HONEST MEDICINE: My Dream for the Future

My Apology to Michael Moore

I love to admit I’m wrong, especially in a case like this one. I must admit that, when I first learned that Michael Moore was making a movie called "SICKO," I feared that the then-film-in-progress was going to take the tack that “we have this wonderful health care in this country, but only the rich can afford it.”

I came to this conclusion that Moore was on the wrong track, because of the “plea for medical horror stories” on his site, where he wrote:

"Have you ever found yourself getting ready to file for bankruptcy because you can't pay your kid's hospital bill, and then you say to yourself, "Boy, I sure would like to be in Michael Moore's health care movie!?

“Or, after being turned down for the third time by your HMO for an operation they should be paying for, do you ever think to yourself, 'Now THIS travesty should be in that 'Sicko' movie!'?

“Or maybe you've just been told that your father is going to have to just, well, die because he can't afford the drugs he needs to get better – and it's then that you say, ‘Damn, what did I do with Michael Moore's home number?!’”

I worried that the above quotes implied that Moore might have been influenced by the pharmaceutical companies’ excellent PR on their own behalf.

I am happy to say that I couldn't have been more wrong about Michael Moore.

The first sign that Moore was, indeed, on the right track occurred on August 21st, 2006, when "Advertising Age" reported that “Michael Moore Documentary Rattles Health-Care Giants.” Rich Thomaselli wrote of Michael Moore's film:

“The health-care industry is worried sick over ‘Sicko.’ Pharmaceutical companies have told their employees not to talk to documentary filmmaker Michael Moore, whose next project, 'Sicko,' looks at health care in the U.S."

and

“Added a spokesman for one of the top 10 pharma companies: ‘We expect it will be one-sided and biased, just like his other documentaries.’

“Several other pharmaceutical makers did not return calls for comment. But Pfizer, AstraZeneca and GlaxoSmithKline all advised their employees last year not to speak to Mr. Moore when he began his research for ‘Sicko.’ It is not known whether any HMOs or drug companies will appear in the film.

“‘We were approached, but declined,’ said a spokeswoman for a second top-10 drugmaker. ‘Frankly, as much as we felt like we wanted to get our message across, in the end we didn't want to subject ourselves to the editing process.’”

Moore, for his part, never loses his sense of humor over the lack of cooperation from industry spokespersons. (I don’t doubt that he found plenty of “talkers” without “official” cooperation!) The article went on to say:

“‘They're so hip [to me] that whenever we have a family’ with a health-care nightmare ‘they get free health care,’ Mr. Moore said during panel discussions last month at his second annual Traverse City Film Festival in Michigan. ‘There has been a 100% success rate of the people we're filming of getting whatever they need from the HMOs, pharmaceutical companies, whatever.’”

It's been almost a year since that Advertising Age article was written. Now we know that Moore took some of his film's participants/patients (three 9/11 Ground Zero "first responders," who developed respiratory problems resulting from their patriotic efforts) to Cuba to get the medical care they couldn't get in this country. And our government has launched an investigation to see whether Moore's trip violated U.S. law. (As one of my favorite blogs, The Health Care Blog, pointed out on May 11, 2007: "you can't buy publicity like this!")

Now that "SICKO" was such a stunning success at Cannes, Moore is experiencing an ironic "double whammy": being investigated by our government, and being hailed as one of the boldest filmmakers ever. Even the ultra-conservative Fox News has praised the film, calling it "brilliant and uplifting."

"SICKO" opens on June 29th nationwide. Stay tuned for more. But, until then, please accept my apologies, Michael Moore. I should have known you wouldn't be influenced by Big Pharma’s marketing ploys!

Click here to see the trailer for "SICKO."

(You may also Click here to read my "Open Letter to Michael Moore," which contains the very touching account of my husband Tim's meeting with Michael Moore, as well as some pretty terrifying medical "horror stories" Tim and I experienced during the 15 years following his brain tumor diagnosis.)

The JAMA Controversy, Part 3: A Very Important Postscript

On August 7, veteran Chicago newswoman Carol Marin interviewed Dr. Catherine DeAngelis,  JAMA’s editor in chief, on WTTW-Television’s “Chicago Tonight.”    (You may Download DEANGELIS-MARIN-WTTW-FINAL-TRANSCRIPT.doc)

In the interview, Ms. Marin did not mention the Wall Street Journal articles, discussed in Part 1 and Part 2 of this article, which revealed that JAMA had recently published articles detailing studies whose authors had financial ties to pharmaceutical companies. During this interview, Dr. DeAngelis concentrated on reiterating her stance that every physician who writes for JAMA must disclose financial ties.

