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WTTW-Television – August 7, 2006 interview
> CAROL MARIN: IF YOUR DOCTOR IS GETTING FEES FROM A DRUG COMPANY, SHOULD HE OR SHE TELL YOU ABOUT THAT?
IF A SCIENTIST WRITES A PAPER ON A NEW MEDICAL TREATMENT BUT IS GETTING RESEARCH FUNDING FROM THE DEVELOPER OF THAT TREATMENT, SHOULD YOU KNOW?
THE ANSWER IS AN UNEQUIVOCABLE YES FROM THE EDITOR OF JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION. ANDTHE FIRST WOMAN TO HOLD THAT POSITION IS OUTSPOKEN AND QUITE WILLING TO BE QUITE CONTROVERSIAL.
SHE IS DR. CATHERINE DEANGELIS AND WE WELCOME HER TO CHICAGO TONIGHT.
DR. DEANGELIS, YOU ARE MAKING WAVES ALL OVER THE PLACE, INCLUDING TODAY ON THE JAMA WEB SITE, YOU HAVE AN EDITORIAL ON THE INFLUENCE OF MONEY IN MEDICAL SCIENCE AND IN IT, YOU TALK ABOUT DEALING WITH AUTHORS OF IMPORTANT SCIENTIFIC ARTICLES IN YOUR PUBLICATION WHO HAVE FAILED TO DISCLOSE TO YOU OR TO YOUR READERS THAT THEY ARE ON SOMEBODY'S PAYROLL. WHAT IS GOING ON HERE?
> DR. CATHERINE D. DEANGELIS: WELL, I THINK COMPLETE HONESTY IS THE RULE OF THE DAY.
I’D LIKE TO BE VERY CLEAR THAT I THINK FOR-PROFIT COMPANIES, THE PHARMACEUTICAL COMPANIES, THE DEVICE COMPANIES ARE ABSOLUTELY ESSENTIAL.
THEY DO MOST OF THE CLINICAL RESEARCH IN THIS COUNTRY AND PAY FOR IT AND THAT'S FINE.
THEY ALSO ARE RESPONSIBLE FOR THE DEVELOPING, AND THAT'S FINE.
SO THEY NEED ADVICE FROM PEOPLE, AND WHO BETTER THAN THE EXPERTS, MOST OF WHOM ARE ACADEMICIANS WHO END UP BEING AUTHORS.
THERE'S NOTHING WRONG WITH LEGITIMATELY RECEIVING FUNDS FOR DOING RESEARCH.
THERE'S NOTHING WRONG WITH BEING REIMBURSED APPROPRIATELY FOR YOUR CONSULTATION, YOUR TIME, YOUR ENERGY, YOUR KNOWLEDGE.
WHAT IS WRONG IS WHEN, FOR WHATEVER REASON, YOU FAIL TO DISCLOSE THIS TO PEOPLE.
MY QUESTION IS: WHY WOULD YOU WANT TO HIDE IT IF IT'S PERFECTLY LEGITIMATE?
> CAROL MARIN: ONE OF THE THINGS THAT HAS HAPPENED –AND YOU HAVE BEEN ON THIS CAMPAIGN SINCE YOU TOOK OVER.
> DR. CATHERINE D. DEANGELIS: YES, BEFORE.
> CAROL MARIN: BEFORE.
BUT CERTAINLY YOUR IMPACT HAS BEEN SERIOUSLY FELT AS THE EDITOR OF THIS. AND YET, AT THE SAME TIME, EVEN YOU HAVE NOT BEEN ABLE TO FIGURE IT OUT ALL THE TIME BEING RIGHT?
THERE'S BEEN SEVERAL THERE ARE TWO OR THREE CASES WHERE JAMA PUBLISHED SOMETHING AND ONLY LATER DID YOU FIND OUT THAT SOMEBODY WAS ON THE PAYROLL, WHAT DID YOU DO?
> DR. CATHERINE D. DEANGELIS: WELL, IT DEPENDED.
IF I THOUGHT IT WAS AN HONEST OR LEGITIMATE MISUNDERSTANDING – NOW, YOU’VE GOT TO REMEMBER, NOT EVERY JOURNAL REQUIRES DISCLOSURE.THAT'S ONE OF THE BIG PROBLEMS.
SO AN AUTHOR MAY ROUTINELY SEND MANUSCRIPTS OR STUDIES TO FIVE OR SIX OR TEN JOURNALS, ONLY SOME OF WHICH REQUIRE DISCLOSURE.
> CAROL MARIN: LIKE THE NEW ENGLAND JOURNAL OF MEDICINE DOES, AS WELL.
