St. Petersburg Times

BAD MEDICINE

A Times Editorial

Tuesday, September 22, 2009

It’s now clear that the pharmaceutical industry that claims its goal is to improve lives is just as likely as any other industry to manipulate the truth to make a buck. Even more disturbing: Drug companies have found a stable of doctors willing to help them in exchange for cash or prestige. Doctors should know better, particularly those affiliated with medical schools, and the medical schools should adopt stricter rules.
Recent disclosures, forced by court cases or federal regulators, have laid bare the complicity of doctors, including some in Tampa Bay, in helping drug companies sell their products. Experts estimate for each $1 spent on such marketing, companies reap $12 in increased prescription sales. When doctors receive thousands of dollars from drugmakers to help deliver their message, it creates an inherent conflict of interest with their primary job: Caring for their patients. Medical schools should be attacking this ethical problem directly, particular in an era when costs are leaving many uninsured.
Some schools, such as Harvard and Stanford, have banned the lucrative relationships. Short of that, medical schools should at least require strict reporting and public disclosure, with serious consequences for lapses. That hasn’t been the case in the past at the University of South Florida College of Medicine.
The St. Petersburg Times’ Kris Hundley reported on Sunday how drugmaker Wyeth for years paid for and influenced the ghostwriting of medical journal articles and continuing education conferences in an effort to boost sales of its hormone treatments for menopause. The campaign continued even after a federal study indicated the drugs might make it harder to detect breast cancer in patients. Dr. James Fiorica, then a professor at USF and head of the gynecologic oncology program at H. Lee Moffitt Cancer Center, was among those who participated. He chaired a Wyeth-backed conference and signed his name to two ghostwritten articles. He, like other doctors earning money from pharmaceutical companies, said he never signed his name to a position he couldn’t scientifically defend.
And last month, Hundley wrote about Eli Lilly & Co.’s program that paid physicians tens of millions of dollars in the first quarter of this year to talk about its drugs. One of Lilly’s highest paid physicians and its top earner in the Tampa Bay area is Dr. Maria-Carmen Wilson, a neurologist and USF professor who is director of Tampa General Hospital’s Headache & Pain Center. She was paid $54,400 in the first quarter of the year for speaking with fellow doctors about Lilly’s Cymbalta drug on 27 occasions. Wilson reached Lilly’s annual cap of $75,000 in May.
Nonetheless, Wilson failed to follow USF policy to get prior approval before making presentations on behalf of a drugmaker. Wilson also failed to inform USF when she took free trips to Scotland and Spain for drugmaker Astra-Zeneca. Last month, USF approved Wilson’s Lilly activities retroactively.
Another USF-affiliated physician, Dr. Brian Keefe, also failed to disclose earning $15,000 from Lilly in the first quarter.
In April, USF medical school announced new reporting guidelines for interactions between faculty and drug- and medical device makers. But it seems the message has not gotten through, and faculty who ignore the rules are retroactively given a pass.
USF’s answer is that more clarity is coming. Dr. Stephen K. Klasko, CEO for USF Health and dean of the College of Medicine, says he has convened a group to look at all faculty relationships with pharmaceutical companies in order to make new rules and reporting requirements “as simple and as consistently enforceable and as clear as possible.”
“We’re going to have a zero tolerance policy,” Klasko says.

That can’t happen soon enough. Patients rely on doctors to give them the best treatment possible, not just the treatment they’re paid to support.

If you are struggling with an addiction, then that struggle can itself be the source of constant stress and strife. If someone you love is struggling with addiction then you know the stress and strife is not limited to the person addicted but will definitely extend to those who love the person as well. On both accounts, part of the stress felt is derived from simply not knowing what to do. When it seems like there is no logical reason for this travesty to happen and simultaneously it seems like there is no immediate solution to handle the addiction competently then the result can be personal and societal overwhelms and stress.

This educational series is designed to assist with a part of the overall stress of not understanding why addiction is occurring. With this in mind we begin the history of drug use with an historical view of one of the planets strongest enemies, cocaine.   
 
Coca predates written history in Peru and all of South America. Clear evidence of the predominance and dependence on coca goes easily back to 3500 years ago and beyond with the discovery of coca containers and their accompanying gourd full of shells. When the shells are ground they produce an alkali that makes the coca absorb into the body quicker. This process which is still undergone today in Peru has been unchanged for over 3500 years.

The ancient Inca people, who had at one time become a huge conquering people, show a dependence on coca from before written history all the way until today. Coca was so cherished and widespread that an Inca citizen was buried with it, gifted with it for luck on journeys or headed to war, rationed coca for exemplary bravery shown and more. In truth, the primary thing the culture is based on throughout history is the use of coca. Those who control the coca control the Inca people completely and this seizure of control over the raising and distribution of coca leaves will be used by multiple conquering invaders to enslave the Incas to hard labor while getting large majorities of their pay for selling them their own native coca leaves to continue their reliant habits of coca chewing.

The prime example of the slavery encounter by the Inca people is in the 15th Century at the hands of the Spanish Conquests. The Spaniards invaded and conquered the Inca people, took over the coca production in the area and forced the native Incas to toil in the silver mines to haul silver down the high Andes Mountains to be exported back to the mother Country. The Incas would work to the point of death and live in poverty and squalor, forgoing food purchase for coca purchase. Of course the reason for the purchase of coca was to sustain the energy needed to perform their work. As radical as it might first appear, the Inca people were spending most of the money they could make to purchase coca which facilitated working more to make more money to buy more coca.

The sale of coca had become at that time a huge money maker for the Spanish. This was evidenced poignantly when the very powerful Catholic Church of the day tried to seek a ban on the use and abuse of coca having discovered the enslavement that followed its use. The church had convinced the King of Spain who ruled over Peru that coca use and abuse was immoral and extremely detrimental to the Inca People. However, learning that coca was the #1 industry in Peru as well as the only method of getting the Incan people to work in the silver mines, they promptly denied the ban on coca.

Many more Christian Crusades followed over the years with religious leaders attempting to make the travesties of coca use and abuse end through banning its sale and each one would fail due to the large profits that were being made by the very sale it sought to ban. In short, coca addiction was too profitable to lose, even despite the health and welfare of those who were enslaved by it.

It is clear that even as far back as the early 15th century, drug addiction and the profits born out of controlling drugs and then selling them to those addicted was in full bloom. The similarities to our current predicaments over drug use and abuse versus the profits made by its sale are horrifying and will be included in the coming segments of this history of drugs series. The one key point to make here is that it is the war on addiction , and not the war on drugs that we must strive to handle.  The war on drugs and the legalization issues that follow it only produce changes of who makes a profit from drug abuse and the sale of the substances of abuse. It is only by understanding the true nature of our current drug epidemic that we might proceed with an effective remedy for the masses currently suffering. Meanwhile, large profits will guarantee addiction in massive proportions; the advertising is perfectly honed and the keys to success at drug induced slavery have been known for a very long time. Only mass education will ultimately achieve any notable change in our culture and that education must be achieved by the families and citizens, not be some authoritative select few. It is with this basic purpose in mind that this series is written.

Author: Megan Thorpe