Many children with bi-polar and ADHD symptoms can be helped without the use of dangerous off-label drugs

Let’s try to find ways to relieve illness without the use of drugs

Video by dr rapp, published on 22 February 2008.

Many children with bi-polar and ADHD symptoms can be helped without the use of dangerous off-label drugs.

There are fast, easy and inexpensive answers available.

Each individual is different and the treatment is rarely identical.

Dr. Doris Rapp has dedicated her life to identifying and providing simple solutions to these and other behavior problems.

Our challenge for physicians is to find fast, easy, safe, effective and inexpensive ways to heal.

Association between physicians’ interaction with pharmaceutical companies and their clinical practices

A systematic review and meta-analysis, 2017

Abstract

Background
Pharmaceutical company representatives likely influence the prescribing habits and professional behaviors of physicians. The objective of this study was to systematically review the association between physicians’ interactions with pharmaceutical companies and their clinical practices.

Methods
We used the standard systematic review methodology. Observational and experimental study designs examining any type of targeted interaction between practicing physicians and pharmaceutical companies were eligible. The search strategy included a search of MEDLINE and EMBASE databases up to July 2016. Two reviewers selected studies, abstracted data, and assessed risk of bias in duplicate and independently. We assessed the quality of evidence using the GRADE approach.

Results
Twenty articles reporting on 19 studies met our inclusion criteria. All of these studies were conducted in high-income countries and examined different types of interactions, including detailing, industry-funded continuing medical education, and receiving free gifts. While all included studies assessed prescribing behaviors, four studies also assessed financial outcomes, one assessed physicians’ knowledge, and one assessed their beliefs. None of the studies assessed clinical outcomes. Out of the 19 studies, 15 found a consistent association between interactions promoting a medication, and inappropriately increased prescribing rates, lower prescribing quality, and/or increased prescribing costs. The remaining four studies found both associations and lack of significant associations for the different types of exposures and drugs examined in the studies. A meta-analysis of six of these studies found a statistically significant association between exposure and physicians’ prescribing behaviors (OR = 2.52; 95% CI 1.82–3.50). The quality of evidence was downgraded to moderate for risk of bias and inconsistency. Sensitivity analysis excluding studies at high risk of bias did not substantially change these results. A subgroup analysis did not find a difference by type of exposure.

Conclusion
There is moderate quality evidence that physicians’ interactions with pharmaceutical companies are associated with their prescribing patterns and quality.

Rapports étudiants en médecine et profs avec liens d’intérêts labos pharmaceutiques non déclarés

Les étudiants en médecine sont-ils sous l’influence des labos pharmaceutiques ?

Pendant ses études, un futur médecin croise des enseignants, des professeurs émérites et des labos pharmaceutiques sans toujours s’en rendre compte.

Le cas échéant, les profs informent-ils leurs étudiants de leurs liens d’intérêts avec les laboratoires?

“Je considère que nos étudiants, ils n’y comprendront rien, ils ont 18 ou 19 ans, je ne vois vraiment pas comment ils pourraient avoir accès à une information éclairée.”

déclare le Pr Gilles Freyer, Vice-Président de la Faculté de Médecine de Lyon Sud.

  • Regardez la vidéo édifiante de l’oeil du 20h, 16 mars 2017.
  • Lisez Les étudiants en médecine sont-ils sous l’influence des labos pharmaceutiques?, blog france tv info, 16 mars 2017.

Sur le même sujet

Treat You Better – Pay For Performance Initiatives in Health Care

Parody of the 2016 Shawn Mendes song

Video by James McCormack, published on 22 January 2017.

For those healthcare providers who struggle with adhering to Pay For Performance measures this may resonate somewhat.

Many pay-for performance initiatives in health care have some major limitations – most importantly P4P initiatives typically forget that individual patients should be involved in heath care decision-making activities.

Comment garder son indépendance face à l’industrie pharmaceutique?

Téléchargez le livret du collectif d’étudiants en médecine de La Troupe du Rire

Téléchargez le livret du collectif d’étudiants en médecine de La Troupe du Rire.

Les liens d’intérêts et l’influence de l’industrie pharmaceutique constituent un risque sanitaire non négligeable.

  • Où se cache cette influence dans notre parcours de soignant ?
  • Comment se manifeste-t-elle ?
  • Pour quelles conséquences ?

C’est à ces interrogations que ce petit livret tente de répondre..

En savoir plus

More than 80 Percent of Patient-Advocacy Organizations are Pharma funded

Conflicts of Interest for Patient Groups

More than 80 percent of patient-advocacy organizations accept funding from drug and medical-device companies. For some patient groups, the donations from industry accounted for more than half of their annual income, and in nearly 40 percent of cases, industry executives sit on governing boards.

