Yves here. Sadly, views about medicine and Big Pharma have become so polarized that it’s become difficult to have a discussion that does not quickly devolve into taking sides based on ideological priors. Before we turn to a very informative case study, about the leading pediatrics group that is in the crosshairs of vaccine controversy, let me be explicit about mine.
In general, I am alarmed at the enthusiasm in the commentariat and many parts of America for burning down institutions, particularly since they have no concrete proposals or even visions as to what should go in their place. It’s a bizarre combination of libertarian impulses and regime change logic.
The libertarian angle is the belief that unconstrained human activity produces better results than laws and regulations. But there is no such thing as a free market. They depend on contracts and enforcement, which means bodies that can adjudicate disputes and require the parties to them to submit to their decision. Even under a minimal framework, as Lambert pointed out, the neoliberal outcome is is 1. Because markets; 2. Go die.
Regime change logic is that if you get rid of a bad government (in the US scheme, a “dictator” who may or may not be one but is not on board with our interests), democracy and a thousand other flowers will bloom. In fact, in Iraq and Syria, as much as the old leader was undeniably authoritarian, the overthrow produced a failed state. There is ample evidence that as much as citizens were unhappy with the old guard, knowing what they know now, they’d go back to status quo ante if they could.
In the case of American medicine, the article below describes what can most charitably be called insufficient vigilance at the American Academy of Pediatrics about appearances and potentially substance of its conflicts of interest policies. A big concern is that the Academy is insufficiently transparent about its reviews of researcher links to Big Pharma.
And there are conflicts at the institutional level too. The story below points out that 4% of American Academy of Pediatrics’ revenues come from corporations, which include Pfizer, Merck, Moderna, and Sanofi, plus Mead Johnson Nutrition and Abbott, who produce baby formula. The Academy maintains those monies are not used for policy development. It falls short of the gold standard in disclosing other conflicts, such as in interactions between researchers and Big Pharma, as well as:
Content for parents is branded, too: A 2020 webinar on sleep was sponsored by a company that makes melatonin supplements. A May 2024 newsletter about screen time lists the telecommunications company AT&T among its sponsors.
And a troubling example:
In July, [Lynn] Bero [a University of Colorado researcher who studies the impact of conflicts of interest on health] and three colleagues published a paper in The BMJ analyzing the 2023 AAP guidelines on childhood obesity treatment, which diverged from peer guidelines that have been published or are under development in some other countries by endorsing the use of weight-loss medications for younger children.
“No financial conflicts of interest involving drug companies were disclosed in the AAP’s childhood obesity guidelines,” the authors wrote. But, the team continued, they had “identified 11 developers of GLP-1 drugs that made corporate sponsorship payments during 2012-24” to the AAP. And 10 people involved in producing the guideline had received gifts, perks, or payments from such companies between 2017 and 2023, ranging from small food and beverage purchases to one author who had received more than $17,000 in consulting fees.
And that’s before getting to the efforts to suborn doctors directly:
Pharmaceutical representatives may take physicians out for dinners, pay for travel and lodging, or offer them speaking and consulting fees. To some, these are routine interactions that do not necessarily compromise the independence and integrity of scientific work.
That is complete bullshit. Cognitive bias research has found that a gift as small as a can of soda will predispose the recipient to a salesman’s pitch. Recognizing that, the industry association PhRMA (one assumes to get in front of possible FDA regulation) has made its part of its guidelines for selling to doctors forbids offering any entertainment or personal gifts,not even small goodies like mugs or pens.
The much bigger problem is that America is corrupt, and huge swathes of the medical profession seem indifferent to it. Pediatrics is the least well remunerated of all medical specialities. Go look at oncology for a much more serious version. A good friend (now deceased) had an oncologist son-in-law. She was very disturbed by how often he went on drug-company-paid junkets to exotic places like the Caribbean for conferences. She challenged him on what sure looked like pay-to-play ethics. He saw no issue. Later, she reported that he was being recruited and so solicited other offers. What determined which of his two finalists he chose was the payment he would receive from his employer for each cancer treatment medication prescribed. If I recall correctly, at one institution, it was $500 per relevant Rx, at the other, $750. He chose the one with the higher payout, estimating that it would result in $75,000 more in compensation in a typical year.
