Can the Watchmen save Boston doctors from conflicts of interest?

Health Wonk Review is a “roving digest” of notable blogs entries about health policy. 

This week, Medicaid Front Page hosts, with an entry that would make my comics-reading son happy – The “Watchmen Edition.” Each entry is linked to one of the superheroes in this movie, which is opens today. (My contribution  earned Dr. Jim Kim a Nite Owl comparison.)

 It may take a superhero to sort out our health care system. Today’s Globe has yet another story about another MGH child psychiatrist under investigation. Dr. Jeffrey Bostic allegedly promoted the use of Forest Laboratories’ antidepressants while accepting $750,000 in fees for talks he made about the drugs. The FDA has not approved the drugs for children and the company has admitted to withholding negative research about Celexa and kids.

 (Note – It is illegal for drug companies to promote off-label (non-FDA approved) uses for their drugs. But it is legal for doctors to prescribe a drug like Celexa for children, even though it may not have been tested or approved by the FDA for that purpose. In other words, off-label promotion is banned, but off-label use is tolerated. )

From the Globe:

In a complaint unsealed last week in US District Court in Boston, prosecutors allege that New York-based Forest Laboratories Inc. illegally marketed the drugs Celexa and Lexapro for use in children by paying kickbacks, including lavish meals and cash payments disguised as grants and consulting fees, to induce doctors to prescribe the drugs. They also say the company misled doctors and the public by failing to disclose the results of a negative study.

In the 34-page complaint, prosecutors said that from 1999 to 2006, Dr. Jeffrey Bostic, director of school psychiatry at the hospital, gave more than 350 Forest-sponsored talks and presentations in 28 states, many of which addressed pediatric use of Celexa and Lexapro…. The government said that Bostic became “Forest’s star spokesman in the promotion of Celexa and Lexapro for pediatric use” and that the company paid him more than $750,000 between 2000 and 2006 for his presentations.

Bostic declined to be interviewed, but the hospital gave the Globe a statement describing him as a “highly regarded practitioner and educator in the field of psychiatry.”


Here’s where the Teen Titans come in. (Okay, you’re not a teen in med school but…)

Duff Wilson at the NY Times has a story this week on medical students at Harvard and elsewhere who are opposed to the commercialization of medical schools.


In a first-year pharmacology class at Harvard Medical School, Matt Zerden grew wary as the professor promoted the benefits of cholesterol drugs and seemed to belittle a student who asked about side effects.

Mr. Zerden later discovered something by searching online that he began sharing with his classmates. The professor was not only a full-time member of the Harvard Medical faculty, but a paid consultant to 10 drug companies, including five makers of cholesterol treatments.


I’ve been writing about this stuff for a long time. For some of my work see:

 November 2003, Nature Medicine: The Color of Money: As the line between academia and industry blurs, conflict-of-interest issues have gone from black and white to all shades in between.

 Science for Sale : A Harvard researcher could profit from a product he “independently” reviewed for the National Institutes of Health. The scientific community, dependent on corporate money, has no clear way to handle such conflicts. The Boston Phoenix, April 29, 1999.

 The doctor and his implants: Can doctors with financial ties to medical products put a patient’s best interests ahead of their own? Or do potential payoffs cloud their medical judgment? The News & Observer, March 31 1994.



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