Honesty and Transparency in Medicine


This week, Glaxo Smith Kline was fined three BILLION dollars for health care related fraud in falsely marketing several of their drugs.  Criminal charges would have been more effective, since the company had already put over 8 billion dollars away (in a rainy day legal fund) for just such an eventuality, (and they can always just pass any fees along to consumers in price hikes..)

The company had been falsely advertising the uses of several of their medications in direct-marketing campaigns to consumers as well as materials (bribes and gifts) to health care professionals.

This harkens back to the days of patent medicines and cocaine laced cough syrups were advertised as ‘cure all’ but it’s actually not the most disturbing part of the story.

This is.

Glaxo Smith Kline (GSK) was also caught paying celebrity physicians to endorse these medications for off-label or unapproved uses – including noted personality, Dr. Drew.  Now, this is nothing new, as we’ve stated.  In fact, several of Oprah’s personal gurus have been caught with their hands in the cookie jar, so to speak – but it is part of a disturbing larger trend of betraying public trust for personal gain.

Unfortunately, in this post-modern world of “Greed is good” and almost daily reports of corporate misdeeds – the fact that a huge company such as GSK would do this – is to most people, unsurprising.  A shrug, and a yawn – change the channel to ESPN.

Odious, I know that corporate responsibility has become such a joke, but even more disturbing is the lack of personal and professional responsiblity on the part of the health care providers that helped endorse these products.  

I don’t just mean Dr. Drew, and his equally contemptible counterpart, Dr. Phil – I include every single one of us – in our white lab jackets.  If we are in a position of public / patient trust – then we must take that very, very seriously and know that our integrity, our reputation and our ethics ARE NOT FOR SALE.

I write about medical tourism every day because my absolute conviction that someone needs to provide transparency , honesty, and objective information in this unregulated industry – but at the same time, I strive to ensure that my readers know EXACTLY where I am coming from.. All of these celebrity endorsers, and even our own family doctors need to so the same.

There was a recent bill passed that requires physicians to do exactly that; and the doctors I know back in the USA have been lamenting about disclosing the number of free lunches, and speakers fees that they receive every year because they think ‘it makes me look bad.’  If it makes you look bad – then maybe you should reconsider doing it.

Sometimes it really isn’t greed – its convenience.  Often drug companies provide dinners with speakers who have conducted research or written academic articles on hypertension, or cancer, or other various topics of interest.  [the new restrictions mean that drug companies aren’t supposed to just have speakers say – “hey, prescribe drug X to all your patients.” ]

So – you’ve worked 12 hours taking care of patients all day, and you are tired, but you read a bit about the study in the New England Journal of Medicine – and now you want to know more.. Having a bite to eat at the same time just makes sense, right?  But it’s about transparency.

So – if you really want to hear a presentation about a recent study in cardiology, go to the ‘dinner’ but pay your own way. 

This is why, in recent years – researchers and presenters have to disclose – whether or not they received money, gifts or other services to do their research study, or give the presentation..

In a larger sense – it means that celebrity endorsers and even people like me, (who are writing for a presumably larger audience who doesn’t always know these rules) that we have duties and obligations to the public: we have a duty to be transparent.

It’s not just that we shouldn’t take money to tout a product, or a service.  It’s also that we need to be willing to disclose our financial information, if needed, to demonstrate that.

It’s something I am fully willing to do – and have done, several times.  Embarrassing, yes – to admit to people:

a. I don’t make much – because I don’t receive, and have never received money from medical tourism companies, doctors, etc.. (and my book sales are less than stellar).

b. sometimes my parents have actually helped me – because as embarrassing as it may be as a thirty-something adult – I would rather take money from parents then sell my integrity.  Their money comes with less strings – they give it because they believe in what I am doing.  (Now before you get the idea that I am some sort of “trust-fund baby” – let’s clarify that right now).. if you saw my pathetic financial statements it wouldn’t be an issue, but transparency, right..

you’d see that I make the majority of my living as a nurse, working in short term positions.

my husband, a computer technican, contributes through his own short term work.  (Sometimes he repairs our neighbors’ computers too for a fee).

you’d also see that writing does not pay – or it pays a pathetic amount.. All the articles, books, etc. combined equal less than one paycheck as a nurse. (and Yes – it is humiliating to admit that I’m no best-seller, but readers deserve no less than the truth.)

(You’d also see a pile of student loan debts, that I am slowly, and steadily attempting to pay off, but that’s another issue.)

No huge sums.  No big payouts.  And no sneaky, sideways, or under the table dealings.