Watching the interview, it was not obvious to me whether Carol Marin, usually one of the best prepared newscasters I know of, had read David Armstrong’s Wall Street Journal exposés. Her questions were more clearly influenced by the recent New York Times article, “Tough-Talking Journal Editor Faces Accusations of Leniency,” which concentrated on Dr. DeAngelis’s “tough" stance on the necessity for disclosure of physician/author’s financial ties. Ms. Marin also referred to Dr. DeAngelis' just-published JAMA editorial, "The Influence of Money on Medical Science."

At first, I was skeptical of Dr. DeAngelis’s “tough” stance. However, her on-air assertions that the full disclosure of physician/authors' financial ties to pharmaceutical companies had been a sincere concern of hers since before taking over the JAMA editorship in 2000, led me to do my own research.

What I found both surprised and impressed me. It turns out that Dr. DeAngelis really has advocated for and, in fact, demanded (at least in writing) full disclosure of financial ties since at least July, 2001, with her JAMA editorial, “Reporting Financial Conflicts of Interest and Relationships Between Investigators and Research Sponsors”, written eighteen months after she took over the editorship. This editorial cites 27 references to other articles on similar and related topics, making clear that even in 2001, financial disclosure was a “hot topic” among medical journals. I also discovered that Dr. DeAngelis had written several more articles and editorials on the topic in following years.

I now have no doubt that JAMA clearly HAS had rules that physician/authors were supposed to follow. However, it is becoming clearer that many doctors simply didn’t follow them.

In Dr. DeAngelis' most recent JAMA editorial, she states that, since 1989, "authors have been required to sign a specific statement disclosing the financial interests they have that might be perceived as influencing the article they have written." and that" in 1990, JAMA began publishing these disclosures." (While she provided footnotes in her editorial, actual copy was not provided on the JAMA website.)

But, in July, 2004, JAMA’s instructions for authors clearly stated:

“Conflict of Interest. Authors should indicate potential conflicts of interest, including specific financial interests relevant to the subject of their manuscript, in their cover letter and on THE JOURNAL's financial disclosure form or in an attachment to the form. Authors without relevant financial interests in the manuscript should indicate no such interest (see authorship form)”

And then again, under Author Requirements, the same piece states:

“Authors are required to identify their contributions to the work described in the manuscript. With the cover letter include the authorship form with statements on (1) authorship responsibility, criteria, and contributions, (2) financial disclosure, and . . . .”

Six months later, in January, 2005, JAMA released another “Instructions for Authors.” This time, the “Conflict of Interest” section was a great deal longer, and much more detailed.

“Conflict of Interest. A conflict of interest may exist when an author (or the author's institution or employer) has financial or personal relationships that could inappropriately influence (or bias) the author's decisions, work, or manuscript. All authors are required to report potential conflicts of interest, including specific financial interests relevant to the subject of their manuscript, in their cover letter and on JAMA's financial disclosure form or in an attachment to the form. Authors without relevant financial interests in the manuscript should indicate no such interest (See Authorship Criteria and Responsibility Form).6

“Authors are required to report detailed information regarding all financial and material support for the research and work, including but not limited to grant support, funding sources, and provision of equipment and supplies. Each author also is required to sign and submit the following financial disclosure statement: "I certify that all my affiliations with or financial involvement, within the past 5 years and foreseeable future (eg, employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, royalties) with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript are completely disclosed."

“Authors are expected to provide detailed information about any relevant financial interests or financial conflicts within the past 5 years and for the foreseeable future, particularly those present at the time the research was conducted and up to the time of publication, as well as other financial interests, such as relevant filed or pending patents or patent applications in preparation, that represent potential future financial gain. Although many universities and other institutions and organizations have established policies and thresholds for reporting financial interests and other conflicts of interest, JAMA requires complete disclosure of all relevant financial relationships and potential financial conflicts of interest, regardless of amount or value. If authors are uncertain about what might constitute a potential financial conflict of interest, they should err on the side of full disclosure and should contact the editorial office if they have questions or concerns. In addition, authors who have no relevant financial interests are asked to provide a statement indicating that they have no financial interests related to the material in the manuscript.

“This information is for the editorial office and is not shared with peer reviewers. However, for all accepted manuscripts, each author's disclosures of relevant financial interests and declarations of no relevant financial interests will be published. Decisions about whether financial information provided by authors should be published, and thereby disclosed to readers, are usually straightforward. Although editors are willing to discuss disclosure of specific financial information with authors, JAMA's policy is one of complete disclosure of all relevant financial interests.

