As The FTC Goes After Bloggers, Doctors Making Millions Promoting Drugs With Little Oversight

from the feeling-healthy-yet? dept

Clay Shirky points us to a column from a few months back by Marcia Angell, which explains why clinical research on drugs isn't even remotely trustworthy, as it all-too-often seems to involve doctors who have serious conflicts:

Or consider Dr. Alan F. Schatzberg, chair of Stanford's psychiatry department and president-elect of the American Psychiatric Association. Senator Grassley found that Schatzberg controlled more than $6 million worth of stock in Corcept Therapeutics, a company he cofounded that is testing mifepristone--the abortion drug otherwise known as RU-486--as a treatment for psychotic depression. At the same time, Schatzberg was the principal investigator on a National Institute of Mental Health grant that included research on mifepristone for this use and he was coauthor of three papers on the subject.

Angell notes that this is pretty common:

Indeed, most doctors take money or gifts from drug companies in one way or another. Many are paid consultants, speakers at company-sponsored meetings, ghost-authors of papers written by drug companies or their agents, and ostensible "researchers" whose contribution often consists merely of putting their patients on a drug and transmitting some token information to the company.

And as the relationship between doctors and pharma has gotten deeper and deeper, it means that the results of those all important "clinical trials" -- which the pharma supporters always insist are so important -- are highly suspect:

Because drug companies insist as a condition of providing funding that they be intimately involved in all aspects of the research they sponsor, they can easily introduce bias in order to make their drugs look better and safer than they are. Before the 1980s, they generally gave faculty investigators total responsibility for the conduct of the work, but now company employees or their agents often design the studies, perform the analysis, write the papers, and decide whether and in what form to publish the results. Sometimes the medical faculty who serve as investigators are little more than hired hands, supplying patients and collecting data according to instructions from the company.

In view of this control and the conflicts of interest that permeate the enterprise, it is not surprising that industry-sponsored trials published in medical journals consistently favor sponsors' drugs--largely because negative results are not published, positive results are repeatedly published in slightly different forms, and a positive spin is put on even negative results. A review of seventy-four clinical trials of antidepressants, for example, found that thirty-seven of thirty-eight positive studies were published. But of the thirty-six negative studies, thirty-three were either not published or published in a form that conveyed a positive outcome. It is not unusual for a published paper to shift the focus from the drug's intended effect to a secondary effect that seems more favorable.

And yet the FTC is more worried about a mommy blogger recommending a book that a publisher sent her for free?

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Doctors In Tennessee Have Been Faxing Patient Info To The Wrong Place For Years

from the that-seems-bad dept

Live in Tennessee? Thought the records at your doctor's office were private? You might want to check again. Michael Scott alerts us to the news that a bunch of doctors offices in Tennessee have been accidentally faxing patient records, including confidential info, to a small solar company in Indiana... for three years. Luckily, the guy on the receiving end says he's been shredding the records as they come in, but he's getting pretty damn frustrated. He's contacted tons of people, including the Governor of Tennessee, but no luck. The faxes keep coming. Apparently, the problem is that the phone number of the business is close to the one that doctors are supposed to use. Given the number of faxes, my guess is that it's not so much people mistyping it into their fax machines each time, but at some point there must have been a typo in a mailing or on a website or something. Of course, we won't even get started on why these record transfers are still handled by fax. That's another post for another day...

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Perhaps Brain Surgeons Do Use Wikipedia...

from the brain-surgery? dept

I have a good friend who's a surgeon at a big, well-known hospital. Not so long ago, he told me that he'd often use Google to look up details on a surgery he was about to perform, as it was often a great way to remind him of certain things, or even to reacquaint himself with a few important points for the surgery. He thought it was silly that doctors bashed such things, as it wasn't like all of his medical training and surgical experience and knowledge went out the window by reading up on things online. It reminded me of one of the typical complaints against Wikipedia: that you wouldn't want your brain surgery conducted by the crowd reading Wikipedia, but by a surgeon trained at a medical school. That, of course is a silly strawman, since (a) you wouldn't want someone to conduct brain surgery if they learned about it solely from any written source, rather than going to medical school and (b) it assumed that of all the people looking at and editing Wikipedia, none of them were brain surgeons themselves.

I'm thinking of this, as I see this story noting that 50% of doctors admit to doing research on Wikipedia. I'd guess a few of them are even brain surgeons. So can we get rid of this stupid claim that Wikipedia isn't trustworthy? The studies mentioned in the article found that medical info on Wikipedia has a very high level of accuracy. No, no one's learning brain surgery from Wikipedia, but to pretend its not a useful resource among many others is simply ignoring reality.

