U.S. CHOLESTEROL ADVISERS HAVE COZY TIES TO DRUGMAKERS
Published: Sunday, October 17, 2004
NEWS 11A
By Marilynn Marchione
Associated Press

    They led influential medical groups, starred at prestigious meetings, published in top journals and were undisputed giants in their field.
    But when these doctors advised the government recently on new cholesterol guidelines for the public, something else they had in common wasn't revealed.
    Eight of the nine were making money from the companies whose cholesterol-lowering drugs they were urging. Two own stock in them. Two others went to work for drug companies shortly after working on the guidelines. Another was a senior government scientist who moonlights for 10 companies and serves on one of their boards.
    Consumer groups and others now are questioning not only the advice these doctors gave but also their ability to act in the public's best interest.
    It comes as some of these companies lobby the government to let drugs at the center of this controversy -- statins such as Lipitor and Zocor -- be sold over the counter. Prominent doctors with ties to statin-makers are urging approval.
    There's little doubt that statins save lives or that too few people take them now. But critics say the doctors' coziness with drug companies compromises their credibility and undercuts their latest advice that more people would benefit from these medications.
    Conflicts of interest are increasingly common now that two-thirds of medical research at universities is funded by private industry. Twenty years ago, only one-third was.
    "The government is not producing drugs. All the big statin trials have been paid for by the companies,'' said Dr. Scott Grundy, a University of Texas Southwestern Medical Center cardiologist who headed the cholesterol panel.
    Government has its own problems. A ban on private consulting was lifted a decade ago, and recent years have seen one scandal after another involving federal scientists taking money from companies directly affected by their decisions.
    Conflicts also have bedeviled trusted groups such as the American Heart Association, which rely on private cash for meetings and activities, and the continuing medical-education system, which often gives doctors credits for attending drug-company-sponsored talks.
    The drug industry spent $2 billion in 2001 on events for doctors -- double what it spent five years earlier, Dr. Jerome Kassirer, former editor-in-chief of the New England Journal of Medicine , reports in his new book, On the Take .
    "The time has come to ask whether all of the money floating around medicine has created a pattern of corruption,'' he writes.
    Some say it's naive to think a panel of true experts with no industry ties could be assembled today. Christopher Seymour, executive director of the National Lipid Association, a group that promotes cholesterol control and is largely funded by drug companies, has six of the nine guideline doctors on his board.
    "Who in America is going to write these guidelines if you don't go to the thought leaders? Should I call Dr. X in the middle of Peoria? What gives them credentials to be on my board?'' he asked.
    The statin flap involves drugs with so much science behind them that doctors only partly joke about putting them in the water supply.
    More than half of U.S. adults have high cholesterol, raising their risk of heart attack. Doctors tell them to eat right and exercise, but that usually produces only modest improvement. Statins drop cholesterol dramatically and almost overnight.
    The government's National Cholesterol Education Program periodically asks experts to help set cholesterol guidelines, and rules issued in 2001 advocate using statins to curb it.
    New studies prompted a new panel to be convened to revise the guidelines. Seven of its nine members had been on the previous one. The newcomers -- Dr. Sidney C. Smith of the University of North Carolina at Chapel Hill and Dr. C. Noel Bairey Merz of Cedars-Sinai Medical Center in Los Angeles -- represented the heart association and the American College of Cardiology, respectively.
    These groups in July endorsed and published the new guidelines. A day later, the Center for Science in the Public Interest said the advice was tainted by doctors' industry ties, which weren't disclosed. They ranged from long-ago research grants to stock ownership and deals providing thousands of dollars in income from statin-makers.
    The most complicated situation is that of Dr. H. Bryan Brewer, chief of the molecular disease branch of the National Heart, Lung and Blood Institute, which houses the federal cholesterol program.
    He is on the scientific advisory board of Lipid Sciences Inc., a private biotechnology firm developing cholesterol treatments, and Seymour's National Lipid Association. He also is a consultant or speaker for 10 companies, and attended a meeting in July 2003 of a federal Food and Drug Administration advisory committee debating whether to recommend approval of Crestor, a statin made by one of them -- AstraZeneca.
    He refused requests for an interview. In a memo to National Institutes of Health director Dr. Elias Zerhouni, Brewer wrote that he was "only an observer and did not participate'' in the meeting, which led to the drug's approval a month later.
    Some panel members talk candidly about their industry ties. Grundy said he makes less than $10,000 a year in speaker fees and refuses to promote a particular drug in a talk.
    Dr. Neil J. Stone, of Northwestern University Medical School in Chicago, said he takes speaker fees when a talk forces him to miss work and often donates them to universities.
    Smith said he owns about $10,000 in stock in Johnson & Johnson, which has partnered with Merck & Co. to sell a statin over the counter in England.
    "I didn't even know I had it till I called the fellow that handles the accounts,'' Smith said. "Nobody volunteers time for one of these committees because they think a small amount of stock they may have in a retirement plan is going to benefit.''
    Bairey Merz listed stock in Johnson & Johnson plus consulting, lecture or research money from nine, including several statin-makers. She declined to be interviewed but said in a brief statement that she had not breached any ethics rules.
    Efforts to interview three other panel members were unsuccessful.
    The only panel member with no financial conflicts -- the federal program's coordinator, Dr. James Cleeman -- is upset by attacks on the guidelines like the letter signed by 35 scientists and doctors asking NIH to launch an independent review.
    "They are science-based,'' Cleeman said. "The public should have confidence in them. I'm an unconflicted person, and I read the science the same way.''

