Overdosed America (50 page)

105
sponsor’s drug, costing about $1.50 per day:
Viewed at http://www.drugstore.com. Accessed January 15, 2004.

105
Dr. Thomas Bodenheimer brought many of these issues to light:
T. Bodenheimer, op. cit.

106
A follow-up study:
K. A. Schulman, D. M. Seils, J. W. Timbie, et al., “A National Survey of Provisions in Clinical-Trial Agreements Between Medical Schools and Industry Sponsors,”
New England Journal of Medicine
347:1335–1341, 2002.

107
Melody Petersen in the
New York Times
:
Melody Petersen, “Madison Ave. Has Growing Role in the Business of Drug Research,”
New York Times,
November 22, 2002.

107
11 percent of the articles published:
A. Flanagin, L. A. Carey, P. B. Fontanarosa, et al., “Prevalence of Articles with Honorary Authors and Ghost Authors in Peer-Reviewed Medical Journals,”
Journal of the American Medical Association
280:222–224, 1998.

107
The Antihypertensive and Lipid-lowering Treatment to Prevent Heart Attacks Trial study:
The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group, “Major Cardiovascular Events in Hypertensive Patients Randomized to Doxazosin vs Chlorthalidone: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack (ALLHAT),”
Journal of the American Medical Association
283:1967–1975, 2000.

107
stopped prematurely:
The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group, op. cit.

107
$800 million worth of Cardura:
Lenzer, op. cit.

108
a report in the
British Medical Journal
:
Lenzer, op. cit.

108
marketing consultant for the pharmaceutical industry:
Ibid.

109
Not long before a dramatic meeting:
Douglas M. Birch and Gary Cohn, “Standing Up to Industry,”
Baltimore Sun,
June 26, 2001.

109
explaining the reason for their departure:
W. B. Applegate, C. D. Furberg, R. P. Byington, and R. Grimm Jr., “The Multicenter Isradipine Diuretic Atherosclerosis Study (MIDAS),”
Journal of the American Medical Association
277:297–299, 1997.

109
three largest advertising agencies:
Petersen, op. cit.

110
Drs. Bruce Psaty and Drummond Rennie:
B. M. Psaty and D. Rennie, “Stopping Medical Research to Save Money: A Broken Pact with Researchers and Patients,”
Journal of the American Medical Association
289:2128–2131, 2003.

111
doctors are responsible for about 80 percent:
About 20 percent of health care expenditures goes to doctors’ salaries, and doctors control an additional 60 percent of all expenditures. See Robert A. Hahn,
Sickness and Healing: An Anthropological Perspective,
New London, Conn.: Yale University Press, 1995, p. 162.

112
editor of the
British Medical Journal
:
R. Smith, “Medical Journals and Pharmaceutical Companies: Uneasy Bedfellows,”
British Medical Journal,
326:1202–1205, 2003.

113
Dr. Marcia Angell:
Interview by the author, March 26, 2003.

113
Dr. Robert Fletcher:
R. H. Fletcher, “Adverts in Medical Journals: Caveat Lector,”
The Lancet
361:10–11, 2003.

114
a 2003 article in JAMA:
K. Dickersin and D. Rennie, “Registering Clinical Trials,”
Journal of the American Medical Association
290:516–523, 2003.

114
ranked the new antidepressants:
V. R. Fuchs and H. C. Sox, “Physicians’ Views of the Relative Importance of Thirty Medical Innovations,”
Health Affairs
20:30–41, 2001.

115
application was made to the Swedish Drug Authority:
H. Melander, H. Ahlqvist-Rastard, G. Meijer, and B. Beermann. “Evidence B(i)ased Medicine: Selective Reporting from Studies Sponsored by Pharmaceutical Industry: Review of Studies in New Drug Applications,”
British Medical Journal,
326:1171, 2003.

115
all of the studies . . . that the FDA had reviewed:
A. Khan, H. A. Warner, and W. A. Brown, “Symptom Reduction and Suicide Risk in Patients Treated with Placebo in Antidepressant Clinical Trials: An Analysis of the Food and Drug Administration Database,”
Archives of General Psychiatry
57:311–317, 2000.

116
for people with less severe depression:
“Less severe” defined as initial Hamilton Rating Scale for Depression (HAM-D) score of 24 or less. A. Khan, R. M. Leventhal, S. R. Khan, and W. A. Brown, “Severity of Depression and Response to Antidepressants and Placebos: An Analysis of the Food and Drug Administration Database,”
Journal of Clinical Psychopharmacology
22:40–45, 2002.

