On The Whole

Pharmaceutical companies funding health journalism

HealthNewsReview.org publisher Gary Schwitzer has expressed concerns that the drug company Pfizer is funding National Press Foundation fellowships on cancer issues and that the Society of Professional Journalists is orchestrating a tour of Eli Lilly corporate headquarters including a "professional development session on the reporting of mental health issues" and a "networking reception with Lilly's leaders."

Lilly makes the psychiatric drugs Cymbalta, Prozac and Zyprexa. Pfizer's website indicates it makes several medications for treatment of cancer.

Schwitzer, a professor at the University of Minnesota health journalism program, notes that such actions are conflicts of interest and violate the SPJ code of ethics. He cites a 2008 article in the British Medical Journal warning that "Doctors should be wary of the increasing entanglement of medical journalists and the drug industry."

So should consumers.

Keep this in mind next time you come across news reporting of medical or mental health issues, especially when drugs are involved.

Pharmaceutical industry ties revealed for NPR psychiatrist

The New York Times reported yesterday that Frederick K. Goodwin, M.D., host of the NPR program "The Infinite Mind," has earned more than a million dollars giving "marketing lectures for drugmakers"--- which he never mentioned on the program and denied to his producer.

The Times reports that Dr. Goodwin (who claims he told his producer about his pharmaceutical-company consulting and denies it had any influence on his broadcasts) claimed on his show, among other things, that the "mood stabilizers" increasingly being given to children diagnosed with bipolar disorder (formerly known as manic-depression) were "safe and effective"....never disclosing that GlaxoSmithKline paid him more than $329,000 that year to promote the mood stabilizer Lamictal.

The psychiatrist and radio host...is the latest in a series of doctors and researchers whose ties to drugmakers have been uncovered by Senator Charles E. Grassley, Republican of Iowa. Dr. Goodwin, a former director of the National Institute of Mental Health, is the first news media figure to be investigated.

Dr. Goodwin's weekly radio programs have often touched on subjects important to the commercial interests of the companies for which he consults....

Mr. Grassley's investigation demonstrates how deeply pharmaceutical commercial interests reach into academic medicine, and it has shown that universities are all but incapable of policing these arrangements...

I love this part [Note: sarcasm; emphasis mine.]:

[Goodwin] blamed a changing ethical environment for any misunderstandings with [his producer] about his consulting arrangements. "More than 10 years ago, when he and I got involved in this effort, it didn't occur to me that my doing what every other expert in the field does might be considered a conflict of interest," Dr. Goodwin said.

He defended the views he expressed in many of his radio programs and said that, because he consulted for so many drugmakers at once, he had no particular bias.

"These companies compete with each other and cancel each other out," he said.

Oh, really? Is that why there are so few people on medication in this country? (The Times points out that "experts who consult for drugmakers tend to minimize the value of nondrug or older drug treatments.)

The Times also recently reported that federal drug experts have criticized the growing use of antipsychotic drugs for children, which in part has been driven by the "sudden popularity of the diagnosis of pediatric bipolar."

I wonder when will Grassley -- or the Times -- investigate the ties of "obesity" experts to the pharmaceutical and medical device industries?

Read the complete Goodwin article here.

[In the interest of full disclosure -- about eight years ago a pharmaceutical company paid me to provide expert opinion/commentary on women's body image as part of their marketing of a product intended to increase hair growth. And I currently am part of the Council for Women's Nutrition Solutions, which is funded by the beef industry.]

Paul Campos on the ridiculous notion of "overweight" -- and why the medical establishment's attitude toward weight is unhealthy

Paul Campos has an excellent article in The New Republic addressing the craziness of the medical establishment's pronouncements about weight.

After summarizing important findings in the Journal of the American Medical Association study by Katherine Flegal & others that included "overweight" people being healthier than so-called "normal" weight people, Campos comments that in "America's war on fat, the fact that being called "overweight" makes no medical or scientific sense is hardly a trivial point."

