- Email: [email protected]
Merck Sharpe and Dohme versus Laporte
Correspondence
Merck Sharpe and Dohme versus Laporte
What symbol should represent the medical profession?
Peter Honig (March 27, p 1079)1 states that I refused to allow Merck Sharpe and Dohme (MSD) to respond to our comments on the VIGOR trial in Butlletí Groc. However, the response MSD wanted to publish was laudatory and far too long (twice a full issue of the bulletin). After two meetings with MSD representatives, we were told that they would withdraw their demand. I only knew that MSD had taken legal action when, a year later, I was summoned to court. Honig also claims that the court did not find that MSD engaged in scientific misconduct. This assertion is not true. The verdict explicitly confirmed that our article in Butlletí Groc was accurate, that it reflected the debate on the ethics of publications in medical research, and it echoed the US Food and Drug Administration warnings to MSD regarding misleading information on the cardiovascular adverse effects of rofecoxib in promotional materials.2 Misleading information on the efficacy and safety of new medicines causes confusion at all levels of the therapeutic chain, and it can have serious effects on public health. The provision of independent, high-quality, and clinically relevant information to health professionals is vital in protecting patients from injury and the health services from unnecessary waste. Attempts to suppress such information, as MSD did with our bulletin, are contrary to the public interest.
An increasing number of articles have proposed a fascinating historical reconstruction of the symbol used through the ages to represent the activity of doctors. There has been perplexity about continuing to use the winged caduceus of Hermes, since this symbol has come to be associated with trade, commerce, communication, and even thieves, which is not very flattering for doctors. It has been proposed that we return to the single-serpent-entwined staff of Asklepios,1 or to go back to an even more ancestral symbol: an arrow.2 This debate about what is historically the most appropriate symbol for doctors is an enlightening means for continued reflection and questioning of the roots, developments, and challenges facing medicine today. This profession is now an applied science, ever more open to multidisciplinary and multilateral contributions from the fields of molecular biology, genomics, proteomics, and technology, resulting in bioethical and applicative implications that until a few years ago would have been unimaginable. What symbol would best represent medicine’s value, history, and traditions and at the
2
416
With permission from Perugia University, Italy
[email protected]
Honig P. Merck Sharpe and Dohme versus Laporte. Lancet 2004; 363: 1079–80. Abrams TW. Warning letter. PharmCast. com http://www.pharmcast.com/ WarningLetters/Yr2001/Sept2001/ Merck0901.htm (accessed June 14, 2004).
Enrico Capodicasa [email protected] Perugia University Medical School, Policlinico Monteluce, Perugia, Italy 1
2
Wilcox RA, Whitham EM. The symbol of modern medicine: why one snake is more than two. Ann Intern Med 2003; 138: 673–77. Calman K. The arrow or the Caduceus as the symbol of the doctor. Lancet 2003; 362: 84.
MRC Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet 2004; 363: 1491–502—On page 1496 of this Article, in the last paragraph of the second column (headed Subgroup analyses), the fourth sentence should be “. . . (absolute gain 11·7% [95% CI 7·8–15·7]) . . .”
Joan-Ramon Laporte
1
I wish to thank Francesco Bistoni, Rector of Perugia University, for his valuable work in bringing to light ancient documents of the University.
Department of error
An extended discussion can be found at http://www.icf.uab.es.
Fundació Institut Català de Farmacologia, Universitat Autònoma de Barcelona, Hospital Vall d’Hebron, Institut Català de la Salut, 08035-Barcelona, Spain
same time evoke the heights that man and modern medicine has reached? As is eloquently depicted on the cover of one of the 16th century books conserved at Perugia University in Italy (figure), the single-serpent-entwined staff is placed in the hands of man, almost as though to suggest a doctor’s renewed personal, pluralistic, ethical, and moral pledge towards his patients at the dawning of what was to become a profound scientific and cultural transformation in modern medicine. Might this symbol not be equally as appropriate now?
Figure: Cover of one of the first books of medicine, printed in 1546
Elazary AS, Lador N, Shauer A, et al. Tongue necrosis and pericarditis. Lancet 2004; 363: 948. In this Case Report (Mar 20), the ninth sentence of the first paragraph should read: “IgG was 23 400 mg/L, IgM 2000 mg/L, and IgA 3600 mg/L.”
www.thelancet.com Vol 364 July 31, 2004
Merck Sharpe and Dohme versus Laporte
What symbol should represent the medical profession?