Now before you say, “Oh, this means RFK, Jr. is right!” you need to think twice. Is he going after corruption in medicine generally? Disclosure of conflicts of interest? A new ethical canon and how to reform medical education in light of that? Perhaps I missed it, but as far as I can tell, his salvos about soft or harder forms of corruption have come off more as ad hominem attacks, to discredit opponents in his particularly hobbyhorses of vaccines and diet. Not that those are unimportant, but that suggests that his concern about bad conduct to advance his agenda, and not improve the practice of medicine generally.
Let’s point out the obvious: RFK, Jr. is up to his eyeballs with conflicts of interest with respect to vaccines, not just his need to defend his history but also his current interests. Did you know that Make America Health Again is copyrighted and RFK, Jr. reported earning $100,000 in licensing fees in his financial disclosure forms?
Headlines alone tell the story:
RFK Jr. says he’s not anti-vaccine. But he could profit off claim in vaccine lawsuit. ABC
RFK Jr. plans to keep a financial stake in lawsuits against the drugmaker Merck NPR
At Hearing, Warren Slams RFK Jr. for Dangerous Conflicts of Interest, Profiting From Anti-Vaccine Conspiracies Elizabeth Warren
RFK, Jr. has also promoted wearables as part of advancing his branded MAHA agenda. From ABC:
Last week, Health and Human Services Secretary Robert F. Kennedy Jr. announced the agency was launching a campaign to encourage all Americans to use wearables to track health metrics.
Wearables come in the form of watches, bands, rings, patches and clothes that can be used for a variety of reasons including monitoring glucose levels, measuring activity levels, track heart health and observe sleeping patterns.
“It’s a way … people can take control over their own heath. They can take responsibility,” Kennedy said during a hearing of the House Subcommittee on Health. “They can see, as you know, what food is doing to their glucose levels, their heart rates and a number of other metrics as they eat it. and they can begin to make good judgments about their diet, about their physical activity, about the way that they live their lives.”
He went on, “We think that wearables are a key to the MAHA agenda — Making America Healthy Again. My vision is that every American is wearing a wearable within four years.”
Let’s turn to one he mentioned, glucose monitors. Gee, by happenstance, the Administration pick for Surgeon General, Casey Means, sells a continuous glucose monitor and a related app.
KLG explained that they’ve been demonstrated to be bunk:
The Levels [Casey Means] program, on the other hand, recommends continuous monitoring of “everything” so you can take charge of your body and your health. But as Dr. Alex Harding put it in a recent opinion piece in STAT News, Longevity Seekers Misunderstand a Fundamental Truth About Biology:
“Biohackers” and other longevity seekers…would have you believe that if you diligently measure your every bodily function and meticulously tailor your nutrition and exercise regimens, you can reprogram your body to live longer and evade dreaded diseases, just as a computer can be programmed to perform virtually any desired task.
(The) logical flaw (here) is to assume that the biological processes in your body are just as predictable and controllable as transistors on a microchip. What they don’t understand, or choose to ignore, is that the human organism is far too complex and unpredictable for that level of control.
This brings us directly back to one of the main selling points from Casey Means MD of Levels: Continuous glucose monitoring (CGM) as a proxy for metabolic health. On the surface, this makes sense. If your glucose tolerance (capacity to reduce plasma glucose level after a high-glucose meal) is low, high blood glucose levels persist and will lead to a greater glycation burden. In diabetes glycation is responsible for damage to small blood vessels, which causes circulatory problems in the periphery, often leading to foot and leg amputation and vision loss due to retinal damage. This onset is insidious and must be stopped. CGM was developed for diabetics to closely monitor their blood glucose levels, and as the technology has improved it has made management of diabetes easier.
The goal of the biohacker is to use CGM to optimize his or her diet with respect to glucose levels. However, the surprising result is that CGM really doesn’t work very well. It turns out that in any given individual, the same meal does not produce the same effect on glucose levels. From the STAT News article:
The trouble is, our bodies’ glucose response to food intake is far too inconsistent to produce informative results. Researchers in a recent study fed participants identical meals separated by one week in a highly controlled hospital environment, while the participants wore continuous glucose monitors. Even when eating identical meals under these artificial conditions, the glucose measurements from a given participant looked no more similar than when the participants each ate an entirely different meal. A scatterplot the researchers made comparing the glucose results from one meal against the identical meal a week later looked like it could have been made by a person throwing darts blindfolded.
So RFK, Jr. is about to try to get Medicare, Medicaid, the VA and private insurers to pay for a fad1 among the affluent that does not work very well if at all.