Although leading "obesity" experts try to rationalize the Flegal et al. findings away, their rationalizations don't hold up to the scrutiny that Campos and others provide.

Paul Campos is the author of The Obesity Myth, published in paperback as The Diet Myth. Read his New Republic article here.

Great article on a Health At Every Size approach to diabetes

I miss Radiance magazine.

They stopped publishing new issues several years ago, but thank goodness many of their articles are still online. Like this one on "Diabetes: A Gentle Approach to a Tough Problem" by Susan Lawrence Rich, which contains tips for dealing with doctors' fat prejudice and weight loss bias. Someone just drew it to my attention.

The article was originally published in 1995, so I don't know if the featured doctor and dietitian are still in practice in Salinas, CA. Let's hope so.

Other Health At Every Size oriented resources for people with diabetes include the Fat Diabetics email list (the link's at the left, or click here). And although it doesn't specifically address diabetes, Linda Bacon, Ph.D.'s "Health At Every Size Manifesto" can be printed out and given to physicians (or other health professionals) with the physician cover letter Bacon also provides.

Handling medical/doctor visits

La di Da at the Fat-o-matic blog has a good post about going to the doctor for her "pre-employment physical." She includes a link to a letter by Hanne Blank (author of Big Big Love) that inspired her to write her own version to hand to the doctor, have placed in her file, etc.

Read the Fat-o-matic post here, and Hanne Blank's letter here.

Blank's letter is posted on Stef Jones's website along with her Fat Friendly Health Professionals list and Tips on Obtaining Good Health Care, both great resources as well.

Why are these useful? Sadly, many fat women have felt shamed and humiliated by encounters with medical professionals in which their health problems were ignored or appropriate assessment or treatment refused until they lost weight.

Lynn McAfee of the Council on Size & Weight Discrimination wrote in a guest editorial in Healthy Weight Journal that

We are given a diet as a first line of treatment. We are told not to come back until we lose weight, although we all know that weight loss and maintenance is a nearly unattainable task. If we can't lose weight, we are viewed as weak-willed or, worse, defiant. This is the kind of attitude that makes the 80-year-old woman afraid to see her doctor when her hypertension worsens. It causes a woman to die from uterine cancer because her doctor told her he wouldn't operate on her 225-pound body until she lost weight. Serious complaints, sometimes indicative of potential cancers, are dismissed under the mistaken impression that every fat woman should have menstrual problems. Important testing is not done. Supersized women are particularly victimized by this treatment.

A study by C. Olsen et al. in a 1994 issue of the Archives of Family Medicine indicated that 32% of female health care workers with a BMI over 27 delayed or canceled physician appointments because they knew they would be weighed.  (Gosh, do you think that percentage has gotten larger or smaller since the "war on obesity" has heated up?)

Surprised that health care workers might delay exams because of their weight? Maybe they have firsthand knowledge of how fat people (women in particular) are treated -- or not treated -- by physicians and other health professionals.

A study in the 1998 Archives of Family Medicine found that the higher the weight of women, the less likely they were than thinner women to have had either a clinical breast exam, a gynecologic exam, or a Pap smear in the previous three years, even though they had as many or more doctor contacts. (The only cancer screening performed regularly on larger women was mammography.)

In Women Afraid to Eat, Francine Berg reports that a study of 1,316 physicians showed they were more reluctant to perform pelvic exams on very fat patients. Higher weights of female patients was related to negative physician attitudes about patients' appearance, which in turn was related to lower frequency of pelvic exams. She noted that researchers warned that the lower level of preventive care large women are getting may account for some of the increased health risks found with "obesity."

By the way, a 2003  Obesity Research article by M. Schwartz et al also reported that health professionals specializing in "obesity" displayed significant anti-fat bias, endorsing stereotypes of fat people as "lazy, stupid and worthless." [Hmmm, is the moral here that if you're a fat person wanting good health care -- and personal respect -- don't go to an "obesity" specialist?] The researchers noted that

If patients are uncomfortable in health care settings, it would not be surprising if they avoided care.

