Highly Profitable Conflicts of Interest

“Putting together my next talk on undisclosed conflicts of interest. Authors of ‘my’ go to textbook of medicine ‘funded’ in excess of $11 million without declaration. Makes practicing tricky when you lose trust in your education foundations. #TipOfIceberg”
~ Gary Fettke

We wonder why doctors coming out of medical school lack basic knowledge of treatments that don’t depend upon profitable drugs and invasive procedures. The majority of medical interns fresh out of school get about half the questions wrong on nutrition. Would you turn to someone for authoritative expertise who is as likely to be wrong as to be right in the advice they give you?

That is exactly what is happening when you ask most doctors about diet or about many issues related to diet. For example, look at the sorry state of affairs in the knowledge about cholesterol and statins. It’s standard practice for doctors to recommend statins to patients who, according to research, would not benefit from them. And so there is overprescription of statins, a class of drugs that has worrisome side effects such as neurocognitive decline (your brain needs cholesterol). This is also found with other medical practices that are continued even when doctors know they are ineffective in most cases.

The shocking part is that they’re being well funded to be this ignorant. Drug companies spend more money on advertising than on research and spend more money on influencing doctors than on advertising (they also spend money on influencing nurses, as with pharmacists, who will influence both patients and doctors; and there is the funding that goes to patient organizations).

Such ignorance among doctors doesn’t come naturally or cheaply. It requires systematic planning of a propaganda campaign that goes straight to the most ‘respectable’ gatekeepers of knowledge, such as writers in the textbook industry. This crisis extends into medical research itself, as many researchers follow this same pattern of undeclared conflicts of interest (many of those researchers, by the way, work in universities where they also teach the each new generation of doctors). This could explain at least some of why we are also experiencing a replication crisis in medical research with nutritional studies being one of the worst areas.

So, what exactly is all that money buying? And what is so dark and disturbing that these medical authorities, in not declaring it, are afraid others will find out?

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Undisclosed conflicts of interest among biomedical textbook authors
by Brian J. Piper et al

ABSTRACT
Background: Textbooks are a formative resource for health care providers during their education and are also an enduring reference for pathophysiology and treatment. Unlike the primary literature and clinical guidelines, biomedical textbook authors do not typically disclose potential financial conflicts of interest (pCoIs). The objective of this study was to evaluate whether the authors of textbooks used in the training of physicians, pharmacists, and dentists had appreciable undisclosed pCoIs in the form of patents or compensation received from pharmaceutical or biotechnology companies.

Methods: The most recent editions of six medical textbooks, Harrison’s Principles of Internal Medicine (HarPIM), Katzung and Trevor’s Basic and Clinical Pharmacology (KatBCP), the American Osteopathic Association’s Foundations of Osteopathic Medicine (AOAFOM), Remington: The Science and Practice of Pharmacy (RemSPP), Koda-Kimble and Young’s Applied Therapeutics (KKYAT), and Yagiela’s Pharmacology and Therapeutics for Dentistry (YagPTD), were selected after consulting biomedical educators for evaluation. Author names (N = 1,152, 29.2% female) were submitted to databases to examine patents (Google Scholar) and compensation (ProPublica’s Dollars for Docs [PDD]).

Results: Authors were listed as inventors on 677 patents (maximum/author = 23), with three-quarters (74.9%) to HarPIM authors. Females were significantly underrepresented among patent holders. The PDD 2009–2013 database revealed receipt of US$13.2 million, the majority to (83.9%) to HarPIM. The maximum compensation per author was $869,413. The PDD 2014 database identified receipt of $6.8 million, with 50.4% of eligible authors receiving compensation. The maximum compensation received by a single author was $560,021. Cardiovascular authors were most likely to have a PDD entry and neurologic disorders authors were least likely.

Conclusion: An appreciable subset of biomedical authors have patents and have received remuneration from medical product companies and this information is not disclosed to readers. These findings indicate that full transparency of financial pCoI should become a standard practice among the authors of biomedical educational materials.

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