“This policy applies for all manuscript submissions, including letters to the editor and book reviews.”

Could these instructions have been any clearer? In case there is still a question, the JAMA website also contains a link to the JAMA Authorship Form that physician/authors are required to sign. It is titled: “JAMA Authorship Responsibility, Financial Disclosure, Copyright Transfer, and Acknowledgement.”

So, why was JAMA caught in this “web of deceit” in the first place?

I believe that part of the reason is that JAMA has relied on its physician/authors to come forward and reveal their financial ties on their own. Obviously, according to JAMA policy, which was clearly stated in writing years before these two widely publicized incidents, physician/authors must disclose all financial ties. But it seems like it has been up to them to choose whether or not their financial ties conflict.

Dr. Lee Cohen’s statements, as well as those of Dr. Tobias Kurth, following the well publicized disclosures of their financial ties and the ties of their co-authors, show that perhaps physicians with ties to pharmaceutical companies are not the best judges of what constitutes a relevant financial tie.

In Part 1 of this series, I pointed out that, in their letter to the editor, published in JAMA one week after having been “caught” by the Wall Street Journal, Dr. Cohen and his co-authors stated firmly that “we do not view those associations as relevant to this study.”  Apparently, the Wall Street Journal, the Associated Press and Dr. DeAngelis disagreed.

These, by the way, are the financial ties which Dr. Cohen did not consider relevant. They were published in JAMA after the exposé was published.

"Dr. Cohen reports having received grant support from AstraZeneca Pharmaceuticals, Berlex Laboratories, Eli Lilly, Forest, GlaxoSmithKline, Janssen Pharmaceuticals, Sepracor, and Wyeth-Ayerst; consulting for Eli Lilly, GlaxoSmithKline, Janssen, Ortho-McNeil Pharmaceuticals, Novartis Pharmaceuticals, and Wyeth-Ayerst; and serving on the speakers bureau of AstraZeneca, Berlex, Eli Lilly, Forest, GlaxoSmithKline, Janssen, Pfizer, and Wyeth-Ayerst."

In the New York Times article, mentioned above, Dr. DeAngelis is quoted as saying that she gets 6,000 submissions a year with an average of six authors each, and she therefore cannot check them all. “I’m not the FBI,” she points out.

My Suggestion: Perhaps it is time that JAMA hired researchers, whose main job would be to track down potential financial ties so that damage control doesn't become the publication's modus operandi. There are also websites, such as the Integrity In Science website, which would have revealed that Dr. Cohen, indeed, had some financial ties.

There are also excellent researchers out there, who are adept at tracking down these kinds of financial ties. For instance, Merrill Goozner, whose website I cited in Part 1 of this article, would be an excellent resource for JAMA to consult. Mr. Goozner was quoted in the Wall Street Journal exposé as stating that, in his position as Director of the Integrity in Science project at the Center for Science in the Public Interest, he had publicly exposed this problem of non-disclosure in medical journals. In fact, he had warned that “JAMA’s non-disclosure rate was the highest.” I stated in Part 1 of this article, “His warnings were not heeded. JAMA did not tighten its rules.”

It turns out that I was wrong: JAMA did tighten its rules, but some physicians either ignored them, or failed to heed them.

So, could it be that JAMA and the AMA are just too large and fragmented to handle the job alone?

Dr. DeAngelis made a very telling point in her WTTW interview, when she talked about the disconnect in the pharmaceutical companies between the marketing and research arms. She asserted that there’s nothing wrong with physicians being paid for honest work: for research, for consultation, for time expended in studying and developing drugs. Then she added: “And the scientists who work for the pharmaceutical companies are wonderful. They are outstanding scientists. But there are two sides to the pharmaceutical company. There’s the scientific side and then there’s the marketing side.” This is when a light went on for me: “And about a decade or so ago, something seemed to have happened in the pharmaceutical companies and that is that they seemed to go from really putting an emphasis on the science part and put it on the marketing part.”

Is this also what happened at the AMA, with its publicity department’s proactive marketing of JAMA’s articles/studies? And is it possible that Dr. DeAngelis is not aware of the vigor with which this marketing is carried out -- which, according to my research, may have contributed to JAMA getting “caught” by the Wall Street Journal? (Please see Part 2 of this series, where I discuss JAMA’s use of press releases and video news releases to publicize the two studies whose physician/authors were discovered to have ties to the pharmaceutical industry.)

