Thrills, Spills and Big Pharma Shills

Cross-posted from Subspecies

“Big Pharma shill” has been bandied around so much that it has really started to lose all meaning. Your family doctor is a dealer, the hospital doctors promote drug dependency, scientists have blinders on to all but positive data about drugs, and anyone who says otherwise is brain washed. However, sometimes, there are actual shills for “Big Pharma.” Take, for instance, Ronald C. Petersen, M.D., Ph.D. He recently wrote a Clinical Practice article for the New England Journal of Medicine, detailing what’s currently known about the etiology, diagnosis, progression and treatment of mild cognitive impairment, and makes recommendations for clinicians seeing someone with mild cognitive impairment in their practice. He’s a director for the Mayo Clinic’s research centre on Alzheimer’s. He’s also a (cue ominous music) Big Pharma Shill.

Dr. Petersen reports receiving consulting fees from Elan Pharmaceuticals and GE Healthcare, receiving royalties from Oxford University Press, and serving as chair of data monitoring committees for Pfizer and Janssen Alzheimer Immunotherapy.

With odious credits like working for both GE and a pharmaceutical company, being paid to write books, and playing watchdog for Pfizer, surely the recommendations were to drug them up, use expensive equipment to poke and prod patients, and admit them to a care facility immediately to start billing the insurance company!

…Or not. (Emphasis added)

Depression should be ruled out. Referral for neuropsychological testing may be appropriate, particularly if the concern is the degree of impairment relative to the cognitive changes of aging…  An MRI scan is suggested to rule out other conditions that might explain her memory loss (e.g., vascular disease, tumor, or hydrocephalus); the results might also show changes (e.g., hippocampal atrophy) suggesting that she is at increased risk for rapid progression to Alzheimer’s disease, although more data would be needed to justify the use of MRI for this purpose.

…  At this time, I would not routinely recommend tests to predict the risk of progression (e.g., 18FDG-PET or measurement of biomarkers in cerebrospinal fluid) but would encourage the patient to consider participation in research evaluating these tools. I would explain that at present there are no FDA-approved medications for this condition; I would also review the negative results of medication trials thus far and explain the costs and potential side effects of pharmacotherapy. I would recommend engagement in aerobic exercise, involvement in intellectually stimulating activities and participation in social activities, given that these might be beneficial and pose little risk, although more data are needed to inform their efficacy in reducing the risk of progression to the dementia stage of Alzheimer’s disease.

It’s true! The “Big Pharma shill” is saying, you know what, don’t waste your time and money on fancy tests because we’re not sure they’ll work. He’s explaining to his patient that medication is not a good option due to all the failed trials out there, and explaining why the drugs would be expensive and harmful. What should his patient do instead? Exercise her body, and exercise her brain. Why? The evidence is unclear on all current therapies for halting Alzheimer’s progression, the cause of mild cognitive impairment is probably multi-factoral, and until we know why it happens, we can’t stop it from happening.The drugs available to treat it are cost-prohibitive and detrimental to the patient’s quality of life in other ways. Many people who develop mild cognitive impairment will not progress to dementia, and our tests are just not good enough to distinguish between the stable individuals and the ones who need intervention. There is some demonstrated benefit to physical and intellectual stimulation, and there’s no downside to it.

When it comes right down to it, he’s saying it because the evidence is unclear, and this is how a good doctor and scientist deals with muddy evidence, no matter who is paying his salary.