DOCTORS MUST NOT BE LAPDOGS TO DRUG FIRMS

Doctors must not be lapdogs to drug firms, argues a leading professor in this week’s BMJ.

Her warning comes after she addressed a conference about the influence of the drug industry on continuing medical education.

Professor Adriane Fugh-Berman’s talk covered the costs of drugs, the costs of promoting drugs to doctors, the salaries of drug representatives, and the funding of continuing medical education. She also covered psychological profiling and monitoring of physicians, including prescription tracking.

Following her talk, several companies withdrew or threatened to withdraw their support for future conferences.

Pharmaceutical firms are not interested in presenting information important to prescribers unless it is also important to the drug industry, she writes. “Drug representatives are paid to be nice to us, as long as we cooperate, sustaining market share of targeted drugs, and limiting our continuing medical education lectures to messages that increase drug sales.”

The drug industry is happy to play the generous and genial uncle until physicians want to discuss subjects that are off-limits, such as the benefits of diet or exercise, or the relationship between medicine and pharmaceutical companies, she adds. Any subject with the potential to reduce drug sales is an anathema.

“If we remain dependent on pharmaceutical companies for sponsoring continuing medical education, then these courses will remain under the control of the drug industry. This control is not contractual, but it is enforced through psychological manipulation.”

She suggests that if corporate sponsorship of medical meetings is deemed indispensable, conference organisers could solicit sponsorship from other companies, such as manufacturers of cars, luggage and travel services. Alternatively, physicians could actually pay for their continuing education, as do lawyers, accountants, and many other business people.

“Medicine must shed its docility and the corporate leash,” she says. “Let us not be a lapdog to the pharmaceutical industry. Rather than sitting contentedly in our master’s lap, let us turn around and bite something tender. Freedom calls.”

DRUG COMPANY REPORTS SHOULD BE READ WITH CAUTION

A study published on bmj.com today has found that reviews of drugs which are supported by the pharmaceutical industry are less transparent, and are more likely to reach favourable conclusion on drugs, than independent reviews.

According to the authors, bias in drug trials is common and often favours the trial-sponsor’s product. To balance this effect, independent reviews – which can have a more critical and systematic approach - are essential to ensure doctors and other health professionals have the information they need on drugs.

The authors, based in Denmark, compared the results of 24 pairs of reviews conducted by different people on the same drugs. Compared to reviews supported by the pharmaceutical industry, reviews undertaken by the Cochrane Collaboration – an independent body – were of a higher quality and were more likely to address the potential for bias in the review.

Of seven industry-supported reviews, all recommended the experimental drug without reservation, whilst none of the corresponding Cochrane reviews reached the same conclusion. Six of the eight Cochrane reviews analysed had reservations about the quality or relevance of the trials or their findings and two of them noted that the effect decreased with increasing number of patients in the trial. Seven mentioned higher cost of the experimental drug as a problem. In contrast, none of the industry-supported reviews mentioned higher cost as a problem, and two claimed that the experimental drug was cost-effective.

The researchers also found that the reviews with not-for-profit support or no support had similarly cautious conclusions as the Cochrane reviews.

The authors conclude that industry-supported reviews should be read with caution. They also want greater transparency, including the inclusion of more information on methodology and the estimated effects of the drugs, in order to allow readers to judge the reliability of drug reviews.

VITAMINS: They can make you healthier

The understanding of nutrition plays a tiny part in a doctor's education - in fact, it's around one day out of a five-year programme - and so any study that discovers vitamin supplements can actually keep you well is usually met with astonished wonder. The latest startling piece of evidence is that elderly patients who are given supplements "rich in protein and vitamins" while in hospital are far less likely to be re-admitted within the next six months. Researchers tested the theory on 445 patients with an acute condition. Half were given a nutritional drink, while the rest had a 'placebo' drink, which was presumably poor in protein and vitamins. Those who drank the real thing were far less likely to be re-admitted to hospital, the researchers discovered. Some of the elderly died during the six-month follow-up period, but researchers said it was nothing to do with the nutritional drink. No, probably not.
(Bron: American Journal of Medicine, 2006; 119: 693-9).

Dokter beschuldigt als ‘drugdealer’.

