Maran Wolston, U of M student, on 'betrayal of trust' by neurologist paid by drug companies

Categories: Health
Courtesy Maran Wolston.
Maran Wolston developed symptoms of MS in 2006.
For Maran Wolston, learning she had developed Multiple Sclerosis was frightening enough. But the treatment was a horror in itself.

Wolston, a Ph.D candidate at the University of Minnesota, believes she received years of questionable -- and at times, potentially dangerous -- advice from a doctor whose judgment was clouded because he was paid hundreds of thousands of dollars from drug companies.

Her story, which was recently published in Health Affairs health care and policy journal, offers a window into several ethical issues facing the medical community, including whether doctors should disclose financial relationships with drug companies to patients.

"I come from a perspective that doctors are the buffer between the patient and the drug company," says Wolston. "I think the patients should be protected from drug companies."

Wolston began to notice early signs of MS in 2006. At first, the symptoms seemed more like a minor annoyance than a long-term health problem. Most of the time she was fine, but whenever she finished biking to school or playing a game of racket ball, she experienced vision problems

"It was almost like there was a floodlight shining in my right eye," she says.

Several specialists later, Wolston discovered the problem stemmed from lesions on her brain.

Wolston says the "betrayal of trust" from her neurologist -- who is unnamed in the article -- began on the first appointment after she was diagnosed. He previously told her there was no hurry to begin treatment, but he now said she qualified for an experimental drug study he was conducting.

This gave Wolston reason to pause. She had been pre-med in her undergrad, and her dissertation focused in part on bioethics, so she was well aware of the ethical questions surrounding these types of studies. Wolston asked the neurologist if he was being compensated for running the drug trial, and he confirmed that he was. She decided the study was too risky, and opted not to participate.

At an appointment six months later, Wolston discovered she had developed more lesions, which meant it was time to start medication. She agreed to start using Copaxone (glatiramer acetate), a self-injecting drug that can help reduce the symptoms of MS.

Courtesy Maran Wolston.
Bioethics professor Carl Elliot says companies like Shared Solutions raise ethical questions.
The treatment, says Wolston, was not pleasant. From the article:
Patients are advised to cycle through the various possible injection sites so as to avoid inserting the needle into the same area repeatedly. But no matter where I injected the drug each day, the injection site swelled up into a huge welt and felt like a gigantic bee sting.

Around this time, Wolston began getting regular calls from nurses working for a company called "Shared Solutions" to talk about the treatment. She also received packages in the mail from them containing a wealth of swag: traveling cases for syringes, refrigerator magnets, invitations to MS dinners.

Wolston couldn't quite figure out Shared Solutions. When her doctor had asked permission to give her patient information to the company, he didn't offer any explanation to its nature, so she assumed it had something to do with her health insurance. But for all the pain and discomfort she described, no one at Shared Solutions ever suggested she stop taking and it and try another drug.

After some research, she discovered Shared Solutions was actually a subsidiary of Teva Pharmaceuticals, the manufacturer of Copaxone.

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