Hal Roseman responds
I am Hal Roseman, one of the physicians mentioned in the article ("Pharm League," Dec. 2). Having been misrepresented by the Scene's report, I feel obligated to offer a written response. On the face of it, the Scene article and the ProPublica article from which the Scene article is copied seem reasonable. Pictured is a physician cheering on their Big Pharma benefactor. The message is clear — yet again, another large corporation buying influence through a lecture program led by clinical, community-based physicians "with no published work and few academic associations to burnish their curriculum vitae." But when you start looking at the substance of the article, the report falls short in fully demonstrating that the relationship between industry and physicians, or for that matter, large institutions (such as Vanderbilt Medical Center, which receives an estimated $250 million dollars in grants) causes harm. The inferences are well-projected, telescoped, and predictable, but actual damages not identified. The implication underlying this article is that money buys influence, but does it? I know of no studies that have demonstrated adverse effects from the educational programs provided by Big Pharma. In fact, I suspect because of fair balance requirements built in to the lecture format, health care providers that attend such conferences are better knowledgeable about and avoid inappropriate usage of medications.
To begin with, it should be emphasized that when the reporter first approached me, I requested evidence that the reporter was knowledgeable of the subject matter and that he would approach the subject in a fair-balanced manner. He failed to respond to my lengthy questionnaire. When I asked for proof from the reporter of his unbiased perspective, he offered this response in writing: "It's not that I'm avoiding your questions; I'm simply not interested in the hardships the industry faces when attempting to bring a drug to market. They made $300 billion last year. In 2004 they spent more than 24 percent of their budgets on marketing and only 13 percent on R & D. They seem to be doing fine to me. And if the way they spend money is any indication, they seem more interested in marketing than they are in developing new drugs and bringing them to market." The reporter was obviously prejudiced against the pharmaceutical industry before he even wrote the story, which may explain his single-sided approach expressed in the article.
As in my own case, I became a lecturer because I wanted to be in a situation to influence health care practice. ... My relationship with the pharmaceutical industry has had many benefits. I am a more fully informed physician as result of the many conferences and symposia, which I have attended, and access to the latest research, which is only possible through industry's largesse. I am rewarded with latest insights of disease pathophysiology and new potential targets for pharmaceutical intervention. I have become a better practicing physician as a result of this relationship with industry. ...
As it relates to the issues of profits, the reporter failed to take into account that the pharmaceutical industry is part of our capitalistic system. Is the reporter insinuating that profits made by an industry are unjust; in the case of the pharmaceutical industry, the profits are the engine that drives innovation and drug research for the world. Most of the pharmaceutical companies offer answers to the charges that the marketing budgets are excessive and their R&D efforts are low relative to their profits. The website of two large pharmaceutical companies, GSK and Lilly, offers responses: us.gsk.com/html/healthcare/healthcare-common-questions.html and www.lilly.com/research/value/. None of this was mentioned when the reporter was actively discrediting the industry. Not fair-balanced reporting, just grandstanding! ...
Journalism needs to be fair-balanced and credible. Unfortunately, although the reporter brings up several valid concerns and raises important issues, the report fails to offer any new information or insights, merely inferences, implied accusations, and in some cases misanalysis. The sensationalism, rather than even-handed reporting, appeared to have won out in the writing of this article. When I asked the reporter whether there was an editorial board governing his actions, he indicated no to the question. Given the article's mishandling of some of the issues, maybe the Scene should institute one.
Hal Roseman, MD, MPH, FACC, FACP
Nashville
(Dr. Roseman's entire response can be read in the comments thread to Hargrove's story on www.nashvillescene.com.)
A response to Roseman's response
Actually, Hargrove's article is both fair and accurate, in stark contrast to Dr. Roseman's unwarranted attack on a journalist ("Pharm League," Dec. 2). Regarding the cardiovascular effects of Avandia, a small absolute increase in risk in people with diabetes — not a rare disease — translates to a large number of drug-induced heart attacks and deaths, especially when diabetics already have a higher risk of cardiovascular disease. Sure, Avandia lowers blood sugar, and if it were the only drug that did so, its use just might be justified. But the goal of diabetes treatment is to prevent long-term complications, including cardiovascular disease, kidney disease, and blindness. Why should someone with a disease that increases cardiovascular risk take a drug that increases cardiovascular risk when many other safer drugs are available?
Adriane Fugh-Berman, MD
Washington, D.C.