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Doctors Concerned About The Patenting Of Basic Science

from the seems-like-a-pretty-serious-problem dept

Joe Mullin has another excellent article looking at an important ongoing patent lawsuit, Prometheus Laboratories v. Mayo Collaborative Services, which looks at whether or not certain medical tests can be patented. As Mullin notes, it's a situation where patent system believers find themselves diametrically opposed to doctors, who feel patents on such things are a serious problem and harming patient health. Once again, what you see is a single entity trying to block out competition in an effort to gain monopoly rents, even if people are harmed in the process by not being able to get or afford important medical tests. And the biggest concern (especially among medical professionals) is the idea that you can patent counting something that occurs in nature:

"The patents are based on observations of the laws of nature," says David Herbert, chief administrative officer for Mayo Medical Laboratories. "We chose to make a stand." Such "observational" patents increase costs, slow innovation, and worsen patient care, he says. "It doesn't allow the test to be performed close to the bedside, and there's no ability to have second opinions."

The lawsuit is in the appeals court right now -- with a current ruling that the patents aren't valid for merely observing nature, though an earlier summary judgment found the other way. Still, this isn't just some random discussion on patents and copying. Lives are at stake, and doctors are pissed off at the ridiculousness of the situation:

"Physicians have longstanding obligations to advance and share useful medical knowledge with patients and physicians." Patents on basic scientific principles "threaten to stifle innovation and raise the costs of medical treatment." And claiming exclusive rights to "scientific facts," such as the correlation that Prometheus purports to own, actually harms research and personalized medicine rather than helping it, the doctors argue.

Hopefully the court realizes how dangerous such patents are for society (beyond just being ridiculous) and rejects them.

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Using The DMCA To Stop Patients From Rating Their Doctors

from the signing-over-your-rights dept

Last month, Carlo wrote about how a number of doctors were pushing their patients to sign waivers, promising that they wouldn't review the doctors online -- and that one company would go around trying to enforce these waivers and get critical comments pulled down from ratings sites like RateMyMD.com. The whole thing seemed quite odd -- but in another article about the service (found via Michael Scott), the details make it clear that this is even more questionable than we previously thought. That's because the way the "waivers" from the company "Medical Justice" work is by having the patient "assign all intellectual property rights for anything the patient may write (and publish) about the physician to the physician." Then, the physician can claim copyright infringement on any review, and force it offline. So unlike what was implied in the original article, it wouldn't be a specific contractual issue, but a copyright issue.

This is not what copyright law was intended to do.

Of course, it does bring up a few interesting points of discussion. First, is that the main purpose of using copyright here is so that the doctors can make use of the DMCA's notice-and-takedown safe harbor provisions, rather than be stymied by the similar (but not quite the same) CDA section 230 safe harbors for things like defamation. One of the key differences between the two is that Section 230 doesn't have a notice-and-takedown provision (though some have been trying to add one). So, really, all this is designed to do is figure out a way to shift the critical rules in question from the CDA to the DMCA. Sneaky!

Second, is that I wonder if this would be seen as actual copyright infringement anyway, or if reviewers could make a credible fair use defense. In some cases, the review itself might not even be covered by copyright (i.e., if there's no creative expression in it -- such as simple "he's awful!" reviews). In other cases where copyright might exist, the four factor fair use test might allow its use. While it could hurt the doctor's ability to make money as a doctor, it wouldn't be harming the market for the copyrighted content. Also, the use would be for purposes of "criticism." So, it's difficult to see how such content posted on a review site would actually violate anyone's copyright, even if the rights really were signed over.

But... (and this is where that sneaky first part comes into play), this might not matter. Even though you can get in trouble for filing a false DMCA notification (and even for failing to take fair use into account), most online services will quickly pull down content when receiving a DMCA takedown to preserve their safe harbor protections. So in almost all cases, the content will get pulled down, even if the content isn't really infringing. And, then it seems quite unlikely that any reviewer/patient will find it worth the trouble of filing a counternotice.

So, really, this is a fascinating misuse of the DMCA that will live on (unless someone like the EFF decides to make an example of it). What it really highlights is one of the many problems with the DMCA's notice-and-takedown provision, which heavily incentivizes service providers to pull down content as quickly as possible. As a result of that, companies like Medical Justice have tremendous incentives to come up with a plan like this to shift what they do to a copyright issue, solely to make use of the notice-and-takedown provision, even in cases where there's no actual infringement of the copyright.

