Beware the commercial bias

Over lunch I listened to plugs

For some marginal toe-nail drugs

We don’t have any more

Of the big disease score.

We’ve got shots for most of those bugs

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. I spent the winter in Nome, Alaska, followed by assignments in rural Iowa. This summer included a funeral, a bicycle tour in Michigan, cherry picking in Iowa, and two weeks a month working Urgent Care in suburban Pennsylvania. I’m attending a medical conference in Denver.  Any patient information has been included with permission.

The first lecture I attended at the American Academy of Family Practice Family Medicine Experience (AAFP FMX) included a very nice lunch, and an unappetizing talk on toenail fungus, or onychomycosis.  I don’t mean that the slides depicting deformed toenails took away my appetite; rather, I found the commercial bias disgusting.  We have new agents that, according to the presenters, work better than the old agents, but at best they bring a 35% cure rate.

The next lecturer, playing by the book, revealed commercial connections to several Big Pharma companies.  The presentation that followed would have bored me to tears if it hadn’t put me to sleep.  The format consisted of study after study in excruciating detail, all research sponsored by drug companies.

But the next two talks had nothing in their full disclosure statements and featured evidence-based meta-analyses with rank ordered recommendations.  One presenter qualified as a gifted teacher and a passable stand-up comedian.  He made the analogy between musculo-skeletal injuries and crime scenes: identifying the victim comes easy, but identifying the culprit takes work and wisdom.  Thus applying ice to a painful knee matters less than finding the weak muscles and tight tendons that led to the problem in the first place.

I have come to terrible cynicism regarding the American pharmaceutical industry.  They make wonderful drugs for the most venal of motives.

In a discussion over lunch, I talked to a doc who has been working in Africa for the last couple of decades.  He helped put the small pox genie back in the bottle, and is very cynical about the possibility of ending polio.  He retired into private practice but prior to a a year ago, he worked for an NGO.  Around the table we talked about how vaccinations have made the biggest changes in our business.  Most docs finishing residency now have never seen measles, mumps, polio, epiglottitis, or periorbital cellulitis.  Polio was rare when I did my training; if my sister hadn’t had it in 1953 I would never had seen it.


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