Conflict of Interest: Financial ties between doctors and drugmakers or other companies takes many forms

Institution Grants:  The doctor's hospital, medical group or university gets money to test a product or treatment, indirectly supporting a doctor's salary.
Individual Grants:  The doctor gets paid to help run a study or a fee for each enrolled patient.
Gifts:  Federal rules restrict marketing.
Seminars:  Doctors get education credits, dinners or freebies to listen to a company's pitch.
Lecture Fees:  Doctors get paid to talk about treatments at meetings.
Consulting Deals:  Doctors consult on a one-time or continuing basis.
Scientific Advisory Boards:  Doctors help determine direction of a company.
Patents Or Patent Rights:  Doctors have a financial stake in a drug, device or treatment.
Stock Or Stock Options:  Doctors have a stake in the company itself.

SCHOOLS URGED TO TEACH KIDS HEART HEALTH
Published: Tuesday, October 12, 2004
Associated Press

DALLAS -- Schools should be more aggressive in teaching children about heart disease and the risks of bad diet and little exercise, the American Heart Association said yesterday.
    The call for bolder action in schools follows the Institute of Medicine's call last month for a wide-ranging attack on childhood obesity by involving parents, schools, communities and the government.  Estimates are that more than 15 percent of American children are very overweight or obese.
    Laura Hayman, a nurse and professor who wrote the association's statement, said national data show about 80 percent of children aren't getting enough fruits and vegetables each day.  She also said that 44 percent of high-school students aren't in physical-education classes.
    "Through schools, hopefully, you can reach the children, teachers and parents," she said.
    The statement, published in the journal Circulation, calls for more phys-ed classes, heart-healthy meals and a tobacco-free environment from preschools through 12th grade and in after-school programs.

MOM'S ADVICE ON TAKING CARE OF YOURSELF COULD WARD OFF FLU
Published: Sunday, October 10, 2004
By Linda A. Johnson
Associated Press

TRENTON, N.J. -- The wisdom mothers have been dispensing for ages -- wash your hands, eat your vegetables, go to bed earlier -- turns out to be great advice for avoiding the flu.
    Doctors and nutritionists say careful hygiene, a balanced diet and plenty of rest and fluids can go a long way toward keeping people healthy during the influenza season.
    "Taking care of yourself from a health standpoint is probably the best thing you can do,'' said Dr. R. Michael Gallagher, a family physician and dean of the University of Medicine and Dentistry of New Jersey's School of Osteopathic Medicine.
    Besides getting enough sleep -- at least seven hours a night for adults and more for youngsters -- managing stress is important, Gallagher said, because too much can weaken one's immune system.
    Frequent hand-washing, using soap and hot water and rubbing vigorously for about half a minute, also is crucial.
    "What you want to do it is try to interrupt transmission of disease with the kinds of things our mothers taught us,'' said Dr. Mitchell Cohen of the national Centers for Disease Control and Prevention.
    Avoid touching your eyes, nose or mouth, because germs on your hand could infect you, he said. And, if you do get the flu, stay at home.
    The United States will get only half its expected supply of flu vaccine this year because British health authorities suspended the license of vaccine producer Chiron Corp. at the company's Liverpool, England, factory because of contamination.
    Cohen said the CDC is planning two public-education campaigns, first to explain the shortage and who should or shouldn't get vaccinated, and second to teach people how to protect themselves through hygiene and "cough etiquette.''
    The old advice was to cough or sneeze into your hands, then wash them. Now doctors are urging that, if a tissue isn't at hand, people should sneeze into their sleeve.
    People, especially the elderly and those in poor health, also should avoid crowds and people who are coughing or sneezing, said Dr. Michele Bachhuber, an internal medicine specialist in Marshfield, Wis.
    "Regular exercise helps boost our immune system, so that's important, too,'' she said.
    Then there's the role of diet. Eating a healthy, substantial breakfast -- about one-fourth of the day's calories -- is crucial, said American Dietetic Association spokeswoman Gail Frank, a professor of nutrition at California State University at Long Beach.
    Variety in the diet is important, but people should emphasize plant foods, including whole grains and at least five servings of fruits and vegetables a day, said Elisa Zied, another American Dietetic Association spokeswoman and registered dietitian in New York.