The bigger reason I am not keen about RFK, Jr.’s keen interest in my extensive personal experience on the bleeding edge of dietary supplements, diet and alternative treatments. I have suffered more harm from alternative treatments than from conventional medicine, even having had a serious Covid side effect.2 And as you can imagine, I go to efforts to be careful, getting solid referrals and doing research. Don’t get me started on the product sold by multi-level marketing, or the obvious scam products on YouTube.
But even with all of the understandable reservations about research in the orthodox medicine, it’s a paragon compared to what you find in the alternative treatment arena. The “studies” are underpowered (too few participants, sample bias….). It’s doubtful that they reported on participants who dropped out (because the program bothered them? Because they were getting no benefit?) So it’s a crapshoot. And you can be harmed in more than your wallet. If I was despite investigation and having a good idea of what makes for a decent study, what about the general public?
So yes, I am very leery of a head of Health and Human Services who uses his post to promote Make America Healthy Again when he collects royalties from that name. You should be too.
By Michael Schulson, a contributing editor for Undark. His work has also been published by Aeon, NPR, Pacific Standard, Scientific American, Slate, and Wired, among other publications. Originally published at Undark
The American Academy of Pediatrics, with some 67,000 members, is the most influential pediatrics organization in the United States, if not the world. Among other roles, the AAP issues official recommendations — on everything from Covid-19 vaccines to infant sleep — that shape the way American children are cared for at home and at the doctor’s office.
Recently, new immunization recommendations from the AAP came under fire from Secretary of Health and Human Services Robert F. Kennedy Jr., who argued in an Aug. 19 post on X that AAP “should disclose conflicts of interest” in order to allow Americans to “ask whether the AAP’s recommendations reflect public health interest, or are, perhaps, just a pay-to-play scheme to promote commercial ambitions of AAP’s Big Pharma benefactors.”
Kennedy, who founded an organization that questions the safety of common vaccines, and who has participated in lawsuits against vaccine manufacturers, may carry his own conflicts of interest. And funding or consulting relationships between physicians and pharmaceutical companies are not unusual. But Kennedy’s comments, even if ideologically motivated, do echo broader concerns about the influence that corporate funding might have at many U.S. medical societies, including the AAP — and about why the flagship pediatrics organization does not do more to disclose potential conflicts of interest in its guidelines and other official recommendations and endorsements.
In some cases, those published recommendations suggest that the authors have no potential pharma conflicts worth noting, even when authors have received consulting fees or research funding from companies that have a vested interest in the outcome.
Undark found, for example, that one author of 2018 AAP-endorsed guidelines on adolescent depression treatment has consulted for the makers of the antidepressants Zoloft and Lexapro — a detail that was disclosed on other papers he wrote around that time, but that goes unmentioned in the guidelines.
On a controversial 2023 guideline that opens the door to prescribing some younger children weight-loss drugs (alongside lifestyle changes and other treatment), a recent academic analysis found that several authors have financial relationships with the companies that make those medications. Those relationships, though, are not disclosed on the guideline.
Similarly, a draft policy statement published in August, recommending that many babies and some older children receive the latest Covid-19 shots, indicated that the authors had no potential conflicts of interest to disclose. Public records, however, show that at least nine of the 16 members of the committee responsible for those and other immunization recommendations have received payments, research funding, or perks in the form of meals, travel, or lodging from vaccine manufacturers. Of those, five have financial ties to companies that market Covid-19 vaccines in the U.S.
Shortly after Undark sent questions about those potential conflicts of interest to the AAP, the public draft was updatedto note that two committee members with financial relationships to Covid-19 manufacturers had not participated in developing the recommendations. “Other disclosures of committee members were reviewed and determined not relevant to the work related to the statement,” the draft now adds.
In all of these cases, these financial ties may have had no bearing on the guidelines or policies, and those working to write them are likely to have disclosed potential conflicts of interest to the AAP as part of the vetting process. But the lack of transparency and disclosure from AAP, some experts said, departs from best practices. The AAP’s closed deliberations also make it difficult to know the precise nature of consulting relationships between researchers and drugmakers — including whether the work involved a medication that might be indirectly supported by an AAP policy statement, or some unrelated matter.
