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Institutional Elder Abuse Watch Association is a resource for seniors and their loved ones dealing with over-medication of seniors, elder abuse in institutions, denial of legal rights to seniors and other challenging aspects of aging that seniors are facing in today's society.

The Institutional Elder Abuse Watch Association website is a gathering place for those who are fighting lonely battles for respect, justice and goodwill, often against bureaucracies or other powerful societal organizations and groups.

You are welcome here. We will listen, we will understand, and we will help.

Wednesday, 07 November 2012 18:45

Misuse of antipsychotic drugs in nursing homes

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This public service announcement comes to us from an excellent organization, the National Consumer Voice for Quality Long-Term Care. 

November 5, 2012  

Can you imagine if you had surgery and your doctor did something you hadn’t discussed with him or her?

Can you imagine if a potentially dangerous drug was given to you without your knowing or understanding?

Actually, you do not have to imagine it.

Forty percent (40%) of nursing home residents with dementia nationwide are being given antipsychotic medications that the Food and Drug Administration (FDA) warns put them at serious risk of medical complications and death. Yet far too often, no one discusses these dangers with residents and their families, or whether or not these medications should be given.

Nursing home residents with dementia, or an individual with legal authority to act on their behalf, should have the same clear rights to this information as the rest of us.

Support Senate Bill 3604

Require informed consent for antipsychotic drugs in nursing homes

Just say KNOW! 

That’s what S. 3604, the Improving Dementia Care Treatment for Older Adults Act, introduced by Senators Kohl (D-WI), Grassley (R-IA), and Blumenthal (D-CT) would do. This bill would require nursing homes to tell residents or their decision makers about the possible side effects and risks of antipsychotics and get the permission to give the drug. This is called “informed consent”.

The Improving Dementia Care Treatment for Older Adults Act would also help address the misuse of antipsychotics through:

  • information to doctors and other prescribers about treatment option, 
  • monthly reports to nursing homes on instances where antipsychotics are given to residents with dementia for uses not approved by the FDA, and 
  • a study on the use of antipsychotics in other health care settings, such as hospitals. 

For more information visit:

or contact The National Consumer Voice for Quality Long-Term Care: 

Email  This email address is being protected from spambots. You need JavaScript enabled to view it.    Tel  202.332.2275  

Cleveland, Ohio  June 29, 2011

Images from a hidden video camera helped the son of a 78-year-old woman convince authorities that his mother was being brutally and repeatedly assaulted by nursing home staff. 

The Prentiss Center for Skilled Nursing Care, run by the MetroHealth health care system, initially ignored complaints by Esther Piskor's son, and then denied there was any problem. However, according to the New York Daily News, investigations by Cleveland's WKYC television and the state Department of Health led to investigation by police.

Two nurses aides were fired and a third staff member was charged with felony assault.

Joe Piskor hid the video camera in a fan on his mother's dresser after he saw marks on his mother's face and noticed that she began to raise her hands in fear whenever he visited. However when he brought his concerns to MetroHealth they said he was "taking things out of context".

"They made me out to be the trouble maker, the complainer, the bad guy," he said.

However, the video images were impossible for others to ignore. Staff are shown "jerking the helpless granny out of her wheelchair and tossing her on the bed like a rag doll", punching her in the face, and pushing her face into a wall. 

Dr. James Campbell, the chief of geriatric care at MetroHealth, says he's "incredibly sorry". However he denies that Joe Piskor's complaints were ignored, and claims the hospital and the health department "investigated the claims but didn't find anything."

Joe Piskor said the administrator of the Prentiss Center for Skilled Nursing Care told him, "...accidents happen".

You can judge for yourself by watching the videos whether the actions of the nursing home were self-serving efforts to cover-up brutal abuse by trained caregivers, or simply incompetence and ignorance.
Full Story and Videos HERE

March 1, 2012 

Kathleen Palamarek

Kathleen Palamarek, a Canadian woman in her mid-80's, was denied her rights as a person, confined against her will for five years in an institution, and prescribed medically-unnecessary pharmaceutical drugs which harmed her physical and mental health. Kathleen's home and assets were taken from her, and she was denied the company of her children and friends.

She died – one day after a court deemed she must remain in an institution for the rest of her life – under suspicious circumstances in the nursing home which was already under investigation for suspected attempted murder of Kathleen by morphine overdose a few months prior to her death. She had no terminal illness or pain that would have required prescription of a narcotic painkiller.