2017 Study Abstract

In this examination of 104 large patient-advocacy organizations, 83% receive financial support from drug, device, and biotechnology companies, and industry executives often serve on governing boards. The authors recommend more transparency about industry involvement.

More Information

  • Conflicts of Interest for Patient-Advocacy Organizations, The New England Journal of Medicine, DOI: 10.1056/NEJMsr1610625, March 2, 2017.
  • More Than 80 Percent of Patient Groups Accept Drug Industry Funds, Study Shows, nytimes, MARCH 1, 2017.
  • Pharma Funded “Patient” Groups Keep Drug Prices Astronomical, counterpunch, MARCH 6, 2017.
  • Image credit brewlife, March 13, 2013.

How to eliminate the risk of the third leading cause of death

Dr Peter Gøtzsche’s views on prescription drugs

Video published on 1 April 2015 by John McDougall.

Peter C. Gøtzsche, MD is a Danish medical researcher, and leader of the Nordic Cochrane Center at Rigshospitalet in Copenhagen, Denmark. He has written numerous reviews within the Cochrane collaboration.

Dr.Gøtzsche has been critical of screening for breast cancer using mammography, arguing that it cannot be justified; His critique stems from a meta-analysis he did on mammography screening studies and published as Is screening for breast cancer with mammography justifiable? in The Lancet in 2000. In it he discarded 6 out of 8 studies arguing their randomization was inadequate.

In 2006 a paper by Gøtzsche on mammography screening was electronically published in the European Journal of Cancer ahead of print. The journal later removed the paper completely from the journal website without any formal retraction. The paper was later published in Danish Medical Bulletin with a short note from the editor, and Gøtzsche and his coauthors commented on the unilateral retraction that the authors were not involved in.

In 2012 his book Mammography Screening: Truth, Lies and Controversy was published. In 2013 his book Deadly Medicines and Organized Crime: How Big Pharma has Corrupted Healthcare was published.

Concerns about the real independence of patient advocacy organizations

Patient Advocacy Organizations, Industry Funding, and Conflicts of Interest

Key Points

Question
What is the nature of industry funding of patient advocacy organizations in the United States?

Findings
This survey study found that 67% of a national sample of patient advocacy organizations, virtually all of which were not for profit, reported receiving funding from for-profit companies. Twelve percent received more than half of their funding from industry; a median proportion of 45% of industry funding was derived from the pharmaceutical, device, and/or biotechnology sectors.

Meaning
Most advocacy organizations receive money from industry; therefore, increased transparency and robust conflict of interest policies and practices are needed to help these non-profit organizations maintain their independence.

2017 Study Abstract

Patient Advocacy Organizations, Industry Funding, and Conflicts of Interest, The Jama Network, doi:10.1001/jamainternmed.2016.8443, January 17, 2017.

Image credit eyeforpharma.

Importance
Patient advocacy organizations (PAOs) are influential health care stakeholders that provide direct counseling and education for patients, engage in policy advocacy, and shape research agendas. Many PAOs report having financial relationships with for-profit industry, yet little is known about the nature of these relationships.

Objective
To describe the nature of industry funding and partnerships between PAOs and for-profit companies in the United States.

Design, Setting, and Participants
A survey was conducted from September 1, 2013, to June 30, 2014, of a nationally representative random sample of 439 PAO leaders, representing 5.6% of 7865 PAOs identified in the United States. Survey questions addressed the nature of their activities, their financial relationships with industry, and the perceived effectiveness of their conflict of interest policies.

Main Outcomes and Measures
Amount and sources of revenue as well as organizational experiences with and policies regarding financial conflict of interest.

Results
Of the 439 surveys mailed to PAO leaders, 289 (65.8%) were returned with at least 80% of the questions answered. The PAOs varied widely in terms of size, funding, activities, and disease focus. The median total revenue among responding organizations was $299 140 (interquartile range, $70 000-$1 200 000). A total of 165 of 245 PAOs (67.3%) reported receiving industry funding, with 19 of 160 PAOs (11.9%) receiving more than half of their funding from industry. Among the subset of PAOs that received industry funding, the median amount was $50 000 (interquartile range, $15 000-$200 000); the median proportion of industry support derived from the pharmaceutical, device, and/or biotechnology sectors was 45% (interquartile range, 0%-100%). A total of 220 of 269 respondents (81.8%) indicated that conflicts of interest are very or moderately relevant to PAOs, and 94 of 171 (55.0%) believed that their organizations’ conflict of interest policies were very good. A total of 22 of 285 PAO leaders (7.7%) perceived pressure to conform their positions to the interests of corporate donors.