As the WTTW television interview ended, another telling moment occurred, when Carol Marin quoted the New York Times article, with “it has been said that ‘the sharks are circling Dr. DeAngelis, because she advocates forcing authors of journal articles to disclose every penny that they make.’” Then Ms. Marin said, “And you are causing a lot of waves and meeting a significant amount of resistance. . And people who want to shop an article, let’s say I want to promote my research, maybe I won’t got to JAMA.”

This was followed, almost prophetically, by Ms. Marin’s assertion that, perhaps, since JAMA’s requirements are so tough, some physician/authors may say to themselves: “Maybe I’ll go to this journal with lesser standards, or maybe I’ll put out a video news release and see if TV stations will take it.”

I watched Dr. DeAngelis’ face, which was on camera as these words were spoken, and I played the tape over several times. There was not a flicker of recognition or embarrassment as the words “video news release” were spoken.

I may be naïve, but my gut feeling is that, ironically, Dr. DeAngelis may not have known that this kind of marketing was going on in her very own backyard – complete with slick VNRs publicizing those controversial article/studies; that, just as with the pharmaceutical companies, one branch simply does not know what the other is doing.

Can this possibly be?

Part 1: The JAMA Controversy: Arrogance and Stupidity, Part 2: How JAMA Publicized Its Two Controversial Articles/Studies

Medical Advocates of the 1920s: Julia and Morris Turitz

I never knew my Grandma Julia, after whom I was named, because she died several years before I was born. But, to this day, my grandmother inspires me with admiration and awe, especially because of the way she and my grandfather handled her cancer diagnosis in 1928, when my mother was just 11 years old.

Grandma Julia had been sick for a year. The New York doctors had been treating her for ulcers, but she continued to get worse. She went alone to the Battle Creek Sanitarium, in Michigan, where she was diagnosed with colon cancer. Rather than being operated on there, she “ran away” to the Mayo Clinic in Rochester, Minnesota, where my grandfather joined her. The Mayo Clinic was famous, even then, for being able to diagnose and treat the “difficult cases.”

It was Dr. Charles Mayo – the Charles Mayo – who opened her up, closed her up, and gave my grandfather the bad news: my grandmother would be dead in 6 months.

But my grandfather, Morris Turitz (worth a story in himself), was not one to give up. He was one of the founders of the socialist Yiddish newspaper, the Jewish Daily Forward. It was his “bible.”

In those days, The Forward carried many columns, one by a Dr. Chleminitsky, from Vienna, who wrote about all sorts of health problems. His aim was to educate the recent immigrants to the US. 

One of Dr. Chleminitsky’s columns told of a cancer treatment in Frankfurt-am-Main. My grandfather telegraphed; the reply was hopeful, so my grandmother -- accompanied by my uncle Marko, who spoke German fluently -- took the next boat to Germany. (Remember, this was before airplanes! It was also before Hitler; so Jews could safely travel to Germany.)

In Germany, my grandmother was treated for 6 months, with a combination of ex-ray (radiation) and oxygen (96%) and carbon dioxide (4%). When she came home, my mom tells me that Grandma Julia looked better than she had ever seen her look. Her cancer was in remission, where (with some follow-up treatments) it stayed for several more years.

When Grandma Julia returned to her New York doctors, they were puzzled and embarrassed. They submitted her to examination by many, many doctors – including some from the Rockefeller Institute and Mt. Sinai Hospital, to name two. All the doctors were shocked; several said she never had cancer at all!

When Grandma Julia died in 1939, my mom was 22 years old, having finished college and graduate school. She was out on her own, working. Quite a different story from if she had been left motherless at eleven!

Every year, after her return home, my grandmother sent Dr. Charles Mayo a New Year’s card and he acknowledged it. She outlived him by a few months.

MY COMMENT:

I love hearing my mom tell this story. She is now nearly 90, lives a healthy life and takes as few pharmaceuticals as possible. But every time she tells this story, I want to comment that, yes, it is amazing to me that my grandparents had such “chutzpah” and such “sechel” (wisdom) way back then. And yes, it is remarkable that the Modern German Medicine of the late 1920s gave my Grandma Julia eleven precious extra years of life.

But I always want to add that it is also amazing to me (and not in a good way!) that the treatment that saved my grandmother nearly 80 years ago – radiation – is one of the very same treatments oncologists still use on their patients today.

How far has “Modern Medicine” really come?

Medicine in the "Good Old Days"

My dad, Dr. Lou Schopick, always thought of himself as a salt-of-the-earth kind of guy. In a French restaurant, he would ask the waiter for "beef stew.” (My Mom, who spoke French, would hint that he might want to say it the French way: boeuf bourguignon.)

