Welcome to the March issue

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by David Woods (dwoods@rxcomms.com)

A recent article in the Journal of the American Medical Association (JAMA) concluded that women who stopped taking their antidepressant drugs during pregnancy were at greater risk of relapsing into depression.

But several newspaper and television reports latched onto the fact that most of the JAMA article’s 13 co-authors are consultants to pharmaceutical companies that produce antidepressant medications.

This kind of relationship between key medical specialists and the pharma industry isn’t new. The industry funds a significant number of medical research projects, as well as continuing medical education conferences and scientific publications.

In fact, the JAMA article was funded by the National Institutes of Health with no support from industry. And, as the study’s designer and the analyst and interpreter of its data pointed out: “[It] clearly and strongly suggested that… women who choose to discontinue antidepressant medication during the course of their pregnancy have a substantially greater risk of relapsing into a depression episode compared with those who choose to remain on their medication.”

Moreover, media focus on the perceived conflict of interest among the study’s authors has a negative public health impact and does a disservice to women, who may be confused by the conflicting messages.

That said, there remains an issue of complete transparency and rigor on the part of medical journals. JAMA’s editor said that the journal wasn’t aware of the relationship between some of the authors and the pharmaceutical industry. But it should have been. The International Committee of Medical Journal Editors (ICMJE), of which JAMA is a member, is explicit in the matter, requiring that putative journal authors disclose all potential conflicts; and moreover, to state explicitly that they have no such conflicts.

ICMJE specifically states that “conflict of interest exists when an author… reviewer, or editor has personal or financial relationships that inappropriately influence (bias) his or her actions.”

When you as a potential author submit a manuscript, you’re responsible not only for disclosing all financial and personal relationships but also for stating explicitly whether potential conflicts do or do not exist. The World Association of Medical Editors (WAME) offers a further definition of conflict of interest: “some fact known to a participant in the publication process that if revealed later would make a reasonable reader feel misled or deceived (or an author, editor or reviewer feel defensive).”

And editors must apply stringency by what the ICMJE calls “declining to consider papers unless the authors can attest that they had full access to the data and control over the decision to publish.”

In all of the fuss over the JAMA article, the point was not that it was a matter of duplicity but of laxity. Authors need to be more open about their affiliations, and editors more rigorous in making such connections known to readers. But in the final analysis, patients need to be served by findings they can trust.

No commercial or financial interests supported or influenced the content or contentions of this editorial.

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Drs Lofland (pictured left) and Pizzi (right) are members of Jefferson Medical College’s Department of Health Policy where both are associate professors. They are co-authors of Economic evaluation in US healthcare: Principles and applications (you can find it at Amazon.com.)

The book isn’t just for health economists, they say, but rather it's designed for any healthcare decision-makers… anyone designing or interpreting health economics studies. The health economics group at a major device manufacturer bought 100 copies of the book to disseminate within the company. In fact, Jennifer and Laura agree that scientists don't always understand health economics, in part because they want absolute, black-and-white answers. Health outcomes research is more of a social science, they contend, and is characterised by a lot of grey nuance. Hence, their book also serves to demystify the subject.

The pair believe that while health economics is still a relatively young discipline, broader issues in the current $1.8 trillion US healthcare system are providing the field with a higher profile and greater opportunities. For instance, as federal and state governments increase spending on healthcare services, they'll have to make hardnosed decisions about allocating resources; as employers face rapidly increasing healthcare costs, they want data on the costs and productivity impact of medical treatments. In short, health economists will play a much larger role in decision-making at the highest levels… with presidential candidates of both parties wrestling with how best to streamline the US health system. Even so, they acknowledge, in a market-based system of healthcare delivery there are political constraints engendered by competing and sometimes conflicting interests. In that sense, health economists may have to deal with politics. But there's more consistency in how studies are designed, they believe. And we're ripe for change, they say – a change that also expands the role of health economists into such research issues as the economic impact of such major public health issues as obesity and smoking.

