Conflicts of interest: Jack Abramoff and me

Dr. P's Pediatric Journal Club

Many of us are following the Abramoff case with a combination of horror and self-righteousness: Of course, I would never be corrupted by gifts and handouts if I were a congressman.

But are you really so sure? Are the congressmen who went down that slippery slope really all that different from you and me? After all, it's unlikely they entered Congress with the idea of influence-peddling for monetary gain. How did it come to pass? We are sure to find out as the trial progresses.

It turns out we physicians have been put in a similar position ( although with more subtlety and finesse) by the pharmaceutical industry. Here's my experience.

When I arrived at medical school, our friendly "drug rep" gave us all nice new stethoscopes - no strings attached. Gee, thanks! Later, she provided great lunches for our noon teaching conference. Yum, pastrami sandwiches! Need a new pen? Some note paper? A reflex hammer? You're a pal!

Why refuse? We were poor. She was nice. There was no pressure to do anything at all. What's not to like?

Later, in practice, drug reps would come to my office with their latest and greatest medications, armed with the latest research (carefully screened to only give results that supported their meds and/or discredited the competitors').

A few small freebie knicknacks wouldn't hurt (for some odd reason, there are few happier humans on this earth than a physician who has just gotten a free ballpoint pen). Better still, a fabulous free dinner at the most expensive restaurant in town to hear a talk on a subject of interest by a distinguished physician. Finally, the coup de grace: a free 3 day medical conference in a lovely vacation spot.

Now, the drug companies are anything but stupid. If they are willing to spend all this money to curry my favor, they must have determined that it pays off, that I will be more likely to prescribe their brand of medications. Yet I defy you to find a doc who believes his/her prescription practices have been biased by accepting their largesse.

This bias is unconscious, slow to evolve, and very subtle. We never knew what hit us and most still don't. It occurs to me that the congressmen tainted by Jack Abramoff probably have had a similar slow and unconscious evolution. Much as I'd like to think so, I'm not so sure we are really all that different from them.

What to do?

I'm going to assume that we are all corruptible to some extent and that human nature is unlikely to change. In the latest issue of the prestigious Journal of the American Medical Association (JAMA) the authors propose "stringent regulations" to eliminate or modify the practices I described, especially at academic medical centers.

I'm proud to say that is what has happened at my institution. We have these fabulous young pediatricians in training who will never have received any gifts, eaten any free lunches, nor even copped a ballpont pen from the drug industry. It is this next generation for whom the slow process of influence will be just a curious historical footnote. (Of course, they will think they would have resisted the temptation anyway, but I know better.)

Eat your heart out, Jack Abramoff.

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Article cited:"Health industry practices that create conflicts of interest". Brennan T, et al.JAMA. January 25, 2006

Related Topics: Drug Reps: Helpful or a Pain?, 10 Ways to Save on Your Prescription Medicine

Technorati Tags: pharmaceutical, healthcare, medical practice

Your kids and global warming

Dr. P's favorite quote of the week

"Children are the living messages we send to a time we will not see."

Neil Postman

(1931-2003, social critic, author of Amusing Ourselves to Death)

Dr. P comments

It's official: 2005 was the warmest year on record. And in Boston, where I live, January (the warmest January on record, of course) has been positively spooky with its balmy 60 degree days.

I'm real worried about the world we are leaving for our "living messages". Global warming seems pretty certain at this point and there comes a point where not addressing it becomes a criminal offence.

Got kids? Parents can and should be a powerful force in advocating that we start now to fix this potentially catastrophic problem, so our kids don't come to curse us when we are gone for our selfish lack of foresight and care for the planet.

Related Topics: Air Pollution's Health Risks Underestimated?, Skin Cancer Danger Not Just In Summer

Technorati Tags: global warming, social responsibility

Got lice?

Dr. P's Pediatric Journal Club

The study
133 patients with head lice were given a nontoxic lotion (Cetaphil cleanser) and instructed to:

• Apply to the entire scalp. Leave in for 2 minutes, then comb out the excess.
• Dry it with a hair dryer (to suffocate the lice).
• Leave the dried lotion on the scalp for at least 8 hours.
• Shampoo it all out.
• Wash clothes and heat pillow cases, sheets, etc in the dryer for > 10 minutes.
• Repeat once a week for up to 3 weeks.

What the study found
The overall long-term cure rate was 94-96%. (Removing the nits with a comb did not improve the success rate.)

What the study suggests
For people with head lice, slathering the scalp with Cetaphil and drying it (per the directions above) suffocates the lice and may be an effective new treatment.

Dr. P comments
Lice are pesky, loathsome critters and sometimes hard to eradicate. As a pediatrician, it's nice be able to recommend that parents try a new, simple, inexpensive, and safe treatment.

Actually, there is an interesting story here. When this California dermatologist first published his results 16 months ago, he did not identify what the lotion was. In fact, he called it "Nuvo" and charged his patients $285 for the treatment at his dermatology office - $100 for the Nuvo lotion alone. (Cetaphil cleanser costs less than $10 for 16 ounces).

Only last month, in a letter to the journal Pediatrics, did he reveal the truth: his miracle lotion was plain old Cetaphil cleanser. We can all manage a pretty good guess (and it ain't pretty) as to his motivation for keeping the nature of the lotion secret, but one has to wonder why he finally came clean.

Anyway, give it a try and let me know if you have success.

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Articles cited:

A simple treatment for head lice: Dry-on, suffocation-based pediculicide.

Pearlman DL; Pediatrics. September, 2004.

Cetaphil cleanser (Nuvo lotion) cures head lice.

Pearlman DL. Pediatrics. December, 2005.

Related Topics: A Better Treatment For Head Lice?, When to Keep Junior Home from Day Care

Technorati Tags: head lice, cetaphil, nuvo treatment