The court record – you be the judge

On these pages, we provide the documents that were entered into the court record as a result of Kathleen Palamarek's sons' Petition to have their mother declared incapable and to have themselves appointed as her legal guardian.

Her sons, Ralph, Robert and Ernest Palamarek, wanted to keep Kathleen in an institution, saying she was too incapacitated to live anywhere but in a nursing home. Kathleen's daughter, Lois Sampson, subsequently filed her own Petition to have herself appointed as her mother's guardian, so that her mother could live with Lois and her husband Gil Sampson.

The judge who presided over the final hearing, Justice David Harris of the B.C. Supreme Court, awarded guardianship to the sons, citing the over-whelming unsuitability of Lois Sampson's character ignoring extensive evidence to the contrary presented to the court.

The decision is being appealed, and advocacy groups are demanding a public inquiry be conducted into Kathleen Palamarek's life in BC's residential care system, and at the Lodge at Broadmead (Broadmead Lodge), and the circumstances of her death.

British Columbia laws enable abuse of elder rights

The tragedy of Kathleen Palamarek's last five years of life occurred because the laws of British Columbia allow for anyone to bring an action under the Patients Property Act to have a person declared incapable, and to be appointed their committee (aka legal guardian) of the person and the estate, and because there is no meaningful investigation of suspected abuse by people who are in positions of trust with respect to that person, or enforcement of laws to protect the vulnerable person.

When someone is appointed the legal guardian of someone's "person and estate", then they have virtually all the rights that that person would have. It is often said, that such a legal appointment allows the guardian to "step into the shoes" of the person. The guardian has the power to make decisions about where that person will live, what kind of healthcare they will receive, how their assets are managed, to buy/sell property, who that person can see, where they can go, what they should eat, what they should wear... It's all encompassing.

Public Agencies and Authorities facilitate elder abuse in institutions

A person's legal rights can easily be removed. In many cases, doctors have removed the rights of people as a response to concerns above the quality of care of a patient from the patient's loved ones, in which case the person becomes a ward of the state, under the Public Guardian & Trustee.

Doctors have inordinate powers to declare, in a paragraph or two, that a person is incapable. The quality of the assessment can be very thin; a doctor may see a patient for only a few minutes every couple weeks or months, or see them while they are on medication which impairs their cognitive ability. On that thin basis, a person can be declared incapable. There are no degrees of capability in BC's laws, you are either capable or incapable, according to whatever the particular doctor who makes that declaration thinks is "capable".

Privacy laws are a formidable shield behind which abuse can occur. The guardian can keep information about the person who has been declared legally incapable private from virtually anyone, thereby increasing the opportunity for fraud, theft, over-medication, and anything else they wish to keep from prying eyes. Public agencies and authorities collaborate with health care institutions to prevent or thwart efforts by family members who are concerned about mistreatment. These are some of the issues that Kathleen Palamarek's plight and tragedy highlights.

The Court of Public Opinion

It is important to understand that in British Columbia, Patients Property Act legal actions are only heard in front of a judge (no jury permitted) – one person. And that normally, there are no witnesses called or cross-examinations. Therefore, we felt it was important to bring this matter to the court of public opinion.

We believe no jury of 12 reasonable people would have awarded guardianship to Kathleen Palamarek's sons.

Here you can read the same documents that the judge was provided in the final hearing, and read the judge's "Reasons", and then you can come to your own conclusions.

You can read the summary of arguments (written submissions) presented by the lawyers for the Palamarek brothers and for Lois Sampson, read the affidavits submitted by Kathleen's children, by the nursing home and their doctors, by Kathleen's lawyer, by medical experts, by Kathleen's elder advocate and others.

Read and judge for yourself. You or your loved one could be facing this nightmare soon.