> DR. CATHERINE D. DEANGELIS: RIGHT, THE NEW ENGLAND JOURNAL OF MEDICINE DOES, AND WE DO. BUT SOME OF THE OTHERS, ESPECIALLY THE SPECIALTY JOURNALS IN THEIR FIELDS DO NOT.
SO IN SOME CASES, I JUST SAID, WELL, YOU KNOW, IT'S OBVIOUS, WE ARE NOT AS CLEAR AS WE NEED TO BE.
SO WHAT WE DID SEVERAL MONTHS AGO, WAS TO REITERATE WHAT IT IS WE WANTED AND HOW SERIOUS WE WERE.
BECAUSE WE WON'T PUBLISH SOMETHING UNLESS THE AUTHORS SIGN AN AFFIDAVIT THAT THEY HAD NO NOTHING TO DISCLOSE THAT COULD BE MISCONSTRUED AS A CONFLICT OF INTEREST.
> CAROL MARIN: BUT YOU ALSO PUBLISHED THE DOCTOR WHO DIDN'T DISCLOSE BECAUSE ACCORDING TO THE "NEW YORK TIMES", SOMETHING I JUST READ, ONE DOCTOR CALLED YOU IN TEARS WHEN YOU DISCLOSED HIS OR HER FAILURE TO DISCLOSE.
DO THEY I MEAN, I REALIZE THAT DIFFERENT JOURNALS MAY HAVE DIFFERENT STANDARDS. BUT SERIOUSLY, THIS HAS BEEN A LONG DISCUSSION.
DO DOCTORS JUST NOT GET THIS?
> DR. CATHERINE D. DEANGELIS: WELL, APPARENTLY THEY DIDN'T. BUT I SURE HOPE THEY DO NOW BECAUSE I'M DEAD SERIOUS ABOUT IT.
I'M TIRED OF BEING ON THE OTHER END, WHERE I CAN DO SOMETHING.
AND SO WHAT I DID WAS IT JUST HAPPENED THAT THREE OF THOSE INCIDENCES WHICH I THOUGHT WERE NOT DELIBERATELY NONDISCLOSURE BECAUSE THEY HAD DISCLOSED IN OTHER PLACES. I CALLED THE DEAN AND THE DEAN AGREED WITH ME.
> CAROL MARIN: THE DEAN OF HARVARD?
> DR. CATHERINE D. DEANGELIS: THE DEAN OF HARVARDMEDICALSCHOOL.
> CAROL MARIN:BECAUSE THIS IS THE WEIRD THING, TOO. THESE WERE CREAM OF THE CROP DOCTORS.
THESE WERE NOT DUMMIES, OR PEOPLE WHO LIVED IN A CAVE.
> DR. CATHERINE D. DEANGELIS: OH, NO.
BUT THEY DIDN'T GET IT.
SO I GAVE THEM THE BENEFIT OF THE DOUBT BUT I SAID TO THE I PRETTY MUCH SAID TO THE DEAN, WHO ACTUALLY I KNOW VERY WELL.
I SAID, YOU KNOW, JOE, YOU’VE GOT TO DO SOMETHING WITH YOUR FACULTY BECAUSE THEY DON'T GET IT.
HE WAS VERY SERIOUS.
HE WAS VERY CONCERNED ABOUT IT, AND HE HAS 8,000 FACULTY MEMBERS.8,000.
SO HE’S GOT TO GET TO THEM.SO WHAT’S HE GOING TO DO?
HE SAID HE WAS GOING TO SEND A LETTER TO ALL 8,000 MEMBERS OF HIS FACULTY, WITH THE RULES AND REGULATIONS ABOUT WHAT HE REQUIRES. PLUS, HE WILL SEND THEM OUR EDITORIAL AND WHAT WE REQUIRE AND WHAT THE NEW ENGLAND JOURNAL OF MEDICINE REQUIRES.
> CAROL MARIN: DRUGS AND DEVICES MAKE A LOT OF MONEY.
AND COMPANIES INVEST A LOT OF MONEY TO DEVELOP THEM.
HOW MUCH INFLUENCE DO YOU BELIEVE A DRUG MAKER HAS TO HIRE YOU AS THE DOCTOR/RESEARCHER?
HOW MUCH INFLUENCE DO YOU THINK THEY HAVE IN WHAT I’M GOING TO KNOW ABOUT YOUR RESEARCH, OR WHAT YOU CAN REALLY RESEARCH?
> DR. CATHERINE D. DEANGELIS: IN SOME CASES, TOO MUCH.
> CAROL MARIN: LIKE WHAT?