Pat Lyons, R.N., M.A. and WomanCare Plus of Oakland, CA have developed a handy dandy "Big Woman's Passport to Best Health," which I talked about on the July 3, 2006 Health At Every Size show and blogged about here.

I also recommend the Health At Every Size resources available at Linda Bacon, Ph.D.'s website. She has a "Health At Every Size Manifesto" that can be downloaded and/or printed out and handed to health professionals (or others whom you would like to educate), along with a cover letter that can be included for physicians. (You have to scroll down in the text box on Dr. Bacon's Health At Every Size page to see the link to the cover letter.)

Bacon is a professor, researcher and writer who collaborated on a study indicating the weight-neutral Health At Every Size approach to well-being was much better for fat middle-aged women's physical and emotional health than a traditional weight-loss diet. The research was published in the Journal of the American Dietetic Association in 2005; you can request a PDF of the article by going here.

BBC News program investigates distortion of drug research

The BBC News investigative journalism program Panorama has produced a stunning (well, to anyone who hasn't been following these issues) program about the coverup/distortion of research related to Seroxat (the UK name for Paxil) and children.

You can find an article on the program here, along with links to the online video and a transcript.

The video is lengthy, but is worth watching if you're at all interested in how psychiatric drugs are marketed to the medical community as well as the public. Of particular note are interviews with experts paid by GlaxoSmithKline to promote the drug and even to "co-author" research reports on the drug trials even though they apparently didn't read or understand the data. (In case you don't know....MD training does not include education in experimental design, statistics, or critical analysis of research.)

At one point toward the end of the program the female investigative journalist asks one such expert about the incongruencies in the clinical trials of Seroxat/Paxil (such as the downplaying of any adverse effects -- including sucide -- in those taking the drug), and the male psychiatrist dismisses the question while chucking her under the chin -- a gesture captured by the journalist's hidden camera. (Weird, but to me somehow indicative of such physicians'/researchers' overall attitude about psychiatric drugs....don't worry your little head about anything; just do what I say and take your medicine.)

The reporter also interviews David Healy, the British psychopharmacologist and author of The Antidepressant Era and Let Them Eat Prozac, among other books. Healy lost his academic job a few years ago for speaking out about the hazards of psychiatric drugs (especially SSRIs) and criticizing the pharmaceutical industry.

The truth about weight loss surgery

Sandy Szwarc has posted an excellent article on weight loss surgery (also known as bariatric surgery) at her Junk Food Science blog.

Read it here. (Warning: the post is graphically illustrated by a closeup photo of surgery in process.)

Medscape runs video editorial encouraging physicians to promote Health At Every Size

Somebody better check on Hell -- it must have frozen over. Medscape has posted a pro-Health-At-Every-Size editorial.

The video editorial was even introduced by George Lundberg, MD, who did that awful December 2004 Medscape editorial in which he proposed "curing obesity" by refusing food and service to fat people.

Thanks must go to Linda Bacon, Ph.D., who stars in the video editorial. A transcript is provided next to the webcast.

Check it out at  http://medgenmed.medscape.com/viewarticle/547543. (You may have to register at Medscape to view it.) The editorial will eventually go into the Medscape archives at  http://medgenmed.medscape.com/medgenmed, where it should be found by searching for "Linda Bacon, Ph.D."

Way to go, Linda!

Guess what's one of the first surgical procedures to be marketed direct to consumers in the US?

Cross-posted from the Health At Every Size show blog...

Warning! Warning! Danger, Will (& Willa) Robinson!!!

Coming to (or perhaps already beaming through) a television set near you...Allergan's commercial for its Lap-Band weight-loss surgery. MediaBuyerPlanner.com says it's "one of the industry's first TV campaigns for a surgical procedure."

The "60-second testimonial spot" started airing on national cable channels at the end of October, moving to CBS in early November. The ad campaign is scheduled to run throughout the end of the year. They are also running ads in "professional journals" and providing "materials for display in doctor's offices."