Supreme Court of British Columbia, Victoria Registry: 07-3415 and 08-0327

Judge's Reasons for Decision:

Palamarek (Re), 2011 BCSC 563 (CanLII) — 2011-05-03

[Incomplete – rebuttal of Decision, Appeal to be added. Editor]



The best way to get a thumbnail sketch of the final hearing, we recommend you read the ... [to be completed]


For Lois Sampson

PRESENTATION MATERIALS USED IN COURT: (allow 15 seconds for documents to load)

Delivered in court following Involuntary Apprehension of Kathleen Palamarek on October 31, 2008:

For Ralph and Robert Palamarek



  • Feb 24, 2011:  Narcotic poisoning of Kathleen Palamarek at Broadmead Lodge. Police investigation.
  • April 1, 2011:  Broadmead lawyer severely limits visits to Kathleen Palamarek by Lois Sampson and all who know her/her mother and stipulates that visits must be conducted in the presence of a guard at all times. This is viewed as an attempt by Broadmead Lodge to try to deflect attention from their wrong-doing, and to try to portray Lois Sampson in the most negative light. Lois Sampson wasn't under police investigation; Broadmead Lodge was, and still is (as at late Oct 2011).  The severe access restrictions and the insistence of a guard's presence at all visits by Lois Sampson or any of her acquaintances prevented any outside scrutiny of the manner in which Kathleen Palamarek was being cared for by Broadmead Lodge staff and doctors.
  • April 13, 2011: Discovery that the lawyer Broadmead Lodge had just hired to isolate Kathleen Palamarek from her daughter and others also represented the Saanich Police officer who is in charge of the investigation into the suspected attempted murder of Kathleen Palamarek by morphine overdose at Broadmead Lodge. This major conflict of interest was discovered in mid-April, when the police officer in charge of the narcotic poisoning investigation was found responsible in BC Supreme Court along with other Saanich Police members for the wrongful shooting death of a man, and lying to the court about various aspects of the incident, as well as for their conduct with the man's family members.

(Editing - Documents re above Events need to be uploaded...)

May 3, 2011 – JUDGE'S DECISION:



ONE DAY AFTER THE JUDGE RENDERED HIS DECISION, Kathleen died under suspicious circumstances, similar to the circumstances surrounding the February 24, 2011 morphine overdose administered by Broadmead Lodge which was then, and still remains, under police investigation. Even greater restrictions were imposed on her daughter and the daughter's acquaintances the day of Kathleen's death (e.g. no cameras, no recording devices, no other people permitted to visit).

Lois Sampson asked the Coroner's Service to investigate her mother's death. The Coroner responded but when she hadn't heard any information several days later, Mrs. Sampson emailed to ask for an update. The Coroner replied by email telling Mrs. Sampson that he had spoken to her brother, Ralph Palamarek, but that the Coroner's Service would not provide her with any information because she "was not the designated next of kin". This was untrue; there is no such law or regulation that prevents the Coroners' Office from providing immediate family from being provided information about the death in the family. Mrs. Sampson only found that out when she consulted a lawyer a month later.

After receiving receiving a letter from Mrs. Sampson's lawyer calling into question the refusal to provide information and the rationale for that, the Coroner's Office provided Lois Sampson with a copy of the Autopsy Report, which said that the death was "natural". However, the attempt to mislead Mrs. Sampson in order to prevent her from receiving information about her mother's death has tainted the credibility of the Autopsy Report.



Alphabetical GUIDE to Affidavits
(the party who obtained the affidavit or is supported by the affidavit is listed in brackets):


Ages, Tammy – employee of law firm (Palamarek brothers)

Boies Parker, C – law firm (Sampson)

Brennan, Kathleen – employee of law firm (Sampson)

Cheperdak, David – CEO, Broadmead Lodge (Palamarek brothers)

Dian, Dr. Larry – Specialist in Internal Medicine & Geriatrics (Sampson)

Edwards, Mair – Occupational Therapist (Sampson)

England, Lyne – Registered Nurse (RN), Chair, Association of Vancouver Island Family Councils (residential care) (Sampson)

Hicks, Tim – character reference (Sampson)

Johnson, Nancy – employee of law firm (Sampson)

Kushner Kow, Dr. Janet – Specialist in Internal Medicine & Geriatrics (Sampson)

Nicoll, Dr. R. Dale – GP, Broadmead Lodge house doctor (Palamarek brothers)

Jordan, John – Kathleen Palamarek's lawyer

Leishman, Dr. David – geriatric psychiatrist, Elderly Outreach Services, VIHA (Palamarek brothers)

Matheson, Susan – employee of law firm (Sampson)

McMillan, Elizabeth – employee of law firm (Kathleen Palamarek)

Morrison, Don – former B.C. Police Complaint Commissioner (Sampson)

Neilsen, Kathleen – character reference (Sampson)