Now, Dr. Drew, Dr. Oz and every other ‘expert’ touting themselves on television to the public, under the guise of their medical credentials, or white coat and stethoscope needs to do the same.

The TAVI Registry, journey to the UK and other news


London Bridge, at night.

Just returned from a quick trip to London, UK to interview a couple of fantastic thoracic surgeons. (You can read the interview here.)

In the meantime, a midst multiple conflicting reports regarding the use and safety of TAVI (percutaneous aortic valve replacement) the ACC and STS have finally come together to create a TAVI registry, similar to the PCI and cardiac surgery registries.  The new registry will be used to track TAVI procedures and outcomes.  Hopefully, by gathering information in a standardized fashion and collecting data on patient outcomes, we can finally answer the essential question surrounding TAVI: Is It Safe?

As someone who is intimately involved in the STS database – I can assure readers that if STS is involved, data collection will be extensive, cumbersome and overly complicated.  (The adult cardiac surgery data collection form is fourteen pages long.)  However, the database will allow doctors to identify whether complications are device related/ procedure related or operator related.  (For example, are post-procedural strokes caused by the valve (device related) itself, or by the person (operator related) inserting it?  It will also track 30 day mortality – and the causes of mortality.  (ie. Was the death coincidental versus bleeding/ stroke/ kidney failure, etc?)  The registry will also track one year outcomes – but unfortunately – the essential question  – Is it Safe long-term?  will remain unanswered.

In Big Pharma news – I had the good fortune to meet (and talk to at length) one of the inside investigators* for GlaxoSmithKline.  He was a delightful and charming interview – and it was a fascinating inside look at the future of pharmacology, pharmacy, drug development and marketing.

As readers know – I have vilified and railed against pharmaceutical companies in the past (and most likely – will continue to do so) but it was an excellent opportunity to see the other side of a blighted industry.  [Here at Cartagena Surgery – I may have unabashedly strong opinions, but I do try to be fair.]

As an investigator for a pharmaceutical company, his position is somewhat akin to George Clooney’s character in the recent film ‘Up in the Air’.  He investigates company employees as well as independent contractors who represent the company for moral, ethical and criminal violations.   In the wake of several serious recent ethical and criminal investigations into the pharmaceutical industry in recent years – companies such as GSK take this duty extremely seriously.  As part of this effort – they hired people like the man I am interviewing today.  Mr. X is surprisingly charming, amiable, and witty.  Somehow as a ‘trigger man’ for a big company, and former NYC police officer, the gentleness, and the compassion emanating from him is unexpected.   He tells me that he has received thank you letters from people who were ‘separated from the company’ on his say-so – and I am not surprised.

We talk about public and health care providers perceptions of the pharmaceutical industry, and trends of the past.  We discuss the previous ‘bribe and gift’ atmosphere of the past – and he gently calls me out for my Pfizer bag from a long-ago conference.  [Ironically, I’ve railed against this bag in the past – it’s from a conference I attended as a student, but hypocrite that I am – have neglected to throw it out.  In my own weak defense – I will say that I never again have accepted or received ‘sponsored’ gifts or items.]  But he’s right – and I accept my scolding, hopefully with the grace it was given.

He talks about one of the new projects that GSK is implementing – and I immediately sit up and take notice.  Phasing out the ‘hootie girls’ as we call the often scantily clad, inappropriately dressed, invariable young, attractive (and always! well-endowed) pharmaceutical representatives that cold call doctors offices with girlish laughs, lots of legs and sample supplies of costly drugs.   No, I will not be sad to see the end of the ‘hootie girls’.

Replacing the hootie girls will be nurse educators.  Instead of pushing costly brand name drugs – they will be restricted from mentioning brand specific medications.. But educate they will.  Hopefully these educators will serve as a resource for healthcare providers – to assist us and inform us without trying influence us.  In many ways – it sounds like GSK may be moving in the direction that we need to go.. Afterall – with millions of millions of people needing treatment (and the vast amount of disease out there)  just obtaining and supplying these patients with the medications they need is a phenomenal effort – and companies can still make a HUGE profit on volume alone.    (And I am not against making a profit – it supports drug research etc..)

But the idea of being able to use the vast amount of information collected from these companies and their volumes of research without rancor, or hardcore skepticism – is encouraging.  If we can build bridges and trust – we can ultimately better serve our patients.. Of course, nothing this big ever goes off without a hitch, and Rome wasn’t build in a day – but it’s a start.. 

It’s a hopeful view from an unlikely source at the end of a very long day that started in one country and ends in another..

* I didn’t get a chance to ask his permission to  write about our meeting – so in fairness, I have omitted his name.