De Amerikaanse arts Hurwitz's staat momenteel terecht als drugdealer. Hierbij wordt door de Amerikaanse rechtsspraak als het ware getest wat nog toelaatbaar is als pijnbestrijding omdat vele patiënten verslaaft zijn aan medicijnen. In de USA waar commercieel reclame wordt gemaakt op TV en andere media is het medicijngebruik dermate uit de hand aan het lopen dat mensen die afweging moeten maken koop ik medicijnen of voeding voor wat ik te besteden heb.

Polypil voor gezonde 55 plussers

Al enkele jaren wordt er over gepraat de Poly Pil. Nu wordt er een test gedaan bij gezonde 55 plussers ter voorkoming van hart en vaat ziekten ?!? Deze polypil zou volgens wetenschappers zowel de bloedruk verlagen als cholesterol en het leven van 55 plussers met 3,5 jaar verlengen. Nu krijgen alleen risico patiënten ‘preventief’ medicijnen tegen hart en vaat ziekten. Een Rotterdamse ‘onderzoeker’ pleitte er in 2004 al voor om Nederlanders niet meer eerst te screenen op risicofactoren maar aan alle 55 plussers de polypil voor te schrijven. Screenen kost geld en bovendien spoort het niet alle risicofactoren op”, zo meent de wetenschapper. (bron de Telegraaf 15-06-2006)

Note: Screenen kost geld, de polypil levert geld op voor de farmaceuten. In de NATUUR is ALLES voorhanden om gezond oud te worden. Gezonde mensen hebben dus NOOIT medicijnen nodig om gezond te blijven. Dit is UITSLUITEND noodzakelijk voor mensen die ALLE signalen van het lichaam negeren en gewoon doorgaan met hun lichaam te vergiftigen door alle moderne voeding tot zich te nemen. Voor deze groep is de polypil een uitstekend lapmiddel. Om deze Polypil voor te schrijven door ‘wetenschappers’ aan gezonde mensen begint ernstig te lijken op eh, ..... kwakzalverij!!!

Ik wil niet ziek worden!

Iedereen kan zich vinden in deze statement en toch worden er elke dag mensen ziek? We moeten gevarieerd eten dan krijgen we alle voedingsstoffen binnen en toch haalt slechts 10 procent een royale voldoende voor hun voedingsstatus? Een ding is mij duidelijk geworden de afgelopen jaren, als je gezond oud wilt worden zul je daar wat extra voor ‘moeten’ doen. Niet ziek worden gaat niet vanzelf. Laat het niet van de factor geluk afhangen anders kan het net zo aflopen als met de loterij; “Het is weer eens niets geworden!”

Mosterd na de maaltijd
In een onlangs gehouden onderzoek kwam naar voren dat de huisarts de nummer één bron is van gezondheid advies. Gezien het aantal zieke mensen blijken die adviezen niet goed opgevolgd te worden of het advies op zichzelf is niet afdoende. Een arts vertelde mij onlangs dat mensen gewoon eisen dat ze een medicijn voorgeschreven kregen anders zouden ze naar een andere arts gaan! Jammer, maar deze groep legt de verantwoording voor hun persoonlijke gezondheid bij een ander en weigeren hun persoonlijke leefstijl aan te passen. Hoe gaat een arts echter om met de groep die wel open staan voor preventie? Een deel heeft de keuze zelf al gemaakt en consulteren orthomoleculaire en natuurartsen. Voor de overgrote meerderheid geld nog steeds dat de arts pas in beeld komt als er een probleem is. Je kan dus stellen dat de preventie taak van de arts als mosterd na de maaltijd komt.

Wie gaat de cultuur omslag veroorzaken?
Veel mensen geven aan een vitamine analyse nuttig te vinden. Verder als deze constatering komen echter de meeste niet. Er wordt zelfs niet eens geïnformeerd naar de kosten. Wat zijn de ervaringen met de groep die de test al wel heeft laten uitvoeren? De helft vraagt de test opnieuw aan omdat men gezien heeft dat er grote verbeteringen te behalen zijn. Verbeteringen die rechtstreeks te maken hebben met het verlangen om niet ziek te worden! Vanuit de medische wereld heb ik nog weinig initiatieven gezien naar een actieve rol in de voorlichting. Om precies te zijn; NUL! De cultuuromslag zal dus beginnen bij U!

De grote vraag?
Ik heb al geleerd om de vraag; “Hoeveel kost het?” om te ruilen voor de vraag; “Hoeveel gaat het mij opleveren?”

