Public trust, the CDC and Tamiflu

Why do doctors lose credibility?

Consider the few public doctors out there with millions of followers. The majority of the stuff they recommend is perfect: eat good food, exercise, be nice. and sleep. Check. No problem. Everyone is good with that until they shatter the sense with nonsense. One miracle cure or stupid supplement or financial conflict ruins everything.

That goes, too, for the Centers for Disease Control (CDC). These guys must have the highest of the moral ground. For if we are to believe them about public health matters, there can be no conflicts of interest. The public good, pure evidence, that is all.

I recently wrote about social media. One thing that marketing gurus teach is that social media has heightened the collective BS meter. Staci and I talked about that last night in regards to gaining physician respect in the new generation. The next generation of people are not gifting experts/doctors respect on lore alone. The respected doctor or health organization of the future will be transparent, consistent and humble.

Now to the oseltamivir/Tamiflu CDC trust problem.

The CDC has a Take Three program for Influenza. The third thing they recommend is to take anti-virals (like Tamiflu) if your doctor prescribes them. CDC director Dr Tom Frieden said three flu medications (Tamiflu, Relenza and Rapivab) can prevent “serious complications” and help people avoid hospitalization.

But that is not what the FDA says.

Christie Aschwanden reports on FiveThirtyEight that the FDA, who relies on stronger clinical trial evidence, does not allow the makers of anti-viral meds to make those claims. All the FDA will allow is a statement to the effect that the drugs may reduce symptoms by one day. Two federal agencies, two different statements.

Jeanne Lenzer is an independent journalist and an associate editor for The BMJ. She uncovered a money trail to the CDC, which was guest-posted on the Health News Review site. This is not good.

I spent almost two weeks researching the funding trail before my story was ready to go. What I found was deeply disturbing. Roche had provided a “directed donation” to the CDC through the CDC Foundation for the Take 3 campaign. And there was more. Substantially more: I learned that the CDC Foundation provides an average of $6.3 million in industry funding annually to the CDC.

There was more money to follow. Ms. Lenzer then looked into the large industry-sponsored meta-analysis on Tamiflu, which was published in The Lancet. Not only was the study funded by industry, but “all four researchers received industry funding either directly or through industry donations to organizations that directly funded the study (so-called “pass-through” money).”

On the distrust issue, Daniel Henninger of the WSJ recently wrote a strong warning to scientists about credibility.

The second problem, which can crush such remarkable achievements, is the eroding credibility and authority of science. If too many people think even scientists are lying to them, humanity is headed toward the lemmings’ famous cliff.

The reason I write on this matter is that the best part of being a doctor was having the public trust. It was cool that people thought of us as legit, altruistic, and honest. But this is a new world, an interconnected one, a one with information democracy. Blemishes are not going to be easily painted over.

If the CDC accepts money from Roche and then falsely inflates Tamiflu’s value and promotes its use against the advice of the FDA, that is a huge problem.

Many good recommendations can be nullified by one bad one–especially if money is involved.

JMM

4 comments

  1. True. And John Oliver’s detailed segment on drug sales tactics will further undermine the credibility of everyday doctors. The poly sci major/pharma purveyor who was asked to help the doctor choose the next Rx to try was horrifying.

  2. GREAT post (!) – that I think explains why a percentage of the public also distrusts other public health recommendations (ie, on issues such as vaccinations … ).

    Jeanne Lenzer has strong reputation as a “fact-finder”. But just yesterday, the Medical Letter (Vol. 57; page 14) issued an In-Brief Statement supporting their recommendation in a prior article on Oseltamivir (Tamiflu) for use of this drug to treat “high-risk patients” with confirmed OR suspected influenza illness. The problem is that the CDC definition of “People at High Risk of Developing Flu-Related Complications” includes a huge percentage of the population (http://www.cdc.gov/h1n1flu/highrisk.htm ). Since I just had my 65th birthday – I’ve become one of those “high-risk” people, despite not having any significant medical problems beyond “my age”. Add in the Medical Letter’s acknowledgment that, “most controlled trials of the effectiveness of these drugs in preventing pneumonia or other serious complications of influenza have not been powered adequately to provide convincing evidence of efficacy …”. So the recommendation in favor of Oseltamivir was made because of “a broad consensus of expert clinicians” who “interpreted the combined results (of the studies that were done)” – with that interpretation now tainted by the “money trail” described by Ms Lenzer …

    This of course is not to say that it is impossible for Oseltamivir to have some benefit for some people who are suspected of coming down with influenza. But with a WAC (Wholesaler Acquisition Cost) for a 5 day course of treatment with Oseltamivir = $120.60 – one wonders what a cost analysis of NNT (Number-Needed to Treat to Benefit 1 Patient) would come up with given the huge umbrella recommendations for treatment. One also has to wonder if that umbrella for treatment recommendations would be so broad if there wasn’t a “money trail” …

  3. Thanks for another spot on post shared on FB. I mistakenly thought the medical establishment had accepted that Tamiflu is only minimally helpful (+ side effects!), but then I recently saw an upbeat Tamiflu television ad followed by an article that noted a slightly lower rate of hospitalizations in those with certain co-morbidities.

    I met a nice woman who illustrated your point about declining trust in physicians. She shared her motivation to maintain her health through healthy diet and exercise. I was encouraged and thought, “This woman really gets it!” Then she commented that she was sure doctors “just want to push more and more pills down our throats,” and “get kickbacks” for prescribing meds.

    I didn’t tell her I’m a doctor, and that I *desperately* want patients to treat hypertension, diabetes, and cholesterol through diet and lifestyle so that most people would take less or no medication. I didn’t tell her that I don’t get “kickbacks” for prescribing medicines, but I do get in trouble from a guidelines perspective if I fail to prescribe certain medications for patients with certain diseases.

    I agree that the medical system has perverse incentives and encourages cookie-cutter care that doesn’t work for many people. I personally feel Western medicine can be great for saving lives acutely but is no match for diet, exercise, and stress reduction in managing the chronic diseases that affect too many patients.

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