Palamarek, Donna – wife of Ralph, retired ICBC manager

Palamarek, Ernest – son, retired Canada Services Border guard

Palamarek, Ralph – son, Canada Revenue Agency employee

Palamarek, Robert – son, retired  RCMP (administrative)

Perry, Dr. Tom – Specialist in Internal Medicine & Clinical Pharmacology (Sampson)

Pickup, Carol – retired Registered Nurse, elder advocate (Seniors Entitlement Services (Sampson)

Prowse, Dr. Art – geriatric psychiatrist (Palamarek brothers)

Sampson, Gil – husband of Lois, information systems consultant

Sampson, Lois– daughter, retired management consultant

Sherman, Dr. Mark – M.D., Family Physician (Sampson)

Sudbury, Fiona – Director of Care, Broadmead Lodge, RN (Palamarek brothers)

Tisdell, Ron – toxicologist and pharmacist (Sampson)

Trottershaw, Dr. Terrylene – GP, Saanich Peninsula Hospital geriatric wing house doctor (Palamarek brothers)

Xenos, Elaine – character reference (Sampson)

2007 - Court Petition of Ralph & Robert Palamarek and supporting affidavits:


Affidavit obtained to prevent Kathleen Palamarek from obtaining a lawyer:


2008 - Court Petition of Lois Sampson and supporting affidavits:


2008 - Affidavits OPPOSING Lois Sampson's Court Petition:


2008 - Ralph & Robert Palamarek request Involuntary Apprehension and Interim Committee Appointment

Affidavits SUPPORTING:

Affidavits OPPOSING:


2009 - Lois Sampson requests second medical opinion and medical records

Affidavits SUPPORTING:

Affidavits OPPOSING:


2009 - Lois Sampson requests removal of access restrictions


2009-2010 - Lois Sampson requests disclosure of financial records

Affidavits SUPPORTING:

Affidavits OPPOSING:


Second Medical Opinions sought by Lois Sampson and their supporting affidavits


2010-2011 - Affidavits presented for the Final Hearing

Affidavits SUPPORTING Lois Sampson:

Affidavits SUPPORTING Palamarek brothers:



Tuesday, 04 October 2011 10:19

“Too Many Pills”

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Face to Face with “Too Many Pills”

Interview with Alan Cassels on multiple drug use in the elderly

Drug policy researcher and author Alan Cassels in discussion with Jack Etkin of Face to Face about how the elderly in our society are being needlessly over-medicated in care facilities and at home. Even worse, the often unnecessarily prescribed drugs cause side effects that are then treated with even more drugs, causing more side effects and so on…

Saturday, 02 July 2011 10:16

Kathleen’s Demise: A Cautionary Tale

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BY ROB WIPOND July/August 2011  FOCUS Magazine

There’s much to learn about BC’s laws and eldercare system from the last years of Kathleen Palamarek’s life in a local nursing home—especially from the battles that were fought in her name between her children, care providers and the Vancouver Island Health Authority.

It was a small but important epitaph for a much-loved woman. NDP West Kootenay MLA Katrine Conroy spoke in the provincial legislature in June in support of a public inquiry into the recent “suspicious death” of Kathleen Palamarek, an 88-year-old resident of Broadmead Lodge in Saanich.

During Lois Sampson née Palamarek’s five-year struggle to help get her mother out of the nursing home, Kathleen became an icon to local seniors advocates. That’s why the Saanich Peninsula Health Association, Vancouver Island Association of Family Councils, Old Age Pensioners Organization local, and others have been blitzing politicians, media and public agencies with requests for an inquiry.

“[T]he suspected abuse was due to overmedication, and the family needs answers,” said Conroy.

Yet the story involves much more than possible improper medicating; I’ve been following it since 2006. Kathleen’s life, and now death, is a tragic…

Read More at:

IF YOU WOULD LIKE MORE INFORMATION OR WANT TO KNOW HOW YOU CAN HELP, CONTACT:     This email address is being protected from spambots. You need JavaScript enabled to view it.">This email address is being protected from spambots. You need JavaScript enabled to view it.

Your email address and information will not be disclosed.

Monday, 02 May 2011 07:13

World Elder Abuse Awareness Day

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heartsShow the world that you care about ENDING ELDER ABUSE AND NEGLECT

On JUNE 15th, 2012

Wear PURPLE to honor our elders


Elderly persons who are suffering abuse or have suffered abuse deserve our attention, our protection and our respect.