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Doctor's Orders: Don't Review Me Online

from the stifling dept

The local review site Yelp has been under fire lately from some businesses that aren't happy with reviews people have written about them, or how they're displayed on the site. Not that this is anything new: people have sued the site for defamation before, while others have tried to game the system to make their businesses look more popular. But now, some doctors are trying to get patients to sign waivers saying they won't post comments about their doctors online (via Information Week). A company has set up a service that provides doctors with the waivers, then monitors review sites for comments about them. If they find a comment on one of the subscribing doctors, they attempt to use the waivers to get the sites to remove it. Of course, most of the comments are anonymous, so it's not clear exactly how they link a particular comment to a particular patient who's signed a waiver, and at least one site has refused to comply.

The founder of the service says the only thing that should matter to patients are a doctor's medical skills -- but that hardly seems true. Certainly they play a large role in determining a patient's happiness with their care, but there's the oft-referred-to "bedside manner" that also plays key part. Consumers have the right to as much information about their medical caregivers as they need to feel comfortable, but it can often be difficult to ascertain. That seems to play into doctors' hands, so it's hard to see these attempts to gag patients as little more than a further attempt to stifle anything that challenges the status quo in the world of medicine.

Carlo Longino is an expert at the Insight Community. To get insight and analysis from Carlo Longino and other experts on challenges your company faces, click here.

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ER Doctors Warn About Walking While Texting; When Will We Start Seeing Laws?

from the they're-coming dept

Anyone want to take a guess on when we'll see the first laws proposed to ban the practice of walking-while-texting? We've already seen a few proposals that would ban walking and talking in a crosswalk. And, to add some fuel to the fire, some ER doctors are warning people who walk and text at the same time that it's risky behavior. The doctors say they're seeing a rise in reports of people walking and texting at the same time, leading to some sort of injury, including two people who were hit by a car after paying more attention to their phone than oncoming traffic. Since technopanics always seem to start with a news article, just wait for someone to propose a law against this -- rather than insisting that perhaps it's time to institute a little common sense. Update: Apparently, I'm too late. At least one state has already proposed just such a law.

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Why Do Doctors Still Write Prescriptions (Illegibly) When They Can Type Them?

from the seems-simple-enough dept

Reuters is running an article talking about how folks in India are urging doctors to stop writing prescriptions so illegibly, as it all too often leads to filling the wrong prescription (even to the point of putting someone's life at risk). However, this is hardly just an Indian issue, as the same thing happens in the US as well. In an age where more and more doctors' offices are computerized, it simply doesn't make any sense not to offer computerized prescriptions that accurately display the drug in question (including, perhaps, questions or warnings about possible conflicts or side effects). The fact that it may save a few seconds for a doctor to scribble hardly seems like a reasonable excuse when people's lives are on the line and it's part of the doctor's job to do whatever possible to keep them healthy.

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Canadian Doctors: Let Us Drive While Talking On Mobile Phones!

from the it-saves-patients dept

Bans on using mobile phones while driving are pretty common these days, so there's not much to talk about in hearing about another such ban. However, up in Calgary, some folks are fighting back against such a ban. The Calgary Health Region has banned staff from driving while talking on a phone, but doctors are arguing against the ban, saying they rely on pagers and mobile phones to respond to emergencies -- and that banning the use of mobile devices while driving could put patients at risk. Of course, that leaves out the potential of putting other drivers on the road at risk -- but at least a doctor would be present following any such accident (for the sarcasm impaired, that's a joke). Still, given all the calls for banning driving-while-yakking for safety's sake, it's amusing to see doctors claim safety reasons for allowing the practice.

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The Doctr Is In

from the housecalls-by-IM dept

Back in the day, when you were sick, you would call the doctor, and they make a house call to diagnose your condition and provide care. In this modern age of managed care, where doctors are evaluated on the volume of patients that they are able to process, house calls are now but a distant memory. Now, Dr. Jay Parkinson, a Brooklyn doctor, brought the house call back -- but it's been updated for the times. Parkinson has started a new medical practice that centers around instant messenger, email and house calls. During regular business hours, he is available to his patients for online medical consultations. Dr. Parkinson then pays the patient a house call only if it is really necessary (you get two included house calls in the fee), but most issues can be addressed virtually. This is not surprising since studies confirm that online chat with your doctor is nearly as effective as an in-person visit. Specializing in young adults age 18 to 40 without traditional health insurance, this approach could teach a few things to the health care industry. Of course, what he's doing is really similar to what many nurse practitioners do, so you could see him scaling his practice by employing a staff of nurse practitioners who answer IMs and emails, and then escalating qualifying issues to doctors and specialists. A second interesting point about Parkinson's plan is that since all of his clients are very price conscious (since they're paying out of pocket), he actively shops around for the best value specialists to send his clients to. In the age of copayments and insurance, you very rarely see much price comparison shopping in health care. As we've discussed here before, the current health care system is beset with problems, so it's encouraging to see a differentiated spur some excitement (and competition) in a very homogeneous marketplace.

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