Naked Medicine

This week the American Heart Association and the American College of Cardiology have published updated treatment guidelines for heart attacks (or, as the journal article titled it, “Update of the Clinical Competence Statement on Cardiac Interventional Procedures”). The entire update is currently available in full from the Journal of the American College of Cardiology (JACC) via this link (technical). According to Reuters Health, which reported on this update, the guidelines focus on identifying patients at risk early and the right treatment. In patients with “low risk”, medication therapy is recommended, and tests of cardiac functions are suggested. In patients with “high risk” intervention including angioplasty is recommended.

I’ve been tracking the various developments and commentaries on the controversy surrounding diabetes drug Avandia (rosiglitazone, manufactured by GlaxoSmithKline). For those of you interested in background information and commentaries relating to the use of Avandia and increased risk for heart disease, as well as the affordability of chronic medications like diabetes drugs, I’ve compiled a short reading list including abstracts to the original research articles to help you get started. Please read my conflict of interest disclosure at the end of this article. Read the rest of this entry »

Gardiner Harris of New York Times wrote about Vermont’s disclosure of the amount of funds that the states doctors received from drug companies. While the focus was on psychiatrists, because they received top total dollars, I was particularly intrigued that endocrinologists as a specialty followed a close second. Those of you familiar with the field (I briefly worked in the field when I was a pharma employee) know that compared to psychiatrists, endocrinologists are a much smaller group as a specialty.

Still, I was concerned that psychiatrists earn so much money from drug companies because in general, doctors can earn money from drug companies mainly through consulting fees (including speaking fees) or from participating in clinical trials. In neuroscience, clinical trials tend to be very large and time-consuming to have any meaning behind the results. This means psychiatrists wouldn’t make much money per year from clinical trial participation alone, and the bulk of their revenues would come from “consulting” agreements. Consulting agreements usually comprise of speaking engagements and other “advisory board” activities. While we have many more drugs within the psychiatric therapeutic area than endocrinology, why wasn’t cardiovascular specialists a close second or even topping the list? The number of psych drugs could rival the number of cardiovascular drugs on the market.

Could it be that there is much more off-label (unapproved) use of psychiatric drugs than there is for cardiovascular drugs? This was implied by the NYT article, when it noted that psychiatrists who earned a lot of money tend to prescribe psych meds to children the most often. Read the rest of this entry »

Recently newsgroup user jkellymdmph asked a question that I had brought up when Google Co-op Health first launched:

How can this group health effort can resist infiltration by aggressive marketing?

jkellymdmph goes on to describe a continuing medical education (CME) event he attended that was supported with an unrestricted grant from a pharmaceutical company. There are two important notes in this story:

1) He thought the CME was very good, and “didn’t notice” that the supporter was a pharma company

2) … until the speaker began to tout the company’s drugs as “the best” Read the rest of this entry »

Drs. Paul Ciechanowski and colleagues found that 129 fourth year medical students from Univeristy of Arkansas for Medical Sciences who choose to enter primary care specialties are attracted to a patient centered environment that affords a “secure” relating style. Those who choose to enter non-primary care specialties are attracted to career rewards that afford a “self-reliant” relating style. This study assessed how much the med students’ specialty choices were based on students’ own experiences with caregivers and learned ways of interacting with others (”relationship styles based on attachment theory”).

Choosing a medical specialty specialty is an important decision for medical students because students who change course after making a decision may not receive training funding. Additionally, career choice also predicates the type of work environment that the physician engages in. Fourth year medical students were an appropriate group to study because these students have had significant clinical experiences in medical school and the time to carefully consider their options. Read the rest of this entry »