As one of the stigmatized physicians in the October 18, 2010 ProPublica article “Docs on Pharma Payroll Have Blemished Records, Limited Credentials”, I feel compelled to respond.
On the face of it, the article seems reasonable. The initial part of the report depicts a few individuals that are singled out as poster children for the article’s main theme. The inherent message is clear that Big Pharma, in their aggressive marketing efforts as “pill pushers”, selects any physicians, even with inadequate credentials, to carry the company’s marketing banner to their colleagues in a disguised format of education. Big Pharma’s failure is the result of greed! By inference, with the exception of a few obligatory academics, the lecture bureau of Big Pharma generally consists of disreputable physicians with inadequate pedagogical skills but good marketing skills. The implication is that Big Pharma is indiscriminant in who they choose as a speaker, as long as that physician tolls the line and supports Big Pharma interests. What is clearly projected is an avaricious, socially uncaring, and civically irresponsible industry that seeks to make exorbitant profits at any cost to satisfy their shareholders and pay exorbitant management fees. Nice beginning of supporting the stereotypic condemnation of the industry, or any industry for that matter!
Then the article describes how the industry “makes their own experts”. I am one of those so-called “experts”. Thanks for presenting a fair balanced story, Charlie. Let's look at the reporter’s portrayal of me. "Roseman is not a researcher with published peer-reviewed studies to his name. Nor is he on the staff of a top academic medical center." Although not stated but implied is that I am poorly trained and educated, in order to fit with the message of the report. As discussed with the reporter, I have significant academic and clinical standing and am a well-respected cardiologist. My education was discussed with the reporter: BA, University of Pennsylvania (the reporter’s alma mater); MD, University of Tennessee; MPH, Yale University; Clinical Training at Yale and Brown University affiliated hospitals and Massachusetts General Hospital in Boston. I was one of the first in the country to take the National Lipid Boards, an inspiring subspecialty board under the Board of Internal Medicine. I am a specialist with the American Society of Hypertension. I have fellowship standing with at least three major societies, including the American Colleges of Internal Medicine and Cardiovascular Diseases. I am well regarded as a thought leader in my field of preventive cardiology, at least regionally. I have been offered academic positions, but I chose to remain in clinical practice. I have published, although minimally; a second paper on lipid treatment has been submitted and is awaiting approval. My lack of publication does not mean that I am not knowledgeable or that I am a poor teacher. In fact, a significant publication dossier does not guarantee anything about one’s capacity as an educator. Finally, my practice is one of a limited sites in the United States engaged in two international cardiovascular outcome trials related to contemporary diabetic medications. For further details, please refer to my website: www.cardiologywellnss.net.
Even after having discussed my position on rosiglitazone (Avandia) with the reporter, the article portrayed me as having full confidence in Avandia, despite all of the controversy around and the mounting evidence against the drug. The article insinuated that my alleged continued and unrelenting support of the agent followed from a bias that was a direct result of my association with GSK, the pharmaceutical company that manufactures and markets Avandia. The reporter failed to use any of my three authored position papers on the decision by the FDA in clarifying my opinions, which I sent to the reporter and now listed on my blog: http://cardiologist-on-call.blogspot.com/. The reporter chose to avoid or sidestep the nuances around the controversy and decided instead to take snippets of our discussion to insinuate that I was a bought mega horn for the product. In particular, the reporter chose to omit the information that I made available to him, which conveyed that the safety issue about rosiglitazone (Avandia) remains controversial. Furthermore, absent in the report was the recent statement by the FDA's own Woodcock, Director of the Center for Drug Evaluation and Research, comports with my own views about the uncertainty of harm: http://www.fda.gov/downloads/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/UCM226959.pdf. The issue of Avandia causing heart attacks is not settled, and currently the safety study RECORD is being re-evaluated. The absolute risk of Avandia causing heart attacks appears low, as I asserted!
