cash. For the companies that make the drugs and
    devices, it means access to research talent, as well as affiliation with a
    prestigious “brand.” The
    time-honored custom of drug companies’ gaining entry into teaching hospitals
    by bestowing small gifts on house officers has reached new levels of
    munificence. Trainees now receive free meals and other substantial favors
    from drug companies virtually daily, and they are often invited to opulent
    dinners and other
    quasi-social events to hear lectures on various medical topics. All of this
    is done with the acquiescence of the teaching hospitals.

    What is the justification for this large-scale breaching of the
    boundaries between academic medicine and for-profit industry? Two reasons
    are usually offered, one emphasized more than the other. The first is that
    ties to industry are necessary to facilitate technology transfer — that is,
    the movement of new drugs and devices from the laboratory to the
    marketplace. The term “technology transfer” entered the lexicon in 1980,
    with the passage of federal legislation, called the Bayh-Dole Act, (8) that
    encouraged academic institutions supported by federal grants to patent and
    license new products developed by their faculty members and to share
    royalties with the researchers. The Bayh-Dole Act is now frequently invoked
    to justify the ubiquitous ties between academia and industry. It is argued
    that the more contacts there are between academia and industry, the better it
    is for clinical medicine; the fact that money changes hands is considered
    merely the way of the world.

    A second rationale, less often invoked explicitly, is simply that
    academic medical centers need the money. Many of the most prestigious
    institutions in the country are bleeding red ink as a result of the
    reductions in Medicare reimbursements contained in the 1997 Balanced Budget
    Act and the hard bargaining of other third-party payers to
    keep hospital costs down. Deals with drug companies can help make up for the
    shortfall, so that academic medical centers can continue to carry out their
    crucial missions of education, research, and the provision of clinical care
    for the sickest and neediest. Under the circumstances, it is not surprising
    that institutions feel justified in accepting help from any source.

    I believe the claim that extensive ties between academic researchers and
    industry are necessary for technology transfer is greatly exaggerated,
    particularly with regard to clinical research. There may be some merit to
    the claim for basic research, but in most clinical research, including
    clinical trials, the “technology” is essentially already developed.
    Researchers are simply testing it. Furthermore, whether financial
    arrangements facilitate technology transfer depends crucially on what those
    arrangements are. Certainly grant support is constructive, if administered
    properly. But it is highly doubtful whether many of the other financial
    arrangements facilitate technology transfer or confer any other social
    benefit. For example, there is no conceivable social benefit in researchers’
    having equity interest in companies whose products they are studying.
    Traveling around the world to appear at industry-sponsored symposiums has
    much more to do with
    marketing than with technology transfer. Consulting arrangements may be more
    likely to further the development of useful products, but even this is
    arguable. Industry may ask clinical researchers to become consultants more
    to obtain their goodwill than to benefit from their expertise. The goodwill
    of academic researchers is a very valuable commodity for drug and device
    manufacturers. Finally, it is by no means necessary for technology transfer
    that researchers be personally rewarded. One could imagine a different
    system for accomplishing the same purpose. For example, income from
    consulting might go to a pool earmarked to support research or any other
    mission of the medical center.

    What is wrong with the current situation? Why shouldn’t clinical researchers
    have close ties to industry? One obvious concern is that these ties will
    bias research, both the kind of work that is done and the way it is reported.
    Researchers might undertake studies on the basis of whether they
    can get industry funding, not whether the studies are scientifically
    important. That would mean more research on drugs and devices and less
    designed to gain insights into the causes and mechanisms of disease. It
    would also skew research toward finding trivial differences between drugs,
    because those differences can be exploited for marketing. Of even greater
    concern is the possibility that financial ties may influence the outcome of
    research studies.

    As summarized by Bodenheimer, (5) there is now considerable evidence
    that researchers with ties to drug companies are indeed more likely to
    report results that are favorable to the products of those companies than
    researchers without such ties. That does not conclusively prove that
    researchers are influenced by their financial ties to industry. Conceivably,
    drug companies seek out researchers who happen to be getting positive
    results. But I believe bias is the most likely explanation, and in either
    case, it is clear that the more enthusiastic researchers are, the more
    assured they can be of industry funding.

