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                                                       HEALTH
                                                    HEALTH                                                                                                                                                      M
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                                                                                                 Tuesday, Tuesday, 18, 2009 2009
                                                                                                     E6 August August 18,                                         Tuesday, August 18, 2009
                                                                                                                                                               DM VA                                                                        HEALTH DM VA



Probing                                         Probing                                                  Medical Community
                                                                                                         Frets Over Conflicts
Doctors’                                        Doctors’                                                 CONFLICTS, From Page E1



Ties to                                         Ties to
                                                                                                         about how pharmaceutical compa-
                                                                                                         nies pay doctors. Does that hap-
                                                                                                         pen?’ That is a nice way of opening
                                                                                                         up the topic,” he said.
                                                                                                            Carlat has written about the


Industry                                        Industry
                                                                                                         conflicts of interest he experienced
                                                                                                         while promoting a controversial
                                                                                                         antidepressant to other doctors for
                                                                                                         a pharmaceutical company. In a
                                                                                                         New York Times Magazine essay,
                                                                                                         he recalled putting some of his crit-                                       ISTOCKPHOTO

By Ibby Caputo                                  By Ibby Caputo                                           ical faculties on hold while being
Washington Post Staff Writer                    Washington Post Staff Writer                             wined and dined with other lead-             said he realized he felt beholden to
                                                                                                         ers in his field.                            the companies that paid him. He
   You may not be able to trust your mort-         You may not be able to trust your mort-                  “Doctors are not immune to                said the money he earns from indus-
gage broker, your car salesman or your          gage broker, your car salesman or your                   marketing,” he said in a phone in-           try now goes directly to charity.
congressman, but you can trust your doc-        congressman, but you can trust your doc-                 terview. “Marketing works for peo-              “The trust of our patients is so
tor.                                            tor.                                                     ple who have very little education,          important. I never want a patient
   Can’t you?                                      Can’t you?                                            and marketing works just as well             to not take a medicine because
   Patients might well ask themselves              Patients START! themselves
                                                             might well ask                                                   START!
                                                                                                         for people who have had 10 years             they are concerned that I might   FINISH                                                             FINISH
this question when they learn that 94 per-      this question when they learn that 94 per-               of education after they graduate             have a financial interest,” said
cent of physicians have “a relationship”        cent of physicians have “a relationship”                 from college.”                               Nissen. He said that because pa-
with the pharmaceutical, medical device         with the pharmaceutical, medical device                                                               tients are unlikely to challenge
or other related industries, according to a     or other related industries, according to a                                                           their doctors, patients would be
national survey of physicians published         national survey of physicians published
                                                                                                         A Matter of Trust                            the big beneficiaries of rules re-
two years ago in the New England Jour-          two years ago in the New England Jour-                 In 2003, the District passed a law             quiring more transparency.