SUDDENLY, BABY BOOMERS FEEL CLINTON'S PAIN
Published: Wednesday, September 15, 2004
By Mike Lafferty
The Columbus Dispatch

   Call it middle-age fear.  Call it the "Clinton syndrome."
    Whatever its name, baby boomers are putting down their cheeseburgers long enough to call their doctors to gauge their heart-attack risk. 
    "It's definitely come up during patient visits," said Dr. Mimi Ghosh, a Northwest Side general practitioner.  "I really didn't expect it, but it's kind of a domino effect.  It's good."
    A week after former President Clinton's quadruple bypass surgery and news that he was a prime candidate for a heart attack, more men and women seem to be talking about DIET AND EXERCISE and whether their arteries are clogged.
    Chest pains and shortness of breath, symptoms almost identical to Clinton's, brought the Rev. Kathy Wesley to Healthwise, a Dublin diagnostic center that provides CT scans of the heart and other parts of the body.
    "Some doctor friends suggested the test, but after hearing of what befell the president, it makes me more comfortable," the Newark resident said.
    Some heart centers aren't waiting for patients to come to them.
    Ohio Heart, a for-profit heart clinic in Gahanna where clients pay $249 for a six-minute CT heart scan, has featured Clinton's surgery in advertisements.
    Ghosh said that although CT scans are usually not covered by insurance, they can be useful.
    "It's a good test, and it does detect things early," she said.
    Historians say this type of reaction occurs every now and then, when presidents, entertainers or other national figures suffer an illness.
    Examples include President Reagan's Alzheimer's disease, Katie Couric's husband's fatal colon cancer and Magic Johnson's battle with HIV, said Liette Gidlow, a historian at Bowling Green State University.
    Politicians, Gidlow said, used to hide their illnesses.  Presidents Franklin Roosevelt and Kennedy are prime examples.
    Now, she said, they speak out and boost awareness.
    The American Heart Association has experienced more hits on its Web site since Clinton's surgery, said Kim Schuette, the association's Ohio Valley spokeswoman.
    At Riverside Methodist Hospital and Grant Medical Center, patients are asking questions.
    "People are asking if there is a blockage, do the cardiac markers show a blockage," said Dr. John Drstvensek, who directs the emergency departments at both hospitals.
    While other procedures are on the horizon, bypasses are far and away the preferred treatment for blockages of cardiac arteries.  Surgeons nationwide perform 500,000 annually.  In 2002, 14,960 Ohioans had the same type of bypass as Clinton, according to the Ohio Department of Health.
    The overweight and out-of-shape are at obvious risk for heart attack.  Other factors, including high cholesterol and high blood pressure, are not apparent without medical tests.
    The 58-year-old former president's surgery has doctors, too, thinking about their health.
    "I just turned 45 last week," said Dr. Bill Abraham, director of cardiology at Ohio State University Medical Center.  "I relied on fast food to get by.  Do I exercise as much as I should?  No."
    Quitting smoking, eating less fatty food and spending at least 30 MINUTES A DAY, THREE DAYS A WEEK, EXERCISING  are key, Abraham said.
    With an estimated half of Americans overweight and as many as 25 percent considered obese, doctors say, it's time to start paying attention.
    Obesity alone could knock six or seven years off your life, Abraham said.
    "We have spent decades going down the path of fast food and sedentary lifestyle and now we're starting to pay the price," he said.
    "We have this big baby boom generation eating fast food and sitting in front of the computer, and now it's catching up to them."