    Many researchers profess that they are outraged by the very notion that
    their financial ties to industry could affect their work. They insist that,
    as scientists, they can remain objective, no matter what the blandishments.
    In short, they cannot be bought. What is at issue is not whether researchers
    can be “bought,” in the sense of a quid pro quo. It is that close and
    remunerative collaboration with a company naturally creates goodwill on the
    part of researchers and the hope that the largesse will continue. This
    attitude can subtly influence scientific judgment in ways that may be
    difficult to discern. Can we really believe that clinical researchers are
    more immune to self-interest than
    other people?

    When the boundaries between industry and academic medicine become as
    blurred as they now are, the business goals of industry influence the
    mission of the medical schools in multiple ways. In terms of education,
    medical students and house officers, under the constant tutelage of industry
    representatives, learn to rely on drugs and devices more than they probably
    should. As the critics of medicine so often charge, young physicians learn
    that for every problem, there is a pill (and a drug company representative to
    explain it). They also become accustomed to receiving gifts and favors from
    an industry that uses these courtesies to influence their continuing
    education. The
    academic medical centers, in allowing themselves to become research outposts
    for industry, contribute to the overemphasis on drugs and devices. Finally,
    there is the issue of conflicts of commitment. Faculty members who do
    extensive work for industry may be distracted from their commitment to the
    school’s educational mission.

    All of this is not to gainsay the importance of the spectacular
    advances in therapy and diagnosis made possible by new drugs and devices.
    Nor is it to deny the value of cooperation between academia and industry.
    But that cooperation should be at arm’s length, with both sides maintaining
    their own standards and ethical norms. The incentives of the marketplace
    should not become woven into the fabric of academic medicine. We need to
    remember that for-profit businesses are pledged to increase the value of
    their investors’ stock. That is a very different goal from the mission of
    medical schools.

    What needs to be done — or undone? Softening its conflict-of-interest
    guidelines is exactly the wrong thing for Harvard Medical School to do.
    Instead, it should seek to encourage other institutions to adopt stronger
    ones. If there were general agreement among the major medical schools on
    uniform and rigorous rules, the concern about losing faculty to more lax
    schools — and the consequent race to the bottom — would end. Certain
    financial ties should be prohibited altogether, including equity interest and
    many of the writing and speaking arrangements.Rules regarding conflicts of
    commitment should also be enforced. It is difficult to believe that full-time
    faculty members can generate outside
    income greater than their salaries without shortchanging their institutions
    and students.

    As Rothman urges, teaching hospitals should forbid drug-company
    representatives from coming into the hospital to promote their wares and
    offer gifts to students and house officers. (9) House officers should buy
    their own pizza, and hospitals should pay them enough to do so. To the
    argument that these gifts are too inconsequential to constitute bribes, the
    answer is that the drug companies are not engaging in charity. These gifts
    are intended to buy the goodwill of young physicians with long prescribing
    lives ahead of them. Similarly, academic medical centers should be wary of
    partnerships in which they make available their precious resources of talent
    and prestige to carry out research that serves primarily the interests of
    the companies. That is ultimately a Faustian bargain.

    It is well to remember that the costs of the industry-sponsored trips,
    meals, gifts, conferences, and symposiums and the honorariums, consulting
    fees, and research grants are simply added to the prices of drugs and
    devices. The Clinton administration and Congress are now grappling with the
    serious problem of escalating drug prices in this country. In these difficult
    times, academic medicine depends more than ever on the public’s trust and
    goodwill. If the public begins to perceive academic medical institutions and
    clinical researchers as gaining inappropriately from cozy relations with
    industry — relations that create conflicts of interest and contribute to
    rising drug prices — there will be little sympathy for their difficulties.
    Academic institutions and their
    clinical faculty members must take care not to be open to the charge that
    they are for sale.

    Marcia Angell, M.D.