nal of Medicine.                                nal of Medicine.                                    that requires drug manufacturers to                  Once there is a public database
   It is unclear how much those busi-              It is unclear how much those busi-               disclose their marketing expendi-                 of the sort described in the Grass-
nesses spend on marketing overall, but          nesses spend on marketing overall, but              tures to the city health department,              ley-Kohl bill, he said, “you don’t
Integrated Medical Systems, a research          Integrated Medical Systems, a research              though the information is not pub-                have to confront your orthopedic
firm, estimates that pharmaceutical com-        firm, estimates that pharmaceutical com-            licly available. Several states have              surgeon about whether he has
panies spend more than $20 billion an-          panies spend more than $20 billion an-              passed or considered similar laws,                ties to the company that makes
nually marketing directly to doctors.           nually marketing directly to doctors.               some that include a ban on industry               the knee replacement; you can
   It does seem clear, however, that many          It does seem clear, however, that many           gifts to physicians.                              just look it up.”
patients want a better sense of the links       patients want a better sense of the links              In January, Sen. Chuck Grassley                   “Once the information is out
their doctors have with industry.               their doctors have with industry.                   (R-Iowa) and Sen. Herb Kohl (D-                   there . . . patients will realize that
   A consumer survey last year by the              A consumer survey last year by the               Wis.) introduced legislation — the                there are a lot of physicians in-
Pew Prescription Project, an initiative to
help eliminate conflicts of interest in pre-
                                                Pew Prescription Project, an initiative to
                                                help eliminate conflicts of interest in pre-
                                                                                                    Physician Payments Sunshine Act
                                                                                                    — that would require drug and
                                                                                                                                                      volved in [relationships with in-
                                                                                                                                                      dustry] for the betterment of pa-                   Hundreds Camp Out to R
scribing, showed that 68 percent of re-         scribing, showed that 68 percent of re-             medical device manufacturers to re-               tients,” said Rafael Fonseca, a he-
spondents supported legislation that            spondents supported legislation that                port payments to any physician of                 matologist and the deputy                  Hundreds of people camped outside an are-                          peop
would require public disclosure of finan-       would require public disclosure of finan-           more than $100, whether as a gift                 director of the Mayo Clinic Can-        na in Inglewood, Calif., last week for a chance                       proof
                                                                                                    or for research purposes, and to                  cer Center. Fonseca is on the           to get free medical services, such as eye                             sary.
                                                                                                    publish the information online.                   steering committee of a new or-         exams, mammograms, root canals and X-rays,                            the L
“I never want a patient to not                  “I never want a patient to not                         “PhRMA supports the concept                    ganization called the Association       administered by volunteer doctors and nurses.                         were
                                                                                                    of transparency,” said Marjorie                   of Clinical Researchers and Edu-           Fifteen hundred treatment tickets were dis-                        when
take a medicine because they                    take a medicine because they                        Powell, senior assistant general                  cators (ACRE), formed in re-            tributed to the crowd, composed primarily of                            Th
are concerned that I might                      are concerned that I might                          counsel for Pharmaceutical Re-                    sponse to what it calls the “anti-
have a financial interest.”                                                                         search and Manufacturers of                       industry movement.”
                                                have a financial interest.”                         America (PhRMA), an industry or-
   Steven Nissen of the Cleveland Clinic,            Steven Nissen of the Cleveland Clinic,                                  ILLUSTRATION a na-
                                                                                                    ganization. “We think that BY ALLISON GHAMAN — THE WASHINGTON POST
                                                                                                                                                 Too Much Information?