In a statement forwarded by Susan Martin, the AAP’s vice president of public affairs, the organization insisted that its vetting process was rigorous. The AAP routinely seeks out “additional information about the scope and purpose of any work that an author is doing with a company,” the emailed statement reads. “For an individual with research funding, for example, that would include details about any specific product that is being investigated.”
If the AAP identifies a potential relevant conflict, the organization said, that would preclude the researcher from serving as a lead author on an AAP policy statement related to that product — “in most cases.” Experts whose relationship with a company is focused on a different or unrelated product, the organization added, “may still be able to contribute.”
Authors of guidelines and other recommendations, the organization also told Undark, are subject to a policy that “includes annual disclosures, reporting of new conflicts, and a rigorous review process.”
Still, the precise nature and rigor of that review process, including how the organization adjudicated any particular case of potential conflict, typically remains opaque to the public. And none of the reviewed recommendations disclose that the AAP itself accepts donations from corporate sponsors. On its website, the organization does publicize those partnerships, describing an annual “Corporate Summit” at its Illinois headquarters for donors of $50,000 or more — a status enjoyed by pharmaceutical companies Pfizer, Merck, Moderna, and Sanofi, as well as Mead Johnson Nutrition and Abbott, two leading producers of infant formula.
Content for parents is branded, too: A 2020 webinar on sleep was sponsored by a company that makes melatonin supplements. A May 2024 newsletter about screen time lists the telecommunications company AT&T among its sponsors.
Whether these different kinds of financial relationships have any bearing on AAP’s policies is difficult to determine. The organization told Undark that only around 4 percent of its revenue between July 2024 through June 2025 came from corporate funding, adding that “All external support is transparently reported, aligned with our mission and governed by strict engagement protocols.” That funding is not used for policy development, the statement said.
But several experts in conflict of interest and disclosure questioned why the AAP would not always disclose such financial relationships in its guidelines — or do more to separate itself from such corporate ties the first place.
“The process here clearly is not in line with international gold standards for producing trustworthy guidelines,” said Quinn Grundy, a researcher at the University of Toronto who studies industry influences on health systems, after reviewing details of the AAP guidelines covering weight-loss medications. But, she added, the organization was not an outlier: “The American Academy of Pediatrics, the members of its leadership, these guideline members, are also behaving in a way that is completely normal and acceptable within medical professional societies and the medical profession.”
In a statement to Undark, the CEO of AAP, Mark Del Monte, praised his organization’s approach. “AAP is deeply committed to producing child health recommendations that clinicians and families can confidently rely on,” he wrote. “AAP recommendations are scientifically sound, clinically relevant, and free from undue influence. Our goal is to serve pediatricians and the public with integrity and transparency.”
Often, pharmaceutical funding directed at doctors is used for research: A drug company, for example, might underwrite a physician’s study that involves a particular medication. An academic medical center may conduct clinical trials that are critical for bringing a lifesaving drug to market.
Other forms of payment are more nebulous: Pharmaceutical representatives may take physicians out for dinners, pay for travel and lodging, or offer them speaking and consulting fees. To some, these are routine interactions that do not necessarily compromise the independence and integrity of scientific work. In fact, overzealous policing of conflicts of interest can hamper medical innovation, the late Harvard Medical School professor Thomas Stossel argued in a 2008 article for The BMJ. Such policies, he wrote, “exclude the best experts from providing education and advice, cost time and money, and are deeply disrespectful of physicians and researchers.”
Critics of the current system, however, say such interactions sometimes seem like little more than a quid pro quo — one that, some evidence suggests, does influence physician behavior. “It’s the kind of institutionalized corruption and bribery that has been there for so long that nobody even bats an eye anymore,” said Carl Elliott, a bioethicist at the University of Minnesota and author of the 2010 book “White Coat, Black Hat: Adventures on the Dark Side of Medicine.”
“We wouldn’t really tolerate” that kind of conflict of interest “if you were talking about a journalist, or about a judge or a police officer,” Elliott said. “But somehow, with doctors, we just let them get away with it, as long as they disclose.”
Under federal law, those companies must report those payments to the federal government, which then makes the information available to the public via the Open Payments database.
The stakes are especially high for guidelines, in which relatively small groups of physicians and scientists write recommendations that can shape health care across a country, or around the world. In response, organizations have developed processes for disclosing and adjudicating potential conflicts of interest. The World Health Organization, for example, instructs guideline writers to declare all potentially relevant interests to independent reviewers. The published guidelines list those disclosures, and then note whether the reviewers determined them to pose significant conflicts of interest — and, if so, how the conflicts were managed.