> DR. CATHERINE D. DEANGELIS:WELL, IF THEY LEGITIMATELY PAY FOR THE RESEARCH TO BE DONE, THAT'S FINE. IF THEY LEGITIMATELY PAY FOR THE CONSULTATION, OR LEGITIMATELY PAY FOR THE TIME EXPENDED IN STUDYING THESE DRUGS OR IN DEVELOPING THEM, THAT'S FINE.
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.
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.
NOW, YOU CAN SEE
> CAROL MARIN: YOU CAN'T TURN ON THE TV AND NOT SEE VIOXX, VIAGRA, AND LEVITRA AND PITCHING ME THAT IF I HAVE A CHOLESTEROL PROBLEM OR SOME OTHER KIND OF PROBLEM, THAT THAT'S THE ONE I WANT.
> DR. CATHERINE D. DEANGELIS: EXACTLY.
> CAROL MARIN: IS THAT ETHICAL?
> DR. CATHERINE D. DEANGELIS: I CAN'T SAY IF IT'S ETHICAL OR NOT.
IF PEOPLE WANT TO BELIEVE THAT KIND OF AD, I WORRY ABOUT THEM. I MEAN, YOU SHOULD DISCUSS THAT WITH YOUR PHYSICIAN.
NOW WHAT HAPPENS IS THEY DEPEND ON THE PERSON GOING TO THE PHYSICIAN AND THEY EVEN OFFER A MONTH'S FREE SUPPLY.
YOU KNOW?
AND THEY GIVE FREE SUPPLIES TO THE PHYSICIANS.
> CAROL MARIN: THAT'S NOT ALL THEY GIVE FREE.
THE "NEW YORK TIMES" JUST RECENTLY DID AN ARTICLE ABOUT ALL THE FREE LUNCHES, EXOTIC, EXCELLENT, SUPERB CHINESE CUISINE AND OTHER KINDS OF DELICACIES THAT ARE BROUGHT IN FOR MEDICAL STUDENTS, THAT ARE BROUGHT IN FOR DOCTORS, THAT ARE BROUGHT INTOHOSPITALS.
HAVE YOU EVER HAD A FREE LUNCH?
> DR. CATHERINE D. DEANGELIS: THERE'S NO SUCH THING.
THERE'S NO SUCH THING AS A FREE LUNCH.
> CAROL MARIN: I COULDN'T GIVE YOU A SANDWICH IF I WAS A THE MERCK DRUG COMPANY REPRESENTATIVE?
> DR. CATHERINE D. DEANGELIS: I WOULDN'T TAKE IT. I WOULD POLITELY DECLINE IT.
I DON'T NEED THESANDWICH.
DO YOU THINK THE COMPANIES SPEND MILLIONS OF DOLLARS EVERY YEAR TO DO THIS IF THEY DIDN'T THINK THEY WERE GETTING SOMETHING OUT OF IT?
WHAT PERCENTAGE OF DOCTORS ARE LIKE YOU AND WHAT PERCENTAGE OF DOCTORS ARE PICKING UP SANDWICHES OR MUGS OR FREE VACATIONS OR LECTURE FEES?
> DR. CATHERINE D. DEANGELIS: I DON'T KNOW.
> CAROL MARIN: WHAT’S YOUR GUESS?
> DR. CATHERINE D. DEANGELIS: A SUBSTANTIAL PROPORTION.
AND I THINK IT'S PART OF THIS CULTURE THAT HAS DEVELOPED AND I DON'T UNDERSTAND IT.
PHYSICIANS MAKE A VERY DECENT LIVING.
WE CERTAINLY ARE IN THE TOP AT LEAST 10% OF WAGE EARNERS IN THIS COUNTRY.
AND WHY DO YOU NEED THIS EXTRA MONEY?
WHAT DO YOU NEED A PIZZA OR A CHINESE DINNER OR ANY OF THAT?
YOU DON'T NEED IT.
AND TO EXPECT IT, I THINK IS WRONG.
> CAROL MARIN:AT THE SAME TIME, I KNOW DOCTORS. ONE JUST RECENTLY TOLD ME THAT ON TOP OF THE COST OF MALPRACTICE INSURANCE, COMES HOW WELL MEDICAID OR MEDICARE REIMBURSE.
ONE DOCTOR TOLD ME RECENTLY WAS, FOR A WOMAN WHO IS IN HER 40S TO 50S, SHE MAY HAVE TROUBLE GETTING A NEW DOCTOR BECAUSE SHE'S GETTING TOO OLD AND THEY DON'T WANT TO PICK UP MEDICARE.
> DR. CATHERINE D. DEANGELIS: WELL, YES.