                                                                                            Rx: Xbox?Xbox?
                                                                                                 Rx:
  who says the money he earns from industry        who says the money he earns from industry        tional reporting system makes
                                                                                                                                                                                             ILLUSTRATION BY ALLISON GHAMAN — THE WASHINGTON POST




                                                                                                                                                                                                      Video Games H
                 now goes directly to charity                       now goes directly to charity    much more sense than different                   Fonseca said the conflicts-of-
                                                                                                    state reporting systems.” PhRMA              interest issue has made for a
                                                                                                    has endorsed the Physician Pay-              stressful environment in the med-
cial relationships between physicians and       cial relationships between physicians and           ments Sunshine Act.                          ical community.
industry. Seventy-eight percent believed        industry. Seventy-eight percent believed               While many patients would like                “There is a big fear factor
that accepting gifts from the pharmaceu-        that accepting gifts from the pharmaceu-            to learn about potential conflicts of        among physicians,” he said. “Peo-                GAMES, From Page E1
tical industry influences their doctors’        tical industry influences their doctors’            interest, some physicians and in-            ple are afraid of saying that they
prescribing habits, but only 34 percent         prescribing habits, but only 34 percent             dustry representatives point out             work with industry.”                             points. In her favorite version, col-
said they would be likely to ask their doc-     said they would be likely to ask their doc-         that not all physician-industry rela-            But how much information is                  ored gems drop endlessly onto the
tors about potentially troubling financial      tors about potentially troubling financial          tionships are bad; some are essen-           too much?                                        screen, and Nichols said she falls
ties.
   Short of asking, patients have few op-
                                                ties.                          Researchers Explore Mental Researchers Explore Mental Health Benefits of Video G
                                                   Short of asking, patients have few op-
                                                                                                          Health Benefits of Video Games
                                                                                                    tial to the development of new
                                                                                                    therapies.
                                                                                                                                                     Avi B. Markowitz, who is also
                                                                                                                                                 on the steering committee of
                                                                                                                                                                                                  into a trance of simultaneous con-
                                                                                                                                                                                                  centration and relaxation that she
tions for gaining such information.
                                                tions for gaining such information.                    “Certain relationships are nec-           ACRE, said doctors are entitled                  calls Zen.
   “I think that is a genuinely difficult and                 By Shankar Vedantam
                                                   “I think that is a genuinely difficult and
                                                                                                                  were surprised to hear about its possible
                                                                                                                         Byhealth benefits, and theircompany Markowitz, a Reviewthe Cybertherapy and Te- directs
                                                                                                                              Shankar Vedantam
                                                                                                    essary, and research is a good               to              privacy.
                                                                                                                                                                             the Annual             of
                                                                                                                                                                                    were surprised to hear about its possible
                                                                                                                                                                                                      Carmen Russoniello, who                       the Annual Review o
awkward conversation to have,” said Al-                       Washington Post Staff Writer                        mental                               the                   lemedicine. Now,            company is about to
                                                awkward conversation to have,” said Al-             example,” CoukellWashington Post Staff Writer oncologist at the Univer-
                                                                                                                          said. Many peo-        medical                            mental health benefits, and the companybio-
                                                                                                                                                                                                  the psychophysiology lab and                      lemedicine. Now, th
lan Coukell, the director of the Pew Pre-                                                                         decided to study Bejeweled’s untapped po-                  launch a second phase of testing to see if
                                                lan Coukell, the director of the Pew Pre-           ple in the medical community                 sity of Texas Medical Branch in                  study Bejeweled’s untapped po-
                                                                                                                                                                                    decided to feedback clinic at East Carolina                     launch a second pha
scription Project.                                               Gail Nichols has suffered from depres-           tential systematically. In a preliminary                   the video games can have measurable ef-
                                                scription Project. for years. When the 49-year-old resi-to agree.
                                                                                                    seem                                           suffered from depres-
                                                                                                                            Gail Nichols has Galveston,                                                                      a preliminary
                                                                                                                                                                                    tential systematically. inInGreenville, N.C., is
                                                                                                                                                                                                  University                                        the video games ca
   “Patients are very averse to getting                       sion                                                study that PopCap commissioned and said it is entirely ap-
                                                                                                                                                                    fund-    fects on clinical markers of depression.
into antagonistic relationships with doc-                                                                          lose sight for the fact that the 49-year-old resi- Thestudy
                                                                                                                         sion of years.
                                                               are of St. Marys, Kan., cannot sleep, “We can’t ed, researchers foundWhenvolunteers who to report what thatis part ofcommissioned and fund-
