Ethics: June 2009 Archives
While drugmakers create a vaccine against the currently pandemic swine-flu virus (H1N1 S-OIV 2009), neurologists are advised to monitor the safety of such inoculations, should they be implemented. The caution is founded on a higher-than-expected rate of Guillain-Barre syndrome (GBS) in vaccine recipients during the 1976 immunization campaign against swine flu, reports Neurology Today.
More than 30 years ago, soldiers at Fort Dix, New Jersey, experienced an outbreak of swine flu. Fearing a recurrence of the 1918 influenza epidemic, US government officials implemented a widespread vaccine campaign in which more than 40 million Americans were immunized. However, the drive was aborted after 3 months when reports of GBS in vaccinated individuals emerged. Although GBS surveillance data for the time period are sketchy, evidence suggests that vaccine recipients were significantly more likely to develop the condition within several weeks after inoculation.*
At present, leading neurologists do not anticipate a government-led vaccine campaign against H1N1 S-OIV 2009, given the low mortality rate (0.5%) of the current swine-flu pandemic and the historical risk of GBS with inoculation.
* The typical background rate of GBS is about 1.5 per 100,000 individuals.
In the National Review, conservative journalist Mary Claire Kendall questions the influence that the private Josiah Macy, Jr, Foundation has on the nonprofit Institute of Medicine (IOM). At stake, evidently, is the Foundation's interest in removing all sources of commercial funding for physicians' continuing medical education (CME)—funding which is argued (without supporting evidence) to adversely influence physician practice and, consequently, patient outcomes.
Kendall highlights the possibility that the Foundation itself, a private philanthropy established by the descendant of merchant seamen, is unduly influencing the IOM by funding various IOM committees that are concerned with medical education. The possibility that the Foundation is buying off the IOM to push its own predetermined, but unfounded, idea that commercial support of CME is bad is implicit in the Foundation's support of the IOM's Conflict of Interest Committee ($75,000) and the IOM's upcoming ad-hoc Committee on Planning a Continuing Health Care Professional Education Institute ($428,177). The ad-hoc committee, Kendall notes, will include representatives from the Association of American Medical Colleges and the Institute of Health Policy—both of which have received a cumulative $738,000 from the Macy Foundation.
"What is damning is that they [the Macy Foundation] are dedicated to pushing private industry out of CME in the name of an entirely self-serving definition of 'bias' that reaches predetermined conclusions," Kendall writes. What is also damning and, moreover, ironic is the fact that the IOM has failed to provide detailed evidence of its funding sources, despite a united call for transparency in CME to uncover possible conflicts of interest.
