Cookie Monster, Free Lunch, And The New England Journal Of Medicine

In its efforts to defuse the conflict of interest issue the New England Journal of Medicine keeps setting off new explosions. The recent series of articles by Lisa Rosenbaum in the New England Journal of Medicine about conflict of interest issues provoked a storm of debate, including a powerful response from three former NEJM editors (and my own more eccentric response).

Now NEJM itself has published 4 letters in response to the articles. Only one letter actually attempts to support the viewpoint of the series, which is that the conflict of interest problem has been greatly exaggerated. Unfortunately for Rosenbaum, however, the one supporting letter is more likely to do her more harm than help.

The author of the supporting letter, Dr. Timo Strandberg, uses an anecdote from Catch-22 to make his argument. Here’s the letter:

The three articles by Rosenbaum offered a truly fresh viewpoint on the increasing madness surrounding conflict-of-interest policies, and I applaud the Journal for publishing them. Rosenbaum’s role as a whistle-blower can be compared with some examples found in the literature — Catch-22 by Joseph Heller being a hilarious example. In the novel, oath madness spearheaded by Captain Black reaches its peak when his “Glorious Loyalty Oath Crusade” forces combat pilots to spend their” time in endless and spiraling concessions of pledging, even in the canteen before getting their lunch. The crusade finally comes to an end when Major ——— de Coverley, a mystic and authoritarian person, loudly orders, “Gimme eat.” Decent rules are needed, but too much is too much.

I guess the tortured logic of the letter makes some sense. Dr. Strandberg appears to admire the way “Gimme eat” cuts through all the ritual BS. But with this anecdote Strindberg, inadvertently, brings up a much more relevant concept: greed. “Gimme eat” is the natural primitive response to the offer of a free lunch.

“Gimme eat” also sounds an awful lot like a similar saying from a much more famous character: Cookie Monster. And I think we can pretty much guess where he would stand on these issues.


Cookie Monster

“Me want cookie!”

It may also be worth noting Dr. Strindberg’s own list of disclosures. That’s a lot of cookies.

Dr. Strandberg reports receiving lecture fees, consulting fees, meeting expenses, or research support from Abbott, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Edwards Lifesciences, Novo Nordisk, Nutricia, Orion Pharma, Pfizer, and Servier and holding stock in Orion Pharma.








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