                                                   “Patients dent very averse to getting                she                                      propriate for him                   research PopCap a broad array of research
                                                                                                                                                                                                  conducting the controlled                         fects on clinical mark
tors,” said Cheryl Matheis, senior vice                       falls                                                      dent of St. Marys, Kan., improved agencies, toed, researchers found that volunteers he
                                                                     relationships of entertainment that is is potentially beneficial [todisplayed cannot sleep, sheunconventional efforts that PopCap.game who has
                                                into antagonisticback on a formwith doc-            that it       played Bejeweled               he makes to tax                     his          studies for video He said                            The research is p
president of health strategies at the sen-      tors,” said Cheryl Matheis, senior vice as a medical
                                                              gaining increasing credibility                               and heart a form employer and to
                                                                                                    the public] for industry to interact ofcompared withthat iscompanies are Bejeweledto displayedpattern among
                                                                                                                  moodfalls back onrhythms entertainment regulatory bod-            played devising thefind new mar-
                                                                                                                                                                                                  found                same         improved        unconventional effo
ior citizen advocacy group AARP. “They                         health strategies at the sen-
                                                president ofintervention: video games.              with physicians, because someone playing. heas pre-
                                                                                                                         gaining increasing ies. But The a medicalkets physi- products. volunteers: Certain with
                                                                                                                  volunteers who weren’t credibility questioned how for their and manyMany of these steps games al-
                                                                                                                                                                                    mood           heart rhythms compared                           companies are devis
get farther if they walk an inquisitive line    ior citizen advocacy group AARP. “They the mental to develop thesestudy wasvideo games. year in to disclose toon the low people to fall into a pre-
                                                                 Nichols said she discovered        needs                intervention: published this be asked
                                                                                                                  liminary drugs,” said          cians can                          volunteers idea that depression and rhythm
                                                                                                                                                                             are based             who weren’t playing. The                         kets for their produc
as opposed to an accusatory line.”                                                                                          Nichols said          discovered the mentalother liminary study as they can playthis year either
                                                get farther ifhealthwalk an inquisitive games someSteven Nissen, chairman of the De-she other parties information about fi-
                                                               they benefits of video line           years                                                                                        — was published without in
                                                                                                                                                                                    disorders where well as everyday                                are based on the ide
   “We tell our patients they should have                                                                                health benefits
                                                as opposed to an during a particularly bad spell partment of Cardiovascular Medi-of video games some yearsstress and worry — involve systematic pat-
                                                              ago   accusatory line.”               of de-                                       nancial ties to industry “without                effort or boredom. Russoniello said               other disorders —
conversations with their doctors, and we           “We tell our patients they should have           cine at                                      at the same time de-terns per-
                                                                                                                         ago during a particularly bad spell ofgiving up of thought someself-doubt, and to activate the
                                                              pression. She had just started playing a the Cleveland Clinic. “I                                                                    and games seem that                              stress and worry —
tell them they should write [their ques-                                                                                                          just rights playing agames are
                                                              game their Bejeweled, which requires with many pression. She had sonalstartedand freedoms thatcan distract people and put them in a system,
                                                conversations with calleddoctors, and we            work                   pharmaceutical                                                         parasympathetic nervous                           terns of thought an
tions] down because patients usually get                      players to move gems into                                   believe it is Bejeweled, which to surrender.”
                                                                                                    companies, and I game calledmy
                                                tell them they should write [their ques-rows based on                                            unreasonable requiresdifferent mental which You don’t have to
                                                                                                                                                                                                  zone. can reduce the heightened                   games can distract p
nervous,” Matheis said.                                                                                                   physician move              into rows based onplay with a
                                                tions] downtheir color. When usually get get toresponsibility as aplayers to to fa- gemsIn Coukell’s opinion, transpar- computer or an Xboxa natural response to
                                                               because patients she could not        sleep                                                                                        tension that is 360 to no-                        different mental zon
   Daniel Carlat, a Massachusetts-based                                                                                  their color. new
                                                nervous,” Matheis said.and was tormented by mental the development of When she couldthe answer.
                                                              one night                             cilitate                                     ency is not get to sleeptice the effect: Anyone who has used a
                                                                                                                                                                                                  stress.                                           play with a computer
psychiatrist, agrees the topic is sensitive.       Daniel Carlat, a Massachusetts-based the computer
                                                              pain, she said, she turned on         therapies.”                                      “We are by mentalcrossword
                                                                                                                         one night and was tormented always balancing be- puzzle The Sudoku game hypothesized
                                                                                                                                                                                                      or         researcher to                      tice the effect: Any
“When you are a patient, the last thing         psychiatrist,and played the game for hours.
                                                               agrees the topic is sensitive.                            pain, she said, she tween privacy and public good,”