116
4.6 more committed suicide:
Statistical significance was not reported for comparison of suicide rates between the new antidepressant and the placebo. For the three groups—new and old antidepressants and placebo—the differences in suicide rates were not statistically significant.

117
depressed adolescents were significantly more likely:
M. D. Keller, N. D. Ryan, M. Strober, et al., “Efficacy of Paroxetine in the Treatment of Adolescent Major Depression: A Randomized Controlled Trial (Abstract),”
Journal of the American Academy of Child and Adolescent Psychiatry
40:762–772, 2001.

117
British drug authorities reviewed all nine studies:
“SSRIs: Suicide Risk and Withdrawal (Editorial),”
The Lancet
361:1999, 2003.

117
antidepressants (almost exclusively the newer ones):
“Prescription Drug Expenditures in 2000,” op. cit. See also “Prescription Drug Expenditures in 2001: Another Year of Escalating Costs,” a report by the National Institute for Health Care Management Research and Educational Foundation, May 6, 2002, p. 11. Viewed at http://nihcm.org/spending2001.pdf. Accessed August 3, 2003.

117
ranked number three behind:
“IMS Reports 11.8 Percent Dollar Growth in 2002 U.S. Prescription Sales,” IMS Health, February 21, 2003. Viewed at http://www.imshealth.com/ims/portal/front/articleC/0,2777,1763_3665_41276589,00.html. Accessed October 13, 2003.

118
doctors’ continuing education meetings:
Arnold S. Relman and Marcia Angell, “America’s Other Drug Problem,”
The New Republic,
December 16, 2002.

118
funded more than three-fifths:
Doctors’ CME received a total of $729 million in commercial support in 2001. See Scott Hensley, “When Doctors Go to Class, Industry Often Foots the Bill,”
Wall Street Journal,
December 4, 2002.

118
increased by another 30 percent:
A. S. Relman, “Industry Sponsorship of Continuing Medical Education,”
Journal of the American Medical Association
290:1150, 2003.

119
cultivate relationships with these experts:
Sheryl Gay Stolberg and Jeff Gerth, “Drug Makers Design Studies with Eye to Competitive Edge,”
New York Times,
December 23, 2000.

119
“food, flattery, and friendship:
D. Katz, A. L. Caplan, and J. F. Merz, “All Gifts Large and Small: Toward an Understanding of the Ethics of Pharmaceutical Industry Gift-Giving,”
American Journal of Bioethics
3:39–46, 2003.

120
prescribing habits of 20 doctors:
J. Dana and G. Loewenstein, “A Social Science Perspective on Gifts to Physicians from Industry,”
Journal of the American Medical Association
290:252, 2003.

121
Nearly half of the members of the task force:
A. S. Relman, “Separating Continuing Medical Education from Pharmaceutical Marketing,”
Journal of the American Medical Association
285(15):2009–2012, 2001.

121
own their own educational subsidiaries:
Scott Hensley, “Drug Firms Shown the Classroom Door: Continuing-Ed Programs for Doctors Aim to Reduce Influence of Big Companies,”
Wall Street Journal,
January 14, 2003.

121
the whole new industry that has emerged:
Joseph S. Ross, Peter Lurie, and Sidney M. Wolfe, “Medical Education Services Suppliers: A Threat to Physician Education,” Health Research Group Report, Public Citizen, July 19, 2000.

121
$3 million to the prestigious Massachusetts General Hospital:
Raja Mishra, “Deal May Tie MGH to Furor on Pain Pill,”
Boston Globe,
March 14, 2002.

121
George Annas, commented:
Quoted ibid.

122
Permissible offerings:
D. Grande and K. Volpp, “Cost and Quality of Industry-Sponsored Meals for Medical Residents,”
Journal of the American Medical Association
290:1150–1151, 2003.

122
Alan Holmer, claims that the drug industry:
A. F. Holmer, “Industry Strongly Supports Continuing Medical Education,”
Journal of the American Medical Association
285:2012–2014, 2001.

123
review article published in JAMA:
A. Wazna, op. cit.

123
gifts and meals start in medical school:
“Drug-Company Influence on Medical Education in U.S.A. (Editorial),”
The Lancet
356:781, 2000.

123
Eight out of 10 medical residents:
M. A. Steinman, M. G. Shilpak, and S. J. McPhee. “Of Principles and Pens: Attitudes and Practices of Medicine House-staff Toward Pharmaceutical Industry Promotions,”
Journal of the American Medical Association
110:551–557, 2001.