There is no excuse for anyone abusing and harming our elders — no excuse for family members, for medical practitioners and health care providers, for nursing home administrators, for pharmaceutical companies, for public agencies or private corporations, for lawyers or the legal system. No excuse for anyone or for any act of abuse.

Our legislators must be persuaded to enact laws with sufficient powers to prevent, stop and punish acts of elder abuse – by anyone – and they must compel public agencies and authorities to uphold those laws. We must respect, revere and cherish our beloved elder generations. Do unto others…

WEAAD sponsored by the International Network for the Prevention of Elder Abuse

Fighting Forced Institutionalization –– Kathleen Palamarek

Kathleen in January 2011

Kathleen - January 2011

Victoria, British Columbia, Canada

Kathleen Palamarek, an 88-year-old widow of a WW II veteran who became an international symbol of the fight to prevent forced institutionalization of the elderly, died Wednesday, May 4, one day after a Canadian judge ruled that she must remain confined indefinitely to Broadmead Lodge, a nursing home that is under investigation for the suspected narcotic poisoning of Mrs. Palamarek in February 2011.  Read Kathleen’s story in these articles:

And watch this YouTube video produced just 10 days before her death, showing Kathleen Palamarek to be a vibrant person who should never have been confined to an institution.

Visits with Kathleen April 2011

Saturday, 06 March 2010 07:07

STOP elder abuse in care facilities – TIPS & SIGNS

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World Health Organization stats show institutional elder abuse far more prevalent


Prevalence – Community dwelling Seniors

Population-based studies suggest that between 4% and 6% of community dwelling elderly people (living in their own homes) have experienced some form of abuse (WHO 2002b).


Prevalence – Institutions

In a US survey, 36 % of nursing home staff reported having witnessed at least one incident of physical abuse of an elderly patient in the previous year, 10 % admitted having committed at least one act of physical abuse themselves, and 40% said that they had psychologically abused patients (WHO, 2002b)

Read Complete Presentation:  2010-11-09 World Health Organization institutional elder abuse stats


TIPS to stop elder abuse in nursing homes and residential care facilities:

  • Make sure facilities are proper staffed. One staff for ten elderly clients is abuse waiting to happen. This includes home care services.
  • Consider that one person cannot healthfully care for an elderly individual for long-periods of time. Look into home nursing help, hospice services, or having other family member come and help.
  • Look for good civic support from all levels of government.
  • Make sure that there is good coordination between law enforcement, care facilities, senior advocates, and adult protective services.
  • Learn more about the process. Support and create further educational opportunities for people who work with the elderly population.
  • Review abuse laws. Laws are in place at both state/provincial and national levels.
  • This includes abuse registry for perpetrators. 
  • Seek the assistance of an elder abuse attorney for a better understanding of rights.
  • Enforce mandatory abuse reporting in facilities that care for seniors, including recreation or day activity programs.
  • Speak up.



Older adults who are experiencing abuse or neglect in care may ––

  • tell you they are being harmed
  • show signs of depression or anxiety
  • seem fearful around certain people or care facility staff in general
  • become socially withdrawn (have less contact with people to whom they’ve been close in the past)
  • become passive and very compliant
  • complain that staff are not treating their concerns seriously
  • have unexplained physical injuries
  • lack food, clothing or other necessities, or complain that their belongings are missing
  • show changes in hygiene
Acknowledgement of contributions from:


Wednesday, 02 June 2010 09:54

Granny Snatching – growing menace in North America

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Granny Snatching is an insidious menace creeping across North America from which no one is safe.

This shocking disregard of the law and the rights of individuals is a fast-growing trend both in Canada and in the United States.

Find out how to protect yourself or a loved one from the courts, over-zealous agencies and family members with designs on an elderly family member’s health, wealth and freedom.


Granny Snatching - Elder Abuse WEBSITE:

Ronald Winter is an author, public relations executive, college professor and award winning journalist. He regularly writes and speaks on the military and politics.

Ron WinterRon is author of the book Masters of the Art, A Fighting Marine’s Memoir of Vietnam published by Random House, and writes Winter’s Soldier Story, his website blog column.

His newest work of non-fiction is Granny Snatching, How a 92-Year-Old Widow Fought the Courts and Her Family to Win Her Freedom.

Ron gave up an academic scholarship at the State University of New York at Albany in 1966 to join the Marines and fight in Vietnam as a helicopter crewman and machine gunner. He flew 300 combat missions and was awarded 15 Air Medals, Combat Aircrew Wings, and the Vietnamese Cross of Gallantry.

