[e-drug] Just how tainted has medicine become?

[Kirsten Myhr <kirsten.myhr@relis.ulleval.no>]

E-drug: Just how tainted has medicine become?
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[Should you not have time to read the full text of this Lancet
editorial, please read at the very least the last paragraph. Copied as
fair use. KM/HH]

Lancet 359(9313):1167 (6 April 2002)

Editorial

Just how tainted has medicine become?

Chief executives of multinational pharmaceutical companies have
much to celebrate this week. They saw spending on prescription
drugs in the USA soar by a remarkable 17% in 2001, according to
figures recently released by the National Institute for Health Care
Management Foundation. As bonuses for corporate leaders ratchet
upwards, so does the unalleviated financial pressure on the elderly,
the largest users of these drugs. Direct-to-consumer advertising
campaigns for cholesterol-lowering agents, anti-ulcer medications,
anti-arthritics, and antidepressants have been strikingly successful.
Total retail spending on prescription drugs was US$155 billion in
2001, almost double what it was in 1997.

The escalating influence of big pharma in medicine persuaded
editors of medical journals to come together last year and agree
strict rules on reporting sponsorship and conflicts of interest (see
Lancet 2001; 358: 854-56). While this consensus sets the highest
standards yet for disclosing commercial influences in medical
research, there are signs that it does not go far enough--or, at the
very least, that this guidance is not being fully heeded.

A study of the interactions between authors of clinical practice
guidelines and the pharmaceutical industry, published in JAMA in
February, found serious omissions in declarations of conflicts of
interest. Almost 90% of authors received research funding from or
acted as consultants for a drug company. Over half had
connections with companies whose drugs were being reviewed in
the guideline, and the same proportion indicated that there was no
formal procedure for reporting these interactions. The guidelines
studied covered all fields where prescription drug use has seen the
greatest increases.

An especially corrosive example of such a commercial influence,
involving one of the most respected US specialist societies--the
American Heart Association--was described in the BMJ last month.
Was the AHA sensible to accept US$11 million in donations from
Genentech while at the same time producing guidelines about
thrombolytics in stroke? Genentech is the US producer of one such
thrombolytic, which was recommended for use in the AHA 2000
guidance on stroke management.

Prestigious institutions are also not averse from mixing research
with commercial gain from industry partnerships. The Seattle Times
has conducted one of the most thorough investigations of how
such relations threaten to poison patient care. In a series of articles
published last year, staff reporters Duff Wilson and David Heath
claimed to reveal how investigators at the Fred Hutchinson Cancer
Research Center completed experiments with biotechnology
products in which they had a direct financial interest. The
journalists allege that doctors did not tell patients that others had
died using these products and that there were safer alternatives
available. The Center denies these allegations but admits that it
"could have handled better" perceptions of conflict of interest.

These concerns extend to journal editors, especially those who edit
part-time while continuing to work in clinical practice and research.
The rules issued by the International Committee of Medical Journal
Editors state that, "Editors who make final decisions about
manuscripts must have no personal, professional, or financial
involvement in any of the issues they might judge". However, the
editor of the British Journal of Psychiatry was recently questioned
about his membership of a drug-company sponsored "educational
organisation", for which he received GBP 2000 annually, together
with his decision to publish a paper favouring a drug manufactured
by the same company. Only after receiving the letter questioning
his behaviour did the editor change his journal's procedure,
excluding himself from decisions about work sponsored by that
same company. He avoided the issue about whether he should have
any commercial liaisons while acting as editor of a supposedly
independent medical journal. The Lancet's policy is that editors
should divest themselves of all such links upon assuming their new
duties.

To return to our first question: how tainted by commercial conflicts
has medicine become? Heavily, and damagingly so, is the answer.
A more important question arises: do those doctors who support
this culture for the best of intentions--eg, to undertake important
research that would otherwise remain unfunded--have the courage
to oppose practices that bring the whole of medicine into disrepute?

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