ONE OF THE PROBLEMS IS THAT THE ACTUAL REIMBURSEMENT IS MORE DIFFICULT.
THE CLINICAL REIMBURSEMENTS, I ONLY KNOW FROM THE ACADEMIC SIDE.
I KNOW THE FIGURES FOR THOSE.
I DON'T KNOW THE EXACT FIGURES FOR PEOPLE IN PRIVATE PRACTICE, BUT I ASSUME IT IS PRETTY MUCH THE SAME.
BUT YOU HAVE TO WORK MUCH, MUCH HARDER TO EARN THE SAME AMOUNT OF MONEY.
BUT STILL, THE AMOUNT YOU EARN IS PRETTY DECENT.
NOW, IT'S ALSO TRUE YOU WORK VERY LONG AND VERY HARD BEFORE YOU START EARNING.
I WAS 33 YEARS OLD BEFORE I WAS FINISHED WITH MY TRAINING AND STARTED EARNING SOME MONEY, OTHER THAN THE RESIDENCY WHICH IS NOT EXACTLY WELL PAID; ALTHOUGH, NOW IT'S MUCH BETTER PAID.
BUT THE PROBLEM IS, WE DON'T NEED IT!
SO THE ONLY MONEY THAT A PHYSICIAN OR A MEDICAL SCIENTIST SHOULD ACCEPT FROM A PHARMACEUTICAL COMPANY IS REIMBURSEMENT FOR DOING THE STUDIES, LEGITIMATE REIMBURSEMENT, LEGITIMATE REIMBURSEMENT FOR THE CONSULTATION, THE TIME, ENERGY, AND YOUR KNOWLEDGE THAT YOU GIVE TO THESE PEOPLE, AND NOTHING ELSE SHOULD BE PART OF WHY YOU GET IT.
YOU SHOULD NOT BE ON THE SPEAKER'S BUREAU, PAID BY THE COMPANY.
> CAROL MARIN: SO IF YOU ARE A PATIENT GOING INTO YOUR DOCTOR I MEAN, THAT'S REALLY YOUR MOST VULNERABLE TIME.
IT'S A REALLY DIFFICULT TIME TO SAY, WOULD YOU MIND TELLING ME WHAT ADDITIONAL INCOME YOU ARE PICKING UP?TRUTHFULLY, WHAT DOES A PATIENT DO TO MAKE SURE THAT THEY ARE NOT GETTING THE DRUGS BECAUSE THE DOCTOR IS ON THE PAYROLL OR NOT IN SOME WAY
> DR. CATHERINE D. DEANGELIS: IT'S NOT THAT THE DOCTORS ARE NECESSARILY ON THE PAYROLL.
FOR EXAMPLE, FREE SAMPLES.
A BIG CONTROVERSY.
BECAUSE ON THE ONE HAND, THE PHYSICIANS SAY I USE THESE FREE SAMPLES FOR PEOPLE WHO CAN'T AFFORD IT.
YES, BUT THOSE DRUGS, THE FREE SAMPLES ARE RELATIVELY NEW DRUGS, NEWLY INTRODUCED AND VERY EXPENSIVE.
WHERE SOMETHING I WILL GIVE YOU AN EXAMPLE.
I HAD SOMEONE WHO IS IN MY FAMILY, WHO NEEDS A SIMPLE DRUG FOR A MIGRAINE.
THE ONLY THING THAT WORKS FOR HER, CATROGOT. (??)
IT COSTS NOTHING.
SHE CAN'T GET IT.
BUT WHAT SHE CAN GET IS ANOTHER MEDICATION SHE NEEDED TWO DAY'S SUPPLY. SHE’S ON VACATION.
IT COST $44 A DAY FOR THIS NEW MEDICATION.
> CAROL MARIN: WHY CAN'T SHE GET THE CHEAP ONE?
> DR. CATHERINE D. DEANGELIS: THEY DON'T MAKE IT ANYMORE.
THEY DON'T STOCK IT. SHE CAN’T FIND IT.
I'M TRYING TO FIND IT FOR HER.
> CAROL MARIN: IT WAS SAID IN ONE THING I READ THAT THE SHARKS ARE CIRCLING DR. DEANGELIS, BECAUSE SHE ADVOCATES FORCING AUTHORS OF JOURNAL ARTICLES TO DISCLOSE EVERY PENNY THAT THEY MAKE AND YOU ARE CAUSING A LOT OF WAVES AND MEETING A SIGNIFICANT AMOUNT OF RESISTANCE, RIGHT?