124
“Twisted together like the snake:
R. Moynihan, “Who Pays for the Pizza? Redefining the Relationships Between Doctors and Drug Companies—1: Entanglement,”
British Medical Journal
326:1189–1192, 2003.

124
number of reps making sales pitches:
Scott Hensley, “As Drug-Sales Teams Multiply, Doctors Start to Tune Them Out,”
Wall Street Journal,
June 13, 2003.

125
80 to 95 percent of doctors:
Moynihan, op. cit.

125
42 percent of the material given to doctors:
D. Stryer and L. A. Bero, “Characteristics of Materials Distributed by Drug Companies: An Evaluation of Appropriateness,”
Journal of General Lateral Medicine
11:575–583, 1996.

125
mostly negative effect:
A. Wazna, op. cit.

126
having drug samples on hand:
“U.S. Physicians Responsive to Patient Requests for Brand-Name Drugs,” IMS Health, April 1, 2002. Viewed at http://www.imshealth.com/ims/portal/front/articleC/0,2777,6599_3665_1003811,00.html. Accessed January 16, 2004.

126
Doctors who interact with drug companies:
M.-M. Chren and C. S. Landefeld, “Physicians’ Behavior and Their Interactions with Drug Companies: A Controlled Study of Physicians Who Requested Additions to a Hospital Drug Formulary,”
Journal of the American Medical Association
27:684–689, 1994.

126
Nine out of 10 doctors:
Earl Lane, “Doctors Still Know Little About Drug Costs,”
Newsday,
February 4, 2003.

127
evaluating the quality of the guidelines:
T. M. Shaneyfelt, M. F. Mayo-Smith, and J. Rothwangl, “Are Guidelines Following Guidelines? The Methodological Quality of Clinical Practice Guidelines in the Peer-Reviewed Medical Literature,”
Journal of the American Medical Association
281:1900–1905, 1999.

127
only one out of the 20 clinical guidelines:
R. Grilli, N. Magrini, A. Penna, et al., “Practice Guidelines Developed by Specialty Societies: The Need for a Critical Appraisal,”
The Lancet
355:103–106, 2000.

127
four out of five of these guidelines:
I. Savoie, A. Kazanjian, and K. Bassett, “Do Clinical Practice Guidelines Reflect Research Evidence? (Abstract),”
Journal of Health Services Research Policy
5:76–82, 2000.

127
the most damning study of all:
N. K. Choudry, H. T. Stelfox, and A. S. Detsky, “Relationships Between Authors of Clinical Practice Guidelines and the Pharmaceutical Industry,”
Journal of the American Medical Association
287:612–617, 2002.

131
even misrepresenting findings reported:
The full report erroneously indicates that the reduction in total mortality in the WOSCOPS study of primary prevention reached statistical significance (Table II.7-1), Similarly, the reduction in coronary mortality in the CARE study of secondary prevention is erroneously reported as statistically significant (Table II.8-2).

134
statins increased the frequency of sexual dysfunction:
E. Bruckert, P. Giral, H. M. Heshmati, and G. Turpin, “Men Treated with Hypolipidaemic Drugs Complain More Frequently of Erectile Dysfunction,”
Journal of Clinical Pharmacology and Therapeutics
21:89–94, 1996.

135
Five of 14 experts:
From the extensive summary in JAMA:
“Financial Disclosure:
Dr. Grundy has received honoraria from Merck, Pfizer, Sankyo, Bayer, and Bristol-Myers Squibb. Dr. Hunninghake has current grants from Merck, Pfizer, Kos Pharmaceuticals, Schering-Plough, Wyeth-Ayerst, Sankyo, Bayer, AstraZeneca, Bristol-Myers Squibb, and G. D. Searle; he has also received consulting honoraria from Merck, Pfizer, Kos Pharmaceuticals, Sankyo, AstraZeneca, and Bayer. Dr. McBride has received grants and/or research support from Pfizer, Merck, Parke-Davis, and AstraZeneca; has served as a consultant for Kos Pharmaceuticals, Abbott, and Merck; and has received honoraria from Abbott, Bristol-Myers Squibb, Novartis, Merck, Kos Pharmaceuticals, Parke-Davis, Pfizer, and DuPont. Dr. Pasternak has served as a consultant for and received honoraria from Merck, Pfizer, and Kos Pharmaceuticals, and has received grants from Merck and Pfizer. Dr. Stone has served as a consultant and/or received honoraria for lectures from Abbott, Bayer, Bristol-Myers Squibb, Kos Pharmaceuticals, Merck, Novartis, Parke-Davis/Pfizer, and Sankyo.”