One issue that bothers Jennifer and Laura is when academics are exploited for marketing and promotional purposes – for example, when companies in the pharmaceutical and biotech industries send nearly identical scientific abstracts to several conferences, or ask universities to issue press releases on findings that favour their product. They contend that each contribution to the literature should be unique and published in a peer-reviewed scientific venue. They call on health economists working for the industry to exercise ‘etiquette’ when working with academics as this will ultimately foster credibility within the field.

As for HOC, the pair are big fans, particularly for the publication's emphasis on the whole spectrum of communications; but they say they’d like to see more content listed in the subject line of emails... and catchier titles for articles (editor’s note: we’re working on both).

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Scientific conferences: time for rigorous appraisal

By Mary Gabb (mgabb@rxcomms.com)

Attending national or international scientific conferences is a must for any researchers hoping to stay current in their research area and to network with colleagues. With ever-tightening budgets, however, you may need to be more selective about which conferences to attend. Don't just flip a coin – think hard about what you want to get out of the event.

There are several factors to consider when evaluating a scientific conference. Of course, the essential one is content. Look at the list of topics covered not only in the scientific sessions but also the keynote addresses, and note the speakers and their affiliations. Have you heard of them? Are they from well-known institutions or organisations? You might also consider asking colleagues for their recommendations.

Another important learning opportunity at a conference is the workshops, typically offered in the one or two days preceding the conference. Are there any workshops of interest?

Will the meeting abstracts, presentation slides, or posters be available in an enduring material (eg, a CD-ROM) after the meeting?

Other considerations:

• Scheduling conflicts: are your topics of interest running in parallel sessions, so that you may not be able to attend all of the sessions you want?
• Is the conference held in an easily accessible city (eg, a hub city)?
• Is the conference held in a venue accessible by public transport or by walking? Or will you have to rely on taxis or a conference shuttle?
• Will there be time and opportunity for networking or for meeting some of the speakers?
• If you are looking for a job, will there be some type of job fair?
• Are travel grants available, for which you could apply?

In a perfect world, we’d like to see a formal “meetings critic” who attends conferences and provides a formal review not only of the conference organisation and management but also the individual speakers, similar to the book reviews by readers on Amazon.com. Until then, it is up to each of us to vote with our feet and carefully consider how we spend our travel budgets.

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A sample book review, previously published in the British Medical Journal, is available on www.rxcomms.com/HOC/review.pdf

“When I am dead, I hope it may be said:
His sins were scarlet, but his books were read.”
Hilaire Belloc (1870–1953)

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Industry commentary – Compulsory licences in Thailand override international patents

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Next month

HOC is your publication, so please send us your requests or comments. Just email to chris.gardiner@rxcomms.com.

Previous issues

If you have missed any of our earlier issues, email chris.gardiner@ rxcomms.com for a copy. See the HOC page on the Rx website for a full list of previous articles.

HOC is available for print in pdf format – free

You can of course print this e-zine straight from your inbox (for best results select landscape in your printer’s print set up), but HOC is also available as a professional 4-page A4 newsletter in pdf format for you to print and keep for reference. Simply email chris.gardiner@rxcomms.com for past copies. If you would like to be sent a pdf version each month let us know and we’ll send one as soon as it is available.

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Healthcare Outcomes Communicator is designed to help you explain and enhance your role and value as healthcare economists and outcomes researchers. But we need input from you – the professionals working "in the trenches". So we encourage you to give us your feedback about how we're doing – to communicate with us so that we can better communicate with you.

Yours sincerely
David Woods and the Rx Communications team

This material is published in good faith and is subject to editorial scrutiny before publication, however no warranty or guarantee of its accuracy is expressed or implied. No liability will be accepted by Rx Communications for any loss resulting from use of this resource. Our regular readership are assured that their details will not be passed on or used in any other promotional activity without permission.
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