 

His language was also pretty salty, especially when talking about his fellow doctors, whom he didn't always admire. Since he was our Dad -- and to us, NOT the wonderful doctor his patients adored -- I didn’t always listen to the things he said about the medical profession. Now, I wish I had listened.

 

It was the 1950s and 1960s, known now as the “Good Old Days,” and the era of medical specialization was just beginning. He told me that his fellow doctors used to make fun of him for opting NOT to choose a specialty. He loved general medicine, with its patient contact. He loved his patients. But his colleagues said he was a fool not to cash in where the “big money” was.

 

But from what he could see, specialists left much to be desired. He was convinced that they were too narrowly focused, and therefore, couldn't diagnose some of the simplest conditions. In fact, he was proud when the “big shots” would consult him about their difficult-to-diagnose patients, and he would come up with the correct diagnoses.

 

As an aside, watching Marcus Welby, MD on television with my dad always turned into a race -– between Dr. Welby and my dad, to reach the correct diagnosis. My dad always won.

 

But he wasn’t a big fan of specialists for another reason: They didn’t look at the patient as a whole person. “One day,” he'd say, with more than a hint of disdain in his voice, “there’ll be a doctor of the big toe.”

 

I hate to admit it, but his prediction has almost come to pass.

 

Sometimes my Dad’s criticisms of the medical system went too far -- or so we thought. One day, extremely discouraged with his profession, he told me: “I’ve seen surgeries performed on patients who didn’t need them, simply because the doctor wanted a new house [substitute ‘boat’ or ‘expensive car’].” He seemed very disheartened. I was a teenager, and thought he might have been kidding. Now, 40+ years later, I know he was quite serious.

 

I wish he were still here, so I could tell him I understand.

 

One day, he said, “Someone, or a group of someones, will come along to rein these guys in.” (When my Dad was angry, he used a stronger word to describe his colleagues than "these guys." It started with a “b.”). “But those ‘someones,’” he told me, “will be worse than the doctors they’ll be reining in.”

 

My Dad foresaw Managed Care.

 

Now, whenever I hear of terrible things happening to patients at the hands of uncaring or incompetent doctors, or when I experienced these things firsthand while advocating for my husband between his brain tumor diagnosis in 1990 until his death in 2005, I think of my Dad.

 

I wish I could tell him that now I understand what he was trying to tell us.          

 

INTRODUCING JAMA 3-Part Series

My website -- Honest Medicine: My Dream for the Future -- now features a special three-part series, entitled “The JAMA Controversy.”

Part 1: Arrogance AND Stupidity?

Part 2: How JAMA Publicized Its Two Controversial Articles/Studies

Part 3: A Very Important Postscript

It seems that the prestigious Journal of the American Medical Association, known as JAMA, has recently been caught in a web of deceit. Three times in the last 6 months, JAMA published articles reporting on studies whose physician authors did NOT report significant financial ties to pharmaceutical companies.

JAMA’s editor in chief responded by saying that the journal was taken in by these physician authors and that, in the future, there would be stricter author guidelines.

For their parts, the authors said that they saw no reason why they should have revealed their financial ties. In fact, they flatly denied that their financial associations with the pharmaceutical companies constituted any conflict of interest at all!

In this 3-part series, I reveal information that is not normally known about how medical news is made -- actual “inside information.” Readers will see, through these three articles, what the media DID and DID NOT know about the stories they reported on.

Was JAMA duped by its physician/authors? Should the JAMA staff have been better detectives? Or was the media actually duped by the AMA?

I hope you will agree that this three-part series answers these questions, and more, and that the information I reveal is eye-opening and thought-provoking.

Summer Campers on Drugs

In case you missed it, The New York Times ran a most peculiar story on Saturday, July 16th: “Checklist for Camp: Bug Spray. Sunscreen. Pills.” Since the article can only be accessed now on a for-pay basis, I will quote liberally from it here.

Checklist for Camp’s tone is light and breezy:

"BURLINGHAM, N.Y., July 15 — The breakfast buffet at Camp Echo starts at a picnic table covered in gingham-patterned oil cloth. Here, children jostle for their morning medications: Zoloft for depression, Abilify for bipolar disorder, Guanfacine for twitchy eyes and a host of medications for attention deficit disorder.

"A quick gulp of water, a greeting from the nurse, and the youngsters move on to the next table for orange juice, Special K and chocolate chip pancakes. The dispensing of pills and pancakes is over in minutes, all part of a typical day at a typical sleep-away camp in the Catskills."