- Henk Mutsaers

Doctors' campaign against alternative therapies

From Professor Michael Baum and others

Re Use of ‘alternative’ medicine in the NHS

We are a group of physicians and scientists who are concerned about ways in which unproven or disproved treatments are being encouraged for general use in the NHS. We would ask you to review practices in your own trust, and to join us in representing our concerns to the Department of Health because we want patients to benefit from the best treatments available.

There are two particular developments to which we would like to draw your attention. First, there is now overt promotion of homeopathy in parts of the NHS (including the NHS Direct website). It is an implausible treatment for which over a dozen systematic reviews have failed to produce convincing evidence of effectiveness. Despite this, a recently-published patient guide, promoting use of homeopathy without making the lack of proven efficacy clear to patients, is being made available through government funding. Further suggestions about benefits of homeopathy in the treatment of asthma have been made in the ‘Smallwood Report’ and in another publication by the Department of Health designed to give primary care groups “a basic source of reference on complementary and alternative therapies.” A Cochrane review of all relevant studies, however, failed to confirm any benefits for asthma treatment.

Secondly, as you may know, there has been a concerted campaign to promote complementary and alternative medicine as a component of healthcare provision. Treatments covered by this definition include some which have not been tested as pharmaceutical products, but which are known to cause adverse effects, and others that have no demonstrable benefits. While medical practice must remain open to new discoveries for which there is convincing evidence, including any branded as ‘alternative’, it would be highly irresponsible to embrace any medicine as though it were a matter of principle.

At a time when the NHS is under intense pressure, patients, the public and the NHS are best served by using the available funds for treatments that are based on solid evidence. Furthermore, as someone in a position of accountability for resource distribution, you will be familiar with just how publicly emotive the decisions concerning which therapies to provide under the NHS can be; our ability to explain and justify to patients the selection of treatments, and to account for expenditure on them more widely, is compromised if we abandon our reference to evidence. We are sensitive to the needs of patients for complementary care to enhance well-being and for spiritual support to deal with the fear of death at a time of critical illness, all of which can be supported through services already available within the NHS without resorting to false claims.

These are not trivial matters. We urge you to take an early opportunity to review practice in your own trust with a view to ensuring that patients do not receive misleading information about the effectiveness of alternative medicines. We would also ask you to write to the Department of Health requesting evidence-based information for trusts and for patients with respect to alternative medicine.

Yours sincerely

Professor Michael Baum
Emeritus Professor of Surgery, University College London

and
Professor Frances Ashcroft FRS
University Laboratory of Physiology, Oxford
Professor Sir Colin Berry
Emeritus Professor of Pathology, Queen Mary, London
Professor Gustav Born FRS
Emeritus Professor of Pharmacology, Kings College London
Professor Sir James Black FRS
Kings College London
Professor David Colquhoun FRS
University College London
Professor Peter Dawson
Clinical Director of Imaging, University College London
Professor Edzard Ernst
Peninsula Medical School, Exeter
Professor John Garrow
Emeritus Professor of Human Nutrition, London
Professor Sir Keith Peters FRS
President, The Academy of Medical Sciences
Mr Leslie Rose
Consultant Clinical Scientist
Professor Raymond Tallis
Emeritus Professor of Geriatric Medicine, University of Manchester
Professor Lewis Wolpert CBE FRS
University College London

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Dear Henk,

Many of you may already be aware of the story released by The Times newspaper in the UK today that has already received significant coverage.  13 British doctors and scientists, headed by Professor Michael Baum, have published an open letter in The Times urging the UK National Health Service to stop using complementary and alternative therapies and to pay only for medicine "based on solid evidence".  You can find the full story at http://www.timesonline.co.uk/article/0,,2-2191985,00.html.
Given the fact that Prince Charles gave a speech on complementary medicine and the need for an integrative approach to healthcare at the World Health Assembly in Geneva earlier today, it is difficult, if not impossible, to believe that the publication of the letter in The Times has not been deliberately timed to coincide with this.

Through our Medical Director, Dr Damien Downing, who is also President of the British Society for Ecological Medicine (BSEM), the ANH is facilitating a group of academics from various UK universities, spearheaded by the BSEM, who are coming together to respond to the letter published in The Times this morning.

Dr Robert Verkerk will be interviewed on Sky News (channel 501) at 9.30pm tonight, Tuesday 23rd May, on this issue.  We appreciate that the nature of news makes this very short notice, but hope that some of you may be able to catch the broadcast.

Kind regards

ALLIANCE FOR NATURAL HEALTH