The AAP’s process is considerably less transparent, according to Lisa Bero, a researcher at the University of Colorado who studies the impact of conflicts of interest on health. She noted the issue around conflicts of interest is not unique to the AAP: “I can’t think of an example of a medical society with a good policy,” she wrote in an email to Undark, “but there may be one.”
In July, Bero and three colleagues published a paper in The BMJ analyzing the 2023 AAP guidelines on childhood obesity treatment, which diverged from peer guidelines that have been published or are under development in some other countries by endorsing the use of weight-loss medications for younger children.
“No financial conflicts of interest involving drug companies were disclosed in the AAP’s childhood obesity guidelines,” the authors wrote. But, the team continued, they had “identified 11 developers of GLP-1 drugs that made corporate sponsorship payments during 2012-24” to the AAP. And 10 people involved in producing the guideline had received gifts, perks, or payments from such companies between 2017 and 2023, ranging from small food and beverage purchases to one author who had received more than $17,000 in consulting fees.
Whether or not those fees swayed the guideline in any way is unclear. But the lack of disclosure, some experts say, opens the door to questions. And the organization’s process for disclosing conflicts of interest, the authors wrote, “departed from international standards.”
Bero elaborated in an email to Undark: “They provide no information on what they actually reviewed in terms of disclosures from participants, or how they evaluated them to come to the no COI judgement.”
Bero also pointed to international organizations that maintain more strict rules around conflict transparency, including Australia’s National Health and Medical Research Council, the National Institute for Health and Care Excellence in the U.K., and the Institute for Quality and Efficiency in Health Care in Germany.
Undark identified other examples in which authors of AAP recommendations or AAP-endorsed guidance had received funding from pharmaceutical companies that was not mentioned in the final product.
In a paper published in a non-AAP-affiliated journal in 2017, for example, child psychiatrist Graham Emslie reported consulting relationships with eight companies, including Pfizer, which makes the popular antidepressant Zoloft. Less than a year later, he was listed as an author on AAP-endorsed guidelines, published in the Academy’s flagship journal, that discuss antidepressant prescribing. The paper did not list any conflicts for Emslie. Those financial relationships may have involved products unrelated to the guidelines, and they could have had no influence on the final policy statement. But the lack of AAP disclosure creates trust issues related to the guidelines, some critics say. (Emslie did not reply to a request for comment.)
In August 2022, a policy statement recommending Covid-19 vaccines for children did not disclose any conflicts for its authors, noting that they had all filed conflict of interest statements with the AAP and any “conflicts have been resolved.” The chair of the committee responsible for the policy, according to Open Payments records, received $17,590 in consulting fees from Pfizer, which manufactures one of the vaccines, between 2018 and 2022, in addition to substantial research funding. Again, that financial relationship may not have impacted the recommendation, but, critics say, more transparency would help bolster public trust.
In its statement to Undark, the AAP pushed back against the use of Open Payments data alone to assess conflicts of interest, saying the records “often lack detailed context” and are not independently verified.
The AAP described having “a comprehensive Conflict of Interest (COI) policy,” but did not make the policy available for review by Undark. The deliberations are not public, and it’s not clear how the AAP determines that some financial relationships with pharmaceutical companies don’t need to be disclosed on the final guideline or recommendation.
Whether any of this changes the way physicians and members of the public should understand these documents is more complicated. Physicians may feel confident that a research payment, or a free meal, won’t influence their judgment in reviewing the evidence. The specific nature of industry relationships can vary widely. Large committees mean no single person necessarily determines a final conclusion. And guideline authors who carry conflicts of interest may be leading experts in their field, widely respected for their work and experience.
“I’m sort of conflicted,” said Kenny Lin, a professor of family medicine at Georgetown University who wrote about Bero and her colleagues’ paper for a medical blog. The AAP, he said, “could have done a better job here.” But he added, he’s not sure “that you have to just throw the whole thing out.” Knowing about the conflicts may give him pause, he said, but many parts of the document, like lifestyle recommendations, were unlikely to have been influenced by conflicts of interest. “The guideline itself,” Lin said, “is probably not fatally compromised.”