This experience with ProPublica “investigative reporting” has left me with a concern about “news’ in general. In an attempt to bring an issue to surface, it appears that any distraction from the main theme is minimized, even if the facts don’t totally match the desired effect. For example, ProPublica’s characterization of me was unfair; the reporter failed to include my background, despite knowing it. He misrepresented that I had no publication to my name, which I do (article included: www.amcp.org/data/jmcp/august_suppl.pdf). My training in the area of diabetes, contrary to what was reported, was not the primary result of corporate paid scholarship but countless hours of my own researching the medical literature and attending numerous conferences and conventions. My library includes hundreds of articles which I have collected about the drug class (thiazolidinediones or TZDs) to which Avandia is a member.
Because of these misrepresentations and omissions, I am left to believe that the reporter was merely using me as an example to demonstrate the extensive bias that he was attributing to industry connected physicians. The reporter cast my views on Avandia as being unreasonable given the alleged overwhelming evidence against the drug. Now I am aware why journalists get such a bad reputation! In situations like this, it appears that their main aim is to get out a controversial story and characterize situations to make a good story line. Based upon this involvement with the ProPublica reporter, I believe that the reporter failed his own ethics tests: http://www.spj.org/ethicscode.asp.
Since I was assumed by the reporter to be bias, I asked the reporter Charlie (Ornstein) when he first contacted me to produce evidence that he was not bias. I submitted him a series of questions, which he refused to answer. The “Objectivity Check-list” as I called it, is listed on my blog: http://cardiologist-on-call.blogspot.com/. Clearly, based upon the tenor of the article, the report had a pre-conceived agenda.
The other segments of this reporting effort “Dollars for Docs” have a larger message- yet again, another large corporation buying influence. But when you start looking at the substance of the article, the report falls short in demonstrating the harm from relationships between industry and physicians, or for that matter, large institutions. The inferences of the article were obvious, but actual damages not identified or fully clarified. The implication underlying this article is that money buys influence, but does it? Are the activities of the pharmaceutical industry causing harm?
The receiving of appropriate payment for services rendered can be assumed as being corrupting, but not necessarily indicate corruption. Just because someone receives compensation from a company does not necessarily indicate bias or prejudice. Were the views of the reporter colored, influenced, affected, tainted, or altered by his employer, ProPublica? Certainly, there is presumption of bias when one is an agent of an institution or corporation. What dictates the nature of that agency relationship is the integrity of the individual, not the source of his income! Judge me for what I say and do; don't prejudge me simply because I am associated with a company. Using financial ties offers a beginning point to determine a person's bias but that metric is deficient in providing a conclusive and complete analysis of the individual's character. Should everyone be judged solely by one’s relationship to his employer?
As it relates to the education programs to which I am a part, I would certainly challenge the ProPublica reporting staff to research and write about the benefits of these educational programs, which are criticized without an opposing viewpoint. The article insinuates that these programs are part of insidious marketing scheme by the pharmaceutical companies to sell drugs for profit sake only. Of course, we do live in a capitalistic society that favors and rewards innovation. However, contrary to a widget company, the pharmaceutical industry’s ultimate aim is to make medications to help people. Certainly there are examples are overly zealous and avaricious businessmen that overstepped the boundaries of ethical practice in promoting their products. But generally, the pharmaceutical industry is in the service of providing safe and efficacious treatments. Even if greed was the main motivation, the current climate is highly punitive of companies that abuse their mandated role in providing effective and novel medications within the regulatory boundaries set forth by Congress and the FDA. Educating the medical personnel on the appropriate use of these medications is an important step to ensure that the health care provider has the most relevant and up-to-date information to make informed decisions about the treatment options for his/her patients.
After considering the content of these series of articles, I am left with an impression that this is adolescent journalism, well-written but not meeting the standards of true investigative reporting which requires fair coverage of all sides of an issue.
As such, I believe that the ProPublica journal should be renamed “PrePubica”!
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