                                                                                                       Nissen said he has received tens turned on the computerdecompress after that one reason for the apparent
                                                                                                                                                                                                  a difficult day recognizes                        crossword puzzle
you want to do is alienate your doctor or                        “In patient, the last thing                             and from indus-
                                                                                                    of thousands of dollarsplayed the game for hours. “I think there is an
                                                “When you are a the day, you can find someone to talk                                            Coukell said.               the idea.            mental health benefits of video                     Gail Nichols says a d
                                                                                                                                                                                                                                                    decompress after tha
cause any negativity,” he said.                                                                                             “In the day,
                                                you want to to,”is alienate your doctor or a big helpfor his research and advice. you can find someone to talk . . . that said she liked athat manyof the in West-
                                                              do Nichols said. “Games are           try in                                       emerging consensus Nichols                       games is version people                           the idea.
   Carlat, who publishes a peer-reviewed                                                                                 to,” It becomes
                                                cause any negativity,” he said. the next morning.” “It’s a lot of money.Nichols said. “Games are a big help ingame where she was not competing against
                                                              getting through to                                                                 transparency is for the greater                  ern countries find it impossible to                  Nichols said (A
                                                                                                                                                                                                                                                     stress disorder.she
psychiatry newsletter, suggests bringing                                                                                 getting through
                                                   Carlat, who Nichols liked the game so much that she over the years as you gain to the next morning.”
                                                                  publishes a peer-reviewed         greater                                      public good.”                                    switch off; up are always
                                                                                                                                                                             anyone or trying to rack theymammoth alert and                         game where she was
                                                                                                                                                                                                                                                     for PopCap put Th
up the subject indirectly.                                                                                                  Nichols liked BILL SNEAD FOR THE WASHINGTON that
                                                psychiatry newsletter, suggests the manufacturer, Pop- . . . Your advice becomes the game so muchPOST she
                                                              got in touch with       bringing      stature.                                 BY                                                   stressed out. When those Type A                   anyone or trying t
                                                                                                                                                                                                                                                     with Nichols.)
   “ ‘I’ve been reading in the paper a lot                                                                        A game that touch with through the night.
                                                up the subject indirectly. The inventors of the more valuable,” hegot inmight get you the manufacturer, Pop-See GAMES, Pagepeople try BILL SNEAD FOR THE WASHINGTON POST
                                                              Cap Games.                             game                 said.                  Comments: health@washpost.                         E6
                                                                                                                                                                                                                 BY
                                                                                                                                                                                                                    to relax, they get bored            Russoniello said
                                                   “ ‘I’ve been reading in the paper a lot                               Cap Games. The com.
                                                                                                       But about five years ago, Nissen inventors of the game                       A game thatbecause they have come tonight. a
                                                                                                                                                                                                   might get you through the require                See GAMES, Page E6
                                                                                                                                                                                                                                                     phase of the study,
See CONFLICTS, Page E6                                                                                                                                                                            certain level of stressful arousal.                domize patients wh
                                                See CONFLICTS, Page E6                                                                                                                            Playing certain video games, Russo-                criteria for depres
                                                                                                                 Seniors can live at home,                                                        niello said, offers just enough men-
                                                                                                                                                                                                  tal challenge to keep such people oc-
                                                                                                                                                                                                                                                     groups. One will be a
                                                                                                                                                                                                                                                     up material on the I
PROBING DOCTORS’ TIES TO INDUSTRY by Ibby Caputo

During a conversation about conflicts of interest while at the Kaiser orientation, I e-
mailed my doctor and asked if he received money from pharmaceutical companies. His
answer – “Yes” – disturbed me greatly and raised many questions that he would not
answer over e-mail. This was my impetus for writing a story investigating physician-
industry relationships.

My editors warned me that this topic was so broad it could bog me down, but I was
determined. While the subject had been discussed within the medical community and
among policy makers, no stories had been written from a patient’s perspective. I did a
ton of reporting and research. The most challenging part was figuring out the agendas
of those I interviewed and how those agendas affect the consumer. After working on the
story for most of the summer, it was finally published on the cover of the Health section.
It was also syndicated in several other newspapers, including The San Francisco
Chronicle. The majority of the feedback I received was from reader-patients who said
they had thought about the issue, but would not dare speak to their doctors about it.

This article, which originally ran on August 18 2009, has been reproduced in its entirety on our
website with permission from The Washington Post.

				
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Description: Xbox is the world's largest computer software company, developed by Microsoft, sales of video game console. In the game market, Xbox and Sony PlayStation 2 Sony's and Nintendo Game Cube issued by the company formed the situation of the Three Kingdoms.