At a time of growing distrust in scientific institutions, some experts suggested, the AAP and other medical societies would benefit from making some changes. Grundy, at the University of Toronto, reflected on the cost of accepting corporate sponsorships that ultimately make up only a fraction of the organization’s budget: “If it’s undermining your ability to create guidance, education, advice that is rigorous, accountable, trustworthy, then it would be possible to find levers for further independence there,” she said.
“I would ask them why they do not adhere to international standards for evaluating evidence and managing COI in the guideline process,” Bero, the Colorado researcher, wrote in an email to Undark. “It would not cost them any more, so why not?”
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1 The only way to have a snowball’s chance in hell of getting with hailing distance of having “every American” sporting a wearable.
2 Took 2 attempts at outpatient surgery, the second successful, so this was costly. And I made a point of not taking an mRNA vaccine, viewing them as too experimental. I had had only one J&J shot.
Scientific ignorance and media suppressions enable all sorts of frauds.
Lear basic science or be in the thrall of the Matrix!
I may have missed it but am unaware of any commenters here defending RFK Jr. the individual. I find his conspiracy theories off he wall and when he ran for president some key supporters deserted him over his defense of Israel. One might question whether he would have any prominence at all if his last name wasn’t Kennedy.
However some of us have defended his skepticism toward US medicine and that is, in my case, is based on the experience of taking care of an aged parent. Plus we the public are perfectly aware that we are being huckstered by Pharma since we see it every day on television.
All of this is not my topic, but surely medicine above all needs to promote trust and high ethical standards that may not apply so severely to other businesses. A Panglossian defense invites the opposite. And the Trump administration clearly has almost nothing to do with ethics so the same applies to it. IMVHO.
Huh? First, this is classic black and white thinking, because American medicine has problems, anyone who says bad things about it is good.
Second, the critique is not about “the man,” but his policies. Otherwise we’d be discussing his brain worm, his heroin addiction, his wife’s suicide.
Third, I do not understand why you give RFK, Jr. the benefit of the doubt. He is not “a skeptic”. He is an follower/booster of West Coast health fads. His “skepticism” is limited to medical practice that differs from that, as opposed to, say, spinal fusion surgeries, or better yet, having a point of view about how to address the cost and quality of nursing home care. He is an active promoter of falsehoods about the measles vaccine, and his intervention in Samoa led to unnecessary deaths. As indicate above, he’s profiteering from being able to promote “Make America Healthy Again” from his office, so he is personally corrupt.
You can’t pretend that RFK, Jr. has a program for how to improve American medicine, either on a research on an institutional level. The man didn’t even know Medicare costs and cost increases!
I’m not defending him at all and frankly don’t know that much about him. I’m merely suggesting that some defenders of the status quo are making Kennedy the issue in defense of a system that does in fact need a reform that few others are talking about. This is how RFK has gained his unlikely position and for that matter how Trump has gained his unlikely position.
One can point out that we’ve been talking about these issues for years here–long before RFK or Trump showed up.
As in he’s been selling snake oil, above all, his “vaccines cause autism” nonsense for many years. That is hardly an endorsement. And you also forget that Trump brought him on board because RFK, Jr. had been a political contestant and so brought votes and funding. Trump did not pick RFK, Jr. for his views on policy but his utility in the campaign. Trump was considering making RFK, Jr. the Attorney General, and IMHO that would have been far better. It was outside the focus of this post, but RFK, Jr. will fail at HHS for the same reasons we predicted Rochelle Wallensky’s failure at the CDC: neither had run anything bigger than a small operation, and were not at all prepared to oversee very large organizations.
Don’t forget the marquee value of the Kennedy name! Trump loves stars. (Or publicly feuds with them such as the recent threat to “revoke” Rosie O’Donnell citizenship.)
Once my third year rotations began I was quite shocked to witness most of the practices I visited arranged for a free lunch everyday single day for the whole office… each day was provided by a different pharma or device rep. Usually this was accompanied by a little presentation we had to listen to about a drug or a product. The dean of our school explained to our class at one point that the system for continuing education after medical school was largely provided by the pharmaceutical industry and that’s just the way it is. I later learned about attending being provided vacations or lavish conferences at fancy destinations. Another big disappointment for me as my ideals about serving in a noble profession were slowly ground into dust.
There was only one attending I came across who felt differently. The same pharma and device reps would still try to visit her office but she reused to even meet with them. One day the secretary of her office handed her a stack of brochures that had been left for her. She took them and threw them directly in the trash, stating “I do not receive my education from the pharmaceutical industry”.
