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Vinay Prasad MD MPH @VPplenarysesh
, 22 tweets, 10 min read Read on Twitter
This series by @charlesornstein and @katiethomas about financial conflicts in medicine is devastating; Should win the @PulitzerPrizes
Some thoughts
[THREAD]
nytimes.com/2018/12/08/hea…
In addition to outright failure to disclose, the profession treats disclosure as a token gesture

Aaron Boothby former @OHSUSOM student found 38% of conflict slides at ASCO flash faster than humans can read!
drive.google.com/file/d/1rBh7z7…
@StellaYooMD and @awadahmedMD find virtually identical findings in a different specialty
Why? Because docs don't give a #^$-- its a token disclosure
ascopubs.org/doi/abs/10.120…
The crux of the issue though isn't disclosure, but whether it is appropriate for doctors to stuff their pockets with pharma cash (personal payments) while using their drugs and recommending them for off label use in guidelines like NCCN
In the @hastingscenter Kevin De Jesus and I argue that financial conflict in medicine is no different than political corruption
Just that doctors get a break because the profession is more respected than politicians
researchgate.net/publication/31…
.@PreetBharara put a congressman in prison for engaging in a financial relationship that looked like this (and rightly so)
(he now has a great podcast @StayTunedPreet )
In contrast, we turn a blind eye to the exact same relationship in medicine.
Take another look at the patient advocacy group part-- some of these sham groups do little more than launder pharma money silent about drug prices-- shameful
researchgate.net/publication/31…
The 'experts' in oncology are not better, but worse than the average oncologist.

My former fellow Austin Lammers showed the 'experts' who peddled for companies at @FDAOncology ODAC had these payments from Pharma
drive.google.com/file/d/10X5-WM…
Oncologists on twitter are happy to be 'Twitter cheerleaders' singing about costly, marginal drugs while taking cash from the sponsors.
As @dlawtao showed
drive.google.com/file/d/10KPQ-3…
85% of NCCN guidelines writers take pharma money while recommending there drugs for off label uses (As @TheWonkologist and @DusetzinaS show)
Which mandates CMS to pay!
jamanetwork.com/journals/jamao…
We weren't surprised then to find that most of that extrapolation was based on lousy evidence, if any given at all
drive.google.com/file/d/1z5jg87…
Spoiler alert: the problem here requires more than disclosure.
It requires DIVESTURE
Personal payments from Pharma to physicians must end.
They make no sense.
They are akin to corruption
The public is not happy with these relationships. Failing to disclose just shows how arrogant and dismissive the profession has gotten. The relationships are problematic.
Bottom line:
1. If you are a doc, sever all financial ties of your own accord. Tic toc,,,
2. Our profession must end these practices, otherwise politicians will end it for us with a blunt instrument
3. Taking 100k per annum from Pharma and writing guidelines that mandate CMS to pay for drugs (like NCCN) is deeply problematic. It cannot be tolerated going forward
4. History will not judge this well.
5. Each year at ASH & ASCO, I hear trainees admire 'experts' for how many hundred k they stuff in their pockets... this is not good people. We are not modeling good behavior. It is lamentable.
6. If you comment on this thread and don't understand the distinction btw CMS open payments general or personal payments and research payments, then I don't have time for you, and neither should anyone else.
7, When you see an oncologist on twitter call a drug that improves survival 10 days or PFS 1 month a "miracle" or "gamechanger" look up their financial conflict here... you are gonna get it
projects.propublica.org/docdollars/
8. These conflicted doctors also love to say 1. why randomized trials are not possible and 2. why PFS or RR and not OS should be the trial endpoint 3. Why a straw man control was acceptable and 4. why lousy post protocol therapy is ok
Why?
projects.propublica.org/docdollars/
9, Because all those things prioritize profits over patients
10. I call many of the "Twitter cheerleaders"
Here is why
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