A senior VP at Allergan (who wouldn't disclose the budget for the ad campaign) is quoted as saying "the responses have exceeded expectations." Sigh.

Read the full article here.

Selling "obesity" hysteria

Paul Ernsberger, Ph.D. of Case Western Reserve Medical School gave me permission to share the following perspective on the etiology of "obesity" hysteria, which he posted on a private egroup for fat studies scholars:

I trace the onset of the the current medical war on obesity to the marketing blitz for fenfluramine, dexfenfluramine and phen-fen. These drugs created a network of 4 drug companies to promote pills that caused only a small amount of weight loss. The only way to get physicians to prescribe dangerous drugs that cause minor weight loss was to exaggerate the health risks of high weight. They created a speakers' bureau and they sent famous obesity warriors all over the country to "educate" physicians about the "dangers of obesity." These included all the usual suspects, whose careers were tremendously advanced by these lecture tours. The traveling lecturers (really propagandists) also came to dominate the talking heads on TV whenever a fat-related news story appeared.

The companies also sponsored "symposia" where speaker after speaker (most of them diet clinic directors) hammered on the epidemiology supporting a link between obesity and ill health. I attended many of these. As far as I recall, they never asked an epidemiologist to speak about epidemiology. These symposia took place at major medical conferences, and to draw a large crowd to fill the ballroom they included (very fattening) full dinner and often an open bar as well. No expense was spared. The odds are good that your personal physician or perhaps a senior physician that he or she trusts has been to one of these one-sided "symposia."

Because of FDA rules, companies are not allowed to promote drugs that are not yet approved. So how do they advance promotion legally? By promoting the indication. The makers of subutramine and orlistat started sponsoring symposia promoting a hysterical view of obesity years before they won FDA approval.

There you have it: a first-person account of the tactics used to sell the concept of obesity as a horrible, life-threatening disease, which in turn would obstensibly justify the prescription of medications with dangeous side effects. (Read Alicia Mundy's Dispensing With the Truth for a closehand look at this in regards to the diet-pill combo of phen-fen).

I doubt this process is limited to the selling of "obesity," by the way. Ernsberger's remark about epidemiologists not being asked (or paid) to speak about epidemiology at these industry-produced "symposia" reminds me of a meeting of a local health professionals' association I attended in Nashville, TN several years ago.

The meeting was held at an expensive restaurant and sponsored by a drug company, which provided free appetizers and meals to the physicians and psychologists in attendance. I arrived too late for the lobster appetizers, but my steak dinner was delicious.

The drug company also provided a physician who gave a 30-minute Powerpoint presentation on depression and the treatment of depression. Not once in the presentation did this physician mention psychotherapy, counseling, or any other non-pharmaceutical "treatment" of depression.

The physician who presented this unbalanced perspective was a gynecologist. Gynecologists, like other non-psychiatrist physicians, get about six weeks' worth of training in "mental health" issues in medical school. I wonder if a psychiatrist would have felt obligated to include non-pharmaceutical perspectives on depression. Possibly not, since psychiatric education has become almost entirely biologically oriented over the past couple of decades.

Ernsberger's quote above was posted in response to a post I made about the book Selling Sickness: How the World's Biggest Pharmaceutical Companies Are Turning Us All Into Patients (Ray Moynihan & Alan Cassels). That book contains a section on a New York ad agency staffer whose job was to work with drug companies to create new diseases (or rather the concept of new diseases) that could be marketed to the public in order to sell them the "solutions." I almost wrote "cures," but the goal really was/is to develop lifelong consumers of the product, not "cure" anything.

Selling Sickness opens with an anecdote about the former CEO of Merck saying (one might think almost wisfully) in an interview 30 years ago that what he really wanted was to be able to sell drugs to healthy people--vastly increasing his potential market. As Cassels and Moynihan noted, his dream has come true.