Conclusions and Relevance
Patient advocacy organizations engage in wide-ranging health activities. Although most PAOs receive modest funding from industry, a minority receive substantial industry support, raising added concerns about independence. Many respondents report a need to improve their conflict of interest policies to help maintain public trust.

Financial ties between researchers and drug industry independently associated with positive trial results

Financial ties of principal investigators and randomized controlled trial outcomes: cross sectional study

2017 Study Abstract

Objective
To examine the association between the presence of individual principal investigators’ financial ties to the manufacturer of the study drug and the trial’s outcomes after accounting for source of research funding.

Design
Cross sectional study of randomized controlled trials (RCTs).

Setting
Studies published in “core clinical” journals, as identified by Medline, between 1 January 2013 and 31 December 2013.

Participants
Random sample of RCTs focused on drug efficacy.

Main outcome measure
Association between financial ties of principal investigators and study outcome.

Results
A total of 190 papers describing 195 studies met inclusion criteria. Financial ties between principal investigators and the pharmaceutical industry were present in 132 (67.7%) studies. Of 397 principal investigators, 231 (58%) had financial ties and 166 (42%) did not. Of all principal investigators, 156 (39%) reported advisor/consultancy payments, 81 (20%) reported speakers’ fees, 81 (20%) reported unspecified financial ties, 52 (13%) reported honorariums, 52 (13%) reported employee relationships, 52 (13%) reported travel fees, 41 (10%) reported stock ownership, and 20 (5%) reported having a patent related to the study drug. The prevalence of financial ties of principal investigators was 76% (103/136) among positive studies and 49% (29/59) among negative studies. In unadjusted analyses, the presence of a financial tie was associated with a positive study outcome (odds ratio 3.23, 95% confidence interval 1.7 to 6.1). In the primary multivariate analysis, a financial tie was significantly associated with positive RCT outcome after adjustment for the study funding source (odds ratio 3.57 (1.7 to 7.7). The secondary analysis controlled for additional RCT characteristics such as study phase, sample size, country of first authors, specialty, trial registration, study design, type of analysis, comparator, and outcome measure. These characteristics did not appreciably affect the relation between financial ties and study outcomes (odds ratio 3.37, 1.4 to 7.9).

Conclusions
Financial ties of principal investigators were independently associated with positive clinical trial results. These findings may be suggestive of bias in the evidence base.

Full study
dx.doi.org/10.1136/bmj.i6770 published 17 January 2017 by The BMJ.

Are Medical Faculty Students protected from Pharma Industry Influence during their Training?

Conflict of Interest Policies at French Medical Schools

January 2017 Study Abstract

Background
Medical faculties have a role in ensuring that their students are protected from undue commercial influence during their training, and are educated about professional-industry interactions. In North America, many medical faculties have introduced more stringent conflict of interest (COI) policies during the last decade. We asked whether similar steps had been taken in France. We hypothesized that such policies may have been introduced following a 2009–2010 drug safety scandal (benfluorex, Mediator) in which COIs in medicine received prominent press attention.

Methods
We searched the websites of all 37 French Faculties of Medicine in May 2015 for COI policies and curriculum, using standardized keyword searches. We also surveyed all deans of medicine on institutional COI policies and curriculum, based on criteria developed in similar US and Canadian surveys. Personal contacts were also consulted. We calculated a summary score per faculty based on 13 criteria. [range 0–26; higher scores denoting stronger policies]

Conflict of Interest Policies at French Medical Schools: Starting from the Bottom, PLOS one, dx.doi.org/10.1371/journal.pone.0168258, January 9, 2017.

Medical image credit thomashawk.

Results
In total, we found that 9/37 (24%) of French medical schools had either introduced related curriculum or implemented a COI-related policy. Of these, only 1 (2.5%) had restrictive policies for any category. No official COI policies were found at any of the schools. However, at 2 (5%), informal policies were reported. The maximum score per faculty was 5/26, with 28 (76%) scoring 0.

Conclusion
This is the first survey in France to examine COI policies at medical faculties. We found little evidence that protection of medical students from undue commercial influence is a priority, either through institutional policies or education. This is despite national transparency legislation on industry financing of health professionals and limits on gifts. The French National Medical Students Association (ANEMF) has called for more attention to COI in medical education; our results strongly support such a call.

In conclusion, the AAMC and others organizations have called for a profound cultural change in the medical profession that must begin with medical education. This is all the more important in that students who have the most contacts with industry are also those who tend to have the most positive attitudes to these relations and to believe themselves to be invulnerable to influence. Policies that restrict interactions contributing to conflict of interest have been shown to reduce industry influence on practice. Medical faculties in France have a responsibility to protect and educate their students and to support the best possible care, in the interests of patient and public health.