AND PEOPLE WHO WANT TO SHOP AN ARTICLE, LET’S SAY I WANT TO PROMOTE MY RESEARCH, MAYBE I WON'T GO TO JAMA.
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.
ISN'T THAT THE ROAD THAT SOME COMPANIES ARE GOING?
> DR. CATHERINE D. DEANGELIS: I HAVE BEEN TOLD, AND SOME AUTHORS HAVE BEEN TOLD DON'T SUBMIT YOUR CLINICAL TRIAL, ESPECIALLY TO JAMA BECAUSE WE REQUIRE THAT IF THE STATISTICIAN WORKS FOR THE COMPANY, WE REQUIRE THAT A SEPARATE STUDY BE DONE BY A STATISTICIAN WHO IS AN ACADEMICIAN.
ONLY BECAUSE IF I HAVE A QUESTION, I CAN USE THE SAME KIND OF MECHANISM I’VE USED IN SEVERAL CASES WITH PEOPLE THAT I THOUGHT, AUTHORS WHO I THOUGHT WERE DELIBERATELY DISHONEST WITH ME.
I PICK UP THE PHONE, I CALL THE DEAN.
I DO WHAT I USED TO DO WHEN I WAS THE VICE DEAN AT HOPKINS.
THAT IS I ASK FOR AN INVESTIGATION. AND I’VE RECEIVED IT.
> CAROL MARIN: DO YOU THINK THAT YOU ARE LONG FOR THIS WORLD AS EDITOR OF JAMA?
OR DO YOU THINK THERE'S GOING TO BE PRESSURE TO GET RID OF YOU?
> DR. CATHERINE D. DEANGELIS: I DON'T THINK SO. THE BOARD OF TRUSTEES HAVE BEEN WONDERFUL.
> CAROL MARIN: ARE YOU HAVING SUCCESS?
DO YOU THINK THAT THIS BATTLESHIP IS BEGINNING TO TURN AROUND IN THE WATER, THAT YOU ARE BEGINNING TO SEE A CHANGE IN THIS REGARD?
> DR. CATHERINE D. DEANGELIS: WELL, IT'S A LITTLE EARLY, BUT I CAN TELL YOU TODAY, I HAD AN EMAIL FROM A VERY HIGH PRIORITY, VERY WELLKNOWN WESTCOASTMEDICALSCHOOL, WHERE THEY ARE GOING TO CHANGE THEIR RULES.
AND THEY ASKED ME IF I WOULD ANSWER SEVEN QUESTIONS THAT THEY COULD SHARE WITH THEIR FACULTY.
> CAROL MARIN:SO FACULTY NOW MIGHT BE GOING IN TO THEIR PATIENTS AND SAYING BY WAY OF FULL DISCLOSURE, THESE ARE THE PAYROLLS I'M ON OR THIS IS THE CONSULTING THAT I DO?
> DR. CATHERINE D. DEANGELIS: I DON'T KNOW WHAT THE RULES ARE BECAUSE I DIDN'T RECEIVE IT, BUT I WOULD HOPE THAT, FIRST OF ALL, PHYSICIANS WOULD NOT ACCEPT THESE UNNECESSARY GIFTS, THAT THEY WOULD ACCEPT ONLY WHAT IS LEGITIMATELY THEIRS TO EXPECT.
AND IF PHYSICIANS DO THAT AND IF MEDICAL SCIENTISTS DO THAT, WE WILL BE IN GREAT SHAPE.
I DON'T KNOW IF PEOPLE ARE LYING TO ME.
I HAVE MD AFTER MY NAME, NOT M-DEITY.
SO I CANNOT ASCERTAIN WHAT PEOPLE ARE THINKING OR WHAT'S IN THEIR HEART.
BUT I CAN TELL YOU THAT I CAN SMELL A RAT WHEN I SEE ONE, OR WHEN I SMELL ONE, I SHOULD SAY.
> CAROL MARIN: GOOD LUCK TO YOU, DR. DEANGELIS, BECAUSE I THINK YOU ARE ON A GREAT CRUSADE.
WE HOPE YOU HAVE GREAT SUCCESS.
> DR. CATHERINE D. DEANGELIS: THANK YOU VERY MUCH.
> CAROL MARIN: AND YOU CAN FIND A LINK TO DR. DEANGELIS'S EDITORIAL, “THE INFLUENCE OF MONEYON MEDICAL SCIENCE,” ON OUR WEB SITE, WTTW.COM AND CLICKONCHICAGO TONIGHT. YOU’LL BE ABLE TO READ IT, IF YOU WANT TO.
PHIL, WE GO BACK TO YOU.
> PHIL PONCE: THANKS, CAROL.