Tuesday, October 26, 2010

Should I read White Coat, Black Hat?

I'm not in the habit of reviewing other people's book reviews but two articles on the book in question, one by Thomas Sullivan and the other by Sally Satel, are worth mentioning here because they nicely address the broader controversy about the relationship between the medical profession and industry. Now that I've read those two articles I think I'll pass on White Coat, Black Hat. The book, based on those two articles and another positive review I recently read seems to be anything but a balanced treatment of the issue. In fact, it comes across as a knee-jerk, intellectually lazy collection of anecdotes designed to appeal to popular animosity against the pharmaceutical industry.

Sullivan and Satel offer a nuanced view of physician-industry relationships. Sullivan makes this point, with which I partially disagree:

For now, there is no data suggesting any harm to patients from working with industry because no studies have used clinical outcomes.

It's true that there are no data suggesting harm to patients from working with industry. The pharmascolds have no data in support of their position. All they can do is appeal to a set of popular beliefs. What I disagree with is the statement that no studies have looked at clinical outcomes. One study did look at clinical outcomes following an industry sponsored campaign. I've blogged about it extensively before. One of the most maligned Pharma campaigns in all of medicine resulted in improved outcomes, even reduced mortality, in septic patients.


Michael Kirsch, M.D. said...

Attacking the pharm guys is great sport now, especially for the press. Of course, they're demonized as evidence by the portrayal of them as 'Big Pharm'. The adjective 'big'as in Big Government or Big Oil, are loaded terms, loaded with bias. As for relationships between physicians and the pharm industry (I have none), does the press ever report how these relationships advance medicine?

A. Tsai said...

Funny that you call Dr. Satel's treatment of industry-physician relationships "nuanced". She is anything but nuanced.

And of course you appeal to the convenient argument "no studies have shown harm to clinical outcomes". Might as well demand a randomized controlled trial. But... wait. You don't need a randomized controlled trial showing that an Abilify pen will cause heart attacks. Hill detailed criteria for assessing causation from observational studies more than 40 years ago, and the evidence linking industry entanglements to a wide range of negative outcomes. At this point, most readers of the literature would agree that it is a sufficient body of evidence from which to draw conclusions.

Pete Pejowski said...

I'm all in favor of the pharmaceutical industry and what they do. I had the restless leg syndrome and they fixed me up real good. So I'm glad those guys are there. And I don't know who that Elliott guy thinks he is, saying all sorts of stuff, but I'm not going to read that book either. No sir.