She was actually a terrible teacher of the medical craft and I learned very little during my rotation… but I at least respected her ethics.
There is an important element of this issue that is not really addressed here, but it is one with which NC readers are very familiar. That is the tendency by the “educated,” particularly the “highly educated,” to be extremely vulnerable to arguments from “expert” authority. This seems counter-intuitive, at least to the “highly educated” who believe themselves to make decisions based on Science, Reason, and Evidence. But as someone who spent his adult life in academia I am very familiar with this phenomenon. Most “professionals” are busy people. While they may have considerable knowledge in one area, they usually don’t have the time or background to follow subjects outside their narrow area of “expertise.” What their education has given them, however, is a high level of deference to credentials and institutions doing the credentialing and certifying. So if the AAP, the AMA, or some other prestigious body gives its stamp of approval, it is *assumed* by the “highly educated” that it must be correct. These “educated” but very busy people have no time to dig into claims about, say, Ukraine or Russia or Russiagate. So they employ the heuristic of “expertise” and assume that those highly trained professional journalists at the NY Times are telling the truth about these subjects, certainly when compared to some “conspiracy theory” promoted by some political bloggers at, say, Naked Capitalism. NC readers know how ridiculous or even dangerous this assumption might be. But the same process is at work here: the assumption that a body of “experts” make claims based on “science” and “evidence,” with no understanding of the many ways this process can be corrupted in such a system as ours.
Add to this the individual biases that operate *within* such certifying institutions and which Yves alludes to – e.g. the belief that while others might be influenced by a free lunch, WE certainly wouldn’t be – and we have the situation as it exists at present. The PMC accepts the word of certified “experts” on faith and rejects non-believers as ignorant deplorables.
Of course the right-wing pseudo-populists turn around and use this to justify their own bad faith arguments for their own agendas. And here we are.
“…the tendency by the “educated” particularly the “highly educated” to be extremely vulnerable to arguments from “expert” authority.”
Some days, like today, I feel that the problem may go even deeper than so-called expertise. It may center on the limitations of thought itself. For someone like me (defining myself as thinker par excellence) this is a most threatening possibility
What if abstract conceptualization, language, and even my own consciousness, primarily supports a sense of self that allows me to slip quite naturally into thinking and believing, forever, only in the validity of either/ or.
My (aborted) graduate education in economics left me with a visceral distrust of anyone who had top credentials in the field and an enduring skepticism of assertions of expertise that were uncoupled from an ability to concretely and concisely explain the underlying work and its limitations. This no doubt contributed to my less successful than expected policy career, but I have no regrets, particularly as we enter this period of All Gaslighting, All the Time, about Everything. These habits of mind are now among my great treasures.
Of course, I long ago lost any ability to have a conversation with most of my former classmates.
Could we agree that pharmaceutical advertising should not be on television?
Anyone watch recent US Open tennis tournament, any golf tournament, football, EVENING NEWS? They are saturated with Pharma ads.
And as you said: Cognitive bias research has found that a gift as small as a can of soda will predispose the recipient to a salesman’s pitch.
Does anyone doubt that news is co-opted to protect Pharma?
If we wanted to promote trust, we’d eliminate this conflict of interest.
Kennedy is snookering the public by raising the issue (yes, this site has long disapproved) while not acknowledging that he can do nothing about it
The FDA reluctantly approved TV ads in 1997 because Supreme Court decisions had made clear that other forms of drug-related advertising were considered commercial speech (as in a form of free speech) and could not be banned save on the grounds of being misleading.
https://www.nejm.org/doi/full/10.1056/NEJMp078080
If memory serves the cigarette companies took their ads off TV voluntarily because the “equal time” anti-smoking ads were killing them. Dead celebrities would come on television and say ‘don’t do like I did.’
Instead Big Tobacco now product places cigs in movies where actors love their ‘cool making’ props. In real life I almost never see anyone smoking now.
‘In real life I almost never see anyone smoking now.’
Good for the US, or Carolina, or whatever …
Here in Finland I see many, many people smoking every day. Vapes and traditional cigarettes. Young and old. I suppose if you look at the statistics there are probably fewer now than there were in days of yore but we are very far from a situation of ‘almost never see anyone smoking now’.
Does “now” include times of Humphrey Bogart, and other actors that made smoking cool in the first place? Those times are the reason there is a smoking disclaimer in the end credits nowdays.