After Vietnam he earned undergraduate degrees in Electrical Engineering and English Literature. In a two-decade journalism career Ron was the recipient of several prestigious awards and a Pulitzer nomination.

He was featured in 2004 in the Library of Congress’ Veterans History Project; is an adjunct professor of communication at the University of Hartford; is a judge for the annual Connecticut Young Writers competition; and is a director for Michael J. London & Associates Public Relations firm in Trumbull, CT.

Corrupt Medical Research Only the Tip of the Iceberg

Alan Cassels, University of Victoria

WE TRUST strongly in our medical system because, metaphorically speaking, we largely don’t mix church and state. For the most part, the medical care we receive from our hospitals and doctors is supported by public funds and delivered on the basis of human goodness, charity and justice. Examples that show how strenuous we are in ensuring that commerce doesn’t taint our medical care include:

  • We don’t let doctors sell drugs; pharmacists do that.
  • We don’t let drug companies run medical schools; universities do that.
  • We don’t let drug manufacturers write prescribing guidelines for physicians; independent experts do that.
  • And we don’t let people selling drugs or medical devices write medical journal articles; academic physicians do that.

Or, at least, that’s what I thought.

April was a particularly hard month for rude awakenings. Cracks in the crumbling edifice between commerce and medicine were revealed and new research unveiled gross, sometimes shocking, levels of conflicts of interest in our medical system. We are finding evidence of academic doctors selling themselves to the highest bidders, medical journals allowing themselves to be prostituted by drug companies and medical schools allowing doctors in residence to be bribed with drug company trinkets. I would argue that of all the factors threatening to undermine our trust in medicine, financial conflicts of interest top the list.

Don’t believe me? Then believe the data: In April, four separate research studies published in four diverse areas showed the widespread and rampant nature of conflicts of interest in medicine. One derives from the world of cancer research. One is from psychiatry. One is from medical education and the last is from the world of medical journals. As you absorb these examples, try to decide for yourself if we are doing enough as a society to eliminate the conflicts of interest infecting medicine.

What do I mean by conflict of interest? Wikipedia generally defines it as “any situation in which an individual or corporation (either private or governmental) is in a position to exploit a professional or official capacity in some way for their personal or corporate benefit.”

One study from the cancer world examined the frequency and impact of conflicts of interest as they related to high-impact, published, clinical cancer research. It basically asked the question: “Are researchers who publish in cancer journals conflicted?” (For instance, do they own shares or have stock in or otherwise benefit financially from their association with a drug manufacturer or do they work for the drug company whose drug they are studying?) The reviewers looked at cancer research published in eight major journals in 2006 to see if conflicts of interest were reported and, if so, who funded the research? They also wanted to discern if there is a real association between the research funders and what the research concludes (i.e. do the industry-sponsored researchers have more positive things to say about their sponsor’s drug than the researchers not on industry’s payroll?)

Their results? Out of 1,534 original oncology studies, almost a third (29 percent) of the researchers had a conflict of interest, including industry funding, yet only 17 percent declared they had received such funding. Studies paid for by industry funding were twice as likely to focus on treatments (as opposed to other aspects of cancer care) and randomized trials that assessed survival were more likely to report positive survival outcomes when there was an obvious conflict of interest. In other words, the drug is shown to “work” better if there is company money involved.

The authors concluded there are indeed conflicts of interest in the clinical cancer research published in high-impact journals; often, those conflicts are not disclosed and the conflicts result in a more positive spin being put on the results of the trial.

The next example comes from the world of mental illness. A report by Boston researchers found that 90 percent of the authors of three American Psychiatric Association (APA) clinical practice guidelines in psychiatry had financial ties to companies that manufacture drugs mentioned in those guidelines. Worse yet, the authors had financial connections, including owning equity in the companies that made the recommended medications, being a consultant or corporate board member, or receiving honoraria. None of these conflicts were disclosed in the guideline.

Translation: The academics who wrote the major guidelines for American physicians on treating serious mental illness – schizophrenia, bipolar disorder and major depression – were basically all funded by the drug companies. If you thought only well meaning psychiatrists, interested in the welfare of patients, provided the guidelines, you’d be wrong. The picture looks even darker when you narrow in on the conflicts of interest of the authors of the guidelines for only bipolar disorder and schizophrenia: Here, 100 percent of the authors had such conflicts. Most people would consider these findings very worrisome, including Tufts University professor Sheldon Krimsky, one of the co-authors of this report. Tufts published a 2006 study examining conflicts of interest of the creators of psychiatry’s “Bible,” the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders).