Peter Honig (March 27, p 1079)1 states that I refused to allow Merck Sharpe and Dohme (MSD) to respond to our comments on the VIGOR trial in Butlletí Groc. However, the response MSD wanted to publish was laudatory and far too long (twice a full issue of the bulletin). After two meetings with MSD representatives, we were told that they would withdraw their demand. I only knew that MSD had taken legal action when, a year later, I was summoned to court. Honig also claims that the court did not find that MSD engaged in scientific misconduct. This assertion is not true. The verdict explicitly confirmed that our article in Butlletí Groc was accurate, that it reflected the debate on the ethics of publications in medical research, and it echoed the US Food and Drug Administration warnings to MSD regarding misleading information on the cardiovascular adverse effects of rofecoxib in promotional materials.2 Misleading information on the efficacy and safety of new medicines causes confusion at all levels of the therapeutic chain, and it can have serious effects on public health. The provision of independent, high-quality, and clinically relevant information to health professionals is vital in protecting patients from injury and the health services from unnecessary waste. Attempts to suppress such information, as MSD did with our bulletin, are contrary to the public interest.
An increasing number of articles have proposed a fascinating historical reconstruction of the symbol used through the ages to represent the activity of doctors. There has been perplexity about continuing to use the winged caduceus of Hermes, since this symbol has come to be associated with trade, commerce, communication, and even thieves, which is not very flattering for doctors. It has been proposed that we return to the single-serpent-entwined staff of Asklepios,1 or to go back to an even more ancestral symbol: an arrow.2 This debate about what is historically the most appropriate symbol for doctors is an enlightening means for continued reflection and questioning of the roots, developments, and challenges facing medicine today. This profession is now an applied science, ever more open to multidisciplinary and multilateral contributions from the fields of molecular biology, genomics, proteomics, and technology, resulting in bioethical and applicative implications that until a few years ago would have been unimaginable. What symbol would best represent medicine’s value, history, and traditions and at the
2
416
With permission from Perugia University, Italy
[email protected]
Honig P. Merck Sharpe and Dohme versus Laporte. Lancet 2004; 363: 1079–80. Abrams TW. Warning letter. PharmCast. com http://www.pharmcast.com/ WarningLetters/Yr2001/Sept2001/ Merck0901.htm (accessed June 14, 2004).
Enrico Capodicasa [email protected] Perugia University Medical School, Policlinico Monteluce, Perugia, Italy 1
2
Wilcox RA, Whitham EM. The symbol of modern medicine: why one snake is more than two. Ann Intern Med 2003; 138: 673–77. Calman K. The arrow or the Caduceus as the symbol of the doctor. Lancet 2003; 362: 84.
MRC Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet 2004; 363: 1491–502—On page 1496 of this Article, in the last paragraph of the second column (headed Subgroup analyses), the fourth sentence should be “. . . (absolute gain 11·7% [95% CI 7·8–15·7]) . . .”
Joan-Ramon Laporte
1
I wish to thank Francesco Bistoni, Rector of Perugia University, for his valuable work in bringing to light ancient documents of the University.
Department of error
An extended discussion can be found at http://www.icf.uab.es.
Fundació Institut Català de Farmacologia, Universitat Autònoma de Barcelona, Hospital Vall d’Hebron, Institut Català de la Salut, 08035-Barcelona, Spain
same time evoke the heights that man and modern medicine has reached? As is eloquently depicted on the cover of one of the 16th century books conserved at Perugia University in Italy (figure), the single-serpent-entwined staff is placed in the hands of man, almost as though to suggest a doctor’s renewed personal, pluralistic, ethical, and moral pledge towards his patients at the dawning of what was to become a profound scientific and cultural transformation in modern medicine. Might this symbol not be equally as appropriate now?
Figure: Cover of one of the first books of medicine, printed in 1546
Elazary AS, Lador N, Shauer A, et al. Tongue necrosis and pericarditis. Lancet 2004; 363: 948. In this Case Report (Mar 20), the ninth sentence of the first paragraph should read: “IgG was 23 400 mg/L, IgM 2000 mg/L, and IgA 3600 mg/L.”
www.thelancet.com Vol 364 July 31, 2004