I think this pairs with the state collapse post. Generally people believe we are poorly served, hear something like the rfkjr slogan and think it’s high time for some attention to this problem so they get behind it, and are subsequently shown that the premise was vaporware intended to get a vote.
Fool me once, shame on you…
Although this really has become commonplace, the kennedy has really crapped in the pudding both in general and specific.
You are on to something. And there’s also the problem of desperation.
And, among those of means, the notion that you can exchange cash for what you want, be that a thinner kid, no heartburn, or a cure for your elderly mother’s COPD. And if you cannot by a solution, than someone is deliberately harming you and should pay!
Yves’ introduction is why I have long followed and contributed financially to this blog. Our society really needs this kind of fierce intelligent analysis. I wish more people would buy into the idea of looking at problems and finding solutions instead of either blowing it all up or believing it can be solved simply by voting harder.
Thank you.
We should call a spade a spade. It’s bribery, not a “conflict of interest.”
As Lambert used to say, “Burn the CDC to the ground and salt the earth”
I see nothing of value that has come from the CDC in last 5 years. In fact the opposite. How many “grandmas” caught covid after the CDC assured us that ” If you get this shot, grandma will be protected.” Have they ever admitted that covid is airborne, or are they still into hand washing?
We are better off without them.
And my wife is getting useful info from her CGM about which foods/meals inpact her blood sugar. Not useless from my POV.
I am sorry but Lambert’s comment was knee jerk and ignorant. I was tempted to chew him out or even rip it out at the time. His deep understanding of Covid did not confer understanding of large bureaucracies. He never looked at the CDC as an institution. I warned Rochelle Wallensky would prove to be an incompetent leader, and that much of what the CDC did wrong was the result of her following political pressure.
The CDC has 32,000 employees and does all sorts of data collection and dissemination. It’s extremely important to clinicians. You want doctors flying even more blindly than they do now?
i guess my reaction to this is what was happening before RFK, JR. and what is happening now. What is the conversation and what actual decisions have been made.
Seems the prior status quo was poor, regardless of what is happening now. Is it improved at the moment? Jury still seems to be out, but at least different conversations are happening, which I can only count as positive.
The problems being faced are systemic and no party or individual, at the moment, seems to offer a holistic or integrated oriented solution to the underlying conditions that have led us here. Corruption is clear, an neither party nor any single individual seems above the fray. And the fray generates attention and clicks and followers and money and thus influence, which is power.
I believe we are better served by continuing to look deeper at the connections between our problems – the common links – which span industries and institutions. To keep focusing on specifics of one or another, and the flawed people who are involved with them (and who in power today isn’t greatly flawed or without skeletons or amplifying agenda’s that are usually hypocritical or commercial or personal profiteering.
I know a now-retired University researcher, who, as an expert on liver function, published some studies documenting the very steep dose curve for Acetaminophen. That is not even a prescription drug, though there are prescription formulations commonly used in hospitals. “They” came after him, trying to damage his academic reputation and interfere with grant applications, academic promotion and so on. So, there can be dark side to the manipulation that goes on; it isn’t just free pens.
I worked for a company that did a national conference for nurse practitioners. We had exhibitors, and sought out big Pharm companies as a draw. It was interesting to me that some required extensive assurance and documentation that their exhibit fees were NOT underwriting the educational content. Somebody has been sued and lost, was my thinking.
I usually would end up abandonng making a comment about this but I’ve hit peak frustration with what I see happening with RFK Jr in America.
It was so transparent, from the moment he started his electoral campaign that this was nothing more than a gd venture for the cranks and kooks selling their tinctures and cures, capitalizing on what are legitimate concerns with the state of modern medicine and food production.
But much like the pharmaceutical industry, they have got no interest in addressing the underlying issues, but rather substituting themselves and their woo woo bs products to cash in by destroying the public health system. It is dismaying how these predators only see these issues as nothing more than an opportunity to line their pockets.
What still astounds me, is RFK called both the Trump and Harris campaigns offering his support to either campaign in exchange for a promised cabinet post. AND YET this man raising his ass like a bitch in heat for whoever would give him his fill never made even a remote dent in his credibility.
I can understand institutional weakness and the skepticism, if not apocalyptic feelings about shutting down, destroying or what have you about bodies like the CDC, but I rarely if ever see a single thought put towards what comes next other than a belief that the law of the jungle will suffice.