The New England Journal of Medicine has generated controversy by publishing a three-part article and editorial suggesting that concerns about conflicts of interest in medicine and psychiatry are overblown. “Have stories about industry greed so permeated our collective consciousness that we have forgotten that industry and physicians often share a mission — to fight disease?” writes Lisa Rosenbaum in the NEJM.
“Having received industry money, the argument goes, even an acknowledged world expert can no longer provide untainted advice,” writes Jeffrey Drazen in the NEJM. “But is this divide between academic researchers and industry in our best interest? I think not — and I am not alone.”
Highly critical responses came from HeathNewsReview.org, Health Care Renewal, Forbes and others.
“Is Dr. Rosenbaum’s consciousness so clouded as to think that pharmaceutical companies don’t exist first and foremost to make money? That their primary responsibility is not to their shareholders?” responds Susan Molchan in HealthNewsReview.org. “It’s true that a means to this end is fighting disease, (including new ‘diseases,’ tailored to one’s drug), but this should not be confused or conflated with the primary mission of (hopefully most) physicians.”
In response to Drazen, Molchan links to a 2006 Wall Street Journal article about the tens of thousands of people estimated to have died from the now-withdrawn anti-inflammatory drug Vioxx. Molchan writes that “data concerning the number of heart attacks while on Vioxx in a pivotal study had been withheld by Merck, and the NEJM were aware that these data were missing from the submitted manuscript. Editors had also rejected letters pointing out the problem (Dr. Drazen was editor at the time).”
In Forbes, Larry Husten writes, “To use a highly imperfect analogy, Rosenbaum’s focus on the imperfections of industry critics without fully appreciating the full magnitude of industry influence is akin to focusing on the imperfections of the extreme anti-slavery abolitionists in the 19th century while ignoring the overwhelming tragedy of slavery.”
“It was more surprising, given the reach of this journal, that these articles featured a catalog of logical fallacies in support of their arguments,” states a post on Health Care Renewal. The post goes on to examine the alleged logical fallacies in detail, including, “Appeal to Authority: Important People and Organizations Agree with Us” and “Ad Hominem Fallacy: People who Advocate Increased Disclosure, Regulation, or Restriction of COIs are ‘Pharmascolds’,” and “Burden of Proof Fallacy: That All Physician-Industry Collaborations are Beneficial is Assumed, but Contentions that Financial Conflicts of Interest Affecting Physicians Must be Disclosed, Regulated or Banned Require Rigorous Proof.”
Drazen, Jeffrey M. “Revisiting the Commercial–Academic Interface.” New England Journal of Medicine 372, no. 19 (May 7, 2015): 1853–54. doi:10.1056/NEJMe1503623. (Full text)
Rosenbaum, Lisa. “Reconnecting the Dots — Reinterpreting Industry–Physician Relations.” New England Journal of Medicine 372, no. 19 (May 7, 2015): 1860–64. doi:10.1056/NEJMms1502493. (Full text – Part one)
Rosenbaum, Lisa. “Understanding Bias — The Case for Careful Study.” New England Journal of Medicine 372, no. 20 (May 14, 2015): 1959–63. doi:10.1056/NEJMms1502497. (Full text – Part two)
Rosenbaum, Lisa. “Beyond Moral Outrage — Weighing the Trade-Offs of COI Regulation.” New England Journal of Medicine 372, no. 21 (May 21, 2015): 2064–68. doi:10.1056/NEJMms1502498. (Full text – Part three)
Say It Ain’t So: Logical Fallacies in Defense of Conflicts of Interest … in the New England Journal of Medicine? (Health Care Renewal, May 21, 2015)
No, Pharmascolds Are Not Worse Than The Pervasive Conflicts Of Interest They Criticize (Forbes, May 21, 2015)
Criticism of NEJM’s defense of industry-physician relations (HealthNewsReview.org, May 14, 2015)