In a telephone interview with Krimsky from his office in Boston, he told me we should be worried about conflicts of interest because they can lead to a “distortion of the scientific record” and that industry-funded activities may lead to an “interpretation of the science in a direction that may not be defensible.”

While he’d like to see these guidelines do a much better job of disclosing conflicts of interests among the authors, such disclosure is only an intermediate step towards erecting a solid firewall between drug companies and guidelines for physicians. “The innovators must be separate from the evaluators,” he notes. That’s right, a separation of church and state.

No doubt guideline committees, such as those sponsored by the APA, need to come clean about their financial conflicts, but they must go further to avoid them in the first place. At the very least, groups like the APA should admit they’ve got a huge potential PR liability on their hands, and if they don’t prevent drug companies from putting their own people on guideline committees, the APA shouldn’t be surprised when our doctors scorn or ignore their guidance.

What about smaller things than prescribing guidelines? What about trinkets – do they influence what our physicians think about drug companies? A recent study conducted in two medical schools in the US found that exposure to even small pharmaceutical items affected a doctor’s treatment preferences.

You might find this hard to believe. Most physicians I know scorn the idea that they could be “bought” with trinkets. (We’re talking drug company pens, free drug samples and other logo-laden paraphernalia.) Most physicians are adamant that these small, promotional items are unlikely to influence prescribing behaviour. Yet, in this study, the researchers measured whether exposure to these items result in doctors looking more favourably on drug companies and whether or not the medical schools with more restrictive policies towards pharmaceutical marketing produce doctors with different attitudes.

Researchers conducted a randomized, controlled experiment with more than 300 senior level medical students at two US medical schools. One of the schools (University of Miami) allowed the students to be exposed to small, branded promotional items for the cholesterol-lowering drug Lipitor (atorvastatin). The control group was comprised of students at the University of Pennsylvania School of Medicine where restrictive policies are in place to limit pharmaceutical marketing.

What did they find? The Miami students exposed to the Lipitor swag were obviously more enamoured with the drug compared to the control group in Pennsylvania. On a “skepticism” scale, the Miami students held more favourable attitudes toward pharmaceutical marketing compared with the other group of students where the opposite effect was observed. Basically, those students not marinating in drug company promotion were less swayed by promotional items related to the drug.

The authors concluded “subtle exposure to small, pharmaceutical, promotional items influences implicit attitudes toward marketed products among medical students.”

A study published in April by Sergio Sismondo at Queens University in Kingston looked at the relationship between drug companies and medical journals and asked, “Are medical researchers and medical journals too close to the pharmaceutical industry for comfort – or patient safety?”

We’ve all heard of the phenomenon of “ghostwriting” where big, important names in medical academia are asked to put their names to papers written by others (often drug company hacks). But Sismondo pushes the concept a bit further referring to the “ghost management” of pharmaceutical research and publication where cradle-to-grave medical publishing is “managed” every step of the way by pharma funders. He notes there has always been a problem with plagiarism and the misallocation of credit (like the prof who puts his own name on the hard work of his graduate students), but those scenarios are only the tip of the iceberg.

A more serious problem in medical publishing is the pharmaceutical industry using “willing participants” in the form of researchers seeking fame, glory and money associated with huge, multimillion-dollar studies. These people, known in the marketing world as KOLs (Key Opinion Leaders), are luminaries who put their names to the body of academic published research and serve as speakers and de facto promoters of the company’s products. They put their names to studies that are published according to the objectives of the funders (usually the drug companies). The published studies are then reprinted and distributed to the offices of physicians and anyone else who influences drug formularies.

As Sismondo says, “Those articles may look like independent confirmation of the reps’ pitches [and] plagiarizing KOLs lend their good names to the pitches.”

If you were to ask me if conflicts of interest are a problem in medicine, I’d say, “Ask the data and then decide for yourself.”

Alan Cassels is a drug policy researcher at the University of Victoria, British Columbia and the co-author of the bestselling Selling Sickness. He does not work for the pharmaceutical industry.

This email address is being protected from spambots. You need JavaScript enabled to view it.

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