Prestigious journal The Lancet Vol 359 Issue 9315 page 1442 uses a historical example to remind us to critically judge the Doctor’s ℞. In 1745 the Royal Physician recommended tobacco smoke enemas for victims of drowning during immersion therapy sessions – their being conducted as a treatment for mania. The modified bellows were subsequently provided at stations alongside the Thames river by The Institution for Affording Immediate Relief to Persons Apparently Dead. In an 1840 Kennisgeving (Notice) the Mayor of Rotterdam exalts those responsible for a successful resuscitation by rectal fumigation with a tabaksrookklisteer, after which the practice declined – since it was determined that nicotine was toxic.
I’m not sure that I can do this comedic material justice. If your health practitioner holds you underwater too long, they’re equipped to blow poison up your anus and that’ll restore life? There’s no reports of rectal tobacco usage on Antipodean shores for the countless victims of drowning during the settling of the colony. And it’s not known whether British Tobacco influenced medical adoption of the toxic weed as a cure-all. Nor do we descendants of convicts know whether inappropriate inducements are behind current prescriber’s choices. Lacking an equivalent of the US Sunshine Act for open payment disclosure between pharma and researchers, sponsorship remains cloaked in secrecy. Likewise it hasn’t been deemed necessary to copy America’s Office of Research Integrity, seemingly more prudent to deal with misconduct offline.
Medicine Australia’s Transparency Working Group was unable to reach consensus on a roadmap to setting something up in around abouts a coupla years. Health Ministerial policy is strictly hands-off, shown in a Feb 2014 reply to concerns of specific misconduct “[ahem]…. The Department is supporting an industry-led implementation advisory group that is guiding work to strengthen self-regulation including through the design and development of shared communication systems and a common complaints mechanism“. That’s a relief! I was worried that this matter was being managed by the cleaners because none of the TWG members endorsed the Transparency Model, and the Discussion Paper hasn’t been heard of since the month previous when the TWG was disbanded. And while reform languishes under whichever carpet it was swept, we must trust in our antidepressants as truly beneficial. There’s nothing to prove otherwise – death certificates do not have provision for medication regimes. Similarly so long as any medical procedure wasn’t in the previous 24 hours, the Coroner needn’t be told about that either. The offer proposed (and subsequently accepted) in Edition 18 of Medicine Australia’s (MA) voluntary Code of Conduct submission to the ACCC, being for reports disclosing consultancy payments from Aug 2016 means the clock for direct kickbacks has only two years left to run. That’s real self-regulated progress. Although the loophole exempting payments to researchers via an institution requires that we add to our lexicon “Trust me, I’m a Vice-Chancellor”.
MA Education Event reports disclose that healthy funding is indeed available, to specialists. Amongst Pfizer’s 1490 payments in the last reporting year was over a million dollars spend in sending 34 rheumatologists to conferences in the US and Europe, and 1-day pain management seminars locally. How apt that their Immunology Business Manager’s qualification is commercial pilot with a marketing degree! I’m unaware as to whether pregabalin was promoted, but can’t imagine any material presented had been sourced locally (there being almost* no fibromyalgia research conducted in Australia). ProPublica ‘Dollars for Docs’ 2012 scrutiny of Pfizer’s global corporate citizenship showed just $USD2.8m for travel alongside $USD144.2m for research. These ex gratia payments recognise that our Aussie rheumies are more world weary than world class. I nonetheless trust that that one day we’ll convulse with laughter at the arcane and archaic ℞ of anti-convulsants Lyrica and Neurontin for an autoimmune disorder.
* A survey in 2012 of seven Monash outpatients using pregabalin found diminished anxiety. Higher levels of trust also, no doubt.