Friday, April 15, 2005

conflicts d'interest

Kids,

happy tax day to all ya'll. My understanding, from having this conversation with a room of slightly inebriated foreign researchers speaking from their boundless experience with the vernaculars of the American south, is that "ya'll," while technically a corruption of "you (plr)," can in fact be seen as a you (sng) in less than polite conversation and thus "all" is needed as an intensifier to truly communicate that the speaker, in fact, means everyone present. Then again, I'd be the first person to admit that this reasoning sounds suspect, and that I really have nothing in the way of southern heritage, and furthermore, I got this information from foreign postdocs. So, what the hell do I know?

Settled down upon my couch tonight for some channel surfing. Caught the end of a mediocre Simpsons episode (is there any other kind? As they continue to dilute the quality of their product, the few superb seasons are being lost in the wave of shit that has followed. If only they could be more like Seinfeld, the greatest syndicated sitcom ever...but I digress) and then switched into the begining of Mr. Deeds, the 2002 Adam Sandler turd that I heard from Seymour Hersh was part of the "torture" package at Abu Ghraib. Then again, being a free man, I didn't have to watch the limp performance of Mr. Sandler and halfway to rehab daze of Ms. Ryder, and so I didn't. It was truly dreadful, though, but I thank the Fox Corporation, the "Id of America," for paying good money to air it on Friday night. I'm glad everyone who thought the extremely poor box office reciepts would prevent friends, family, and former fans from seeing the "performance" that were mailed in (and I'm looking at you, Messirs Sandler and Buschemi, you Peter Gallagher for having a terrible dirt 'stashe, and of course, you, Winona for really not even pretending to care to give a shit) was proved wrong by the appearance of this film on national television. I hope a lot of people won't go to see another film by you assclowns.

But I digress.

Switched to the vastly superior film The Fugitive (1993, Mr. Harrison Ford and Tommy Lee Jones, kicking off his career of playing hard-bitten federal agents) which was showing on TNT. I feel, for me, anyway, that The Fugitive is really "a film that time forgot" (to use TheOnion's rubric). Superb, great pacing, solid performances, real suspense, effective use of Chicago locale and public transit: what more can you ask for? Perhaps I'll answer my rhetorical question. Well, you can ask for a relevant story. This, surprisingly, The Fugitive delivers, dealing with medical ethics, the nature of Big Pharmaceutical money in clinical trials, academic honesty versus consulting cash. Just look at the new NIH rules (here) or the story of Dr. Trey Sunderland who recieved over $500,000 in consulting fees from pharmaceutical corporations (especially Pfizer). Check, for example, this Forbes opinion:
NEW YORK - From breast implants to pain pills, the perception that top U.S. medical experts have been paid off by drug and medical device companies is tarnishing debates that should be about science and patient safety.

...

The FDA can always overrule its panels, which are merely advisory. But patients shouldn't be left feeling that commercial interests played any role in the decision. Matters are only made worse when it seems that potential conflict of interest problems weren't made public. At the Bextra panel, which also dealt with Pfizer's Celebrex and Merck's (nyse: MRK - news - people ) Vioxx, the FDA decided not to read potential conflicts of interest aloud, as is its custom. (Panel members say they did go through tough background checks.)

Similar snafus have come up elsewhere. When new U.S. cholesterol guidelines were announced that would put many patients on powerful drugs like Pfizer's Lipitor and Merck's Zocor, critics pointed out that most of the authors had done work for the drugmakers. The problem is that research medicine generates financial conflicts by its very nature.

It takes some 60 pages to list all the authors who presented studies at the annual meeting of the American College of Cardiology in March, and another 30 pages to list all their financial conflicts. Many academic researchers serve on the speakers' bureau of one company or another, helping to educate other doctors. Others work as consultants, often a necessary step in bringing drugs to market. Still others work on company-funded clinical trials, the main way that medicines are studied for safety and efficacy.

All of these are lucrative gigs that can make or break a career in medical research. If a researcher wants to run a clinical trial on a Genentech (nyse: DNA - news - people ) cancer drug, it's unlikely to happen if the company doesn't want to pay. (The National Institutes of Health funds relatively few trials.) Speaking can help raise an expert's profile among his peers.
All true. Welcome to the brave new world of Modern Medicine. Welcome, perhaps, to the world of The Fugitive, a film from 1993 that isn't dated, not one bit.

watch it again. You'll be impressed.

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