Review of scientific journals shows steadily increasing conflict of interest in funding of drug trials

http://www.newstarget.com/z019981.html

NewsTarget.com printable article
Originally published August 15 2006
Review of scientific journals shows steadily increasing conflict of interest
in funding of drug trials
When scientific research appears in a peer-reviewed journal, readers are
supposed to be able to trust that the research is honest, unbiased and
accurate -- especially when it concerns prescription drug safety. Thus, when
journalists at mainstream news publications in turn relay that scientific
research to the general public, the public should be able to trust that
information.
Unfortunately, in light of a recent review of major scientific journals, the
information contained in many drug safety studies seems to be more
corporate-spun PR than genuine science, especially when it concerns
psychiatric drugs. According to new findings by a team of researchers from
Beth Israel Medical Center in New York, between 1992 and 2002, the number of
psychiatric drug studies paid for by pharmaceutical companies more than
doubled -- from 25 percent in 1992 to 57 percent in 2002.

Psychiatrist Igor Galynker and a team of researchers reviewed clinical
research from four major psychiatric journals -- Archives of General
Psychiatry, American Journal of Psychiatry, Journal of Clinical Psychiatry
and Journal of Clinical Psychopharmacology -- and discovered that eight out
of 10 studies paid for by the pharmaceutical company making the drug in
question showed favorable results. That's an unbelievable 80 percent success
rate. Conversely, when studies were paid for by pharmaceutical companies
competing with the firm making the drug in question, only three in 10
studies showed positive results. The studies conducted with no support from
the pharmaceutical industry showed favorable results five out of 10 times.

The issue at hand is bias, and sadly, it's not a new phenomenon. It is also
not limited to psychiatric drug studies. According to a June 2006 Agence
France-Presse (AFP) article, private drug companies finance 75 percent of
the studies published in the New England Journal of Medicine, the Journal of
the American Medical Association and The Lancet in Britain. Do the math.
That's a lot of potential bias.

"Anytime you leave the conduct, the analysis and writing up of a study in
the hands of those likely to profit for it, you run the risk of bias and
distortion," said Peter Lurie, deputy director of the Health Research Group
at Public Citizen -- an organization for protecting consumers. Lurie also
said that in addition to Big Pharma firms sponsoring drug studies, they also
finance much of the drug approval work done by the Food and Drug
Administration (FDA). "There is a fundamental conflict of interest in
considering a drug for approval when you know the sponsor is paying your
salary," Lurie said.

Dr. John Abramson, a clinical instructor at Harvard Medical School and
author of the critical 2004 book, "Overdosed America: The Broken Promise of
American Medicine," said in an op-ed piece he wrote in January 2006 for the
Los Angeles Times: "Before 1980, most medical studies were publicly funded,
and most academic researchers scorned industry support. Now, however, the
vast majority of clinical trials are commercially funded, and with the
financial stakes so high, there is mounting evidence of individual
scientists and corporations manipulating their findings."

Abramson cited the now-well-known case of Vioxx to illustrate his argument,
pointing out that U.S. doctors prescribed $7 billion of Vioxx prescriptions
after Merck and the FDA knew that Vioxx caused significantly more heart
attacks, strokes and blood clots than naproxen -- sold over the counter as
Aleve -- regardless of whether or not patients had a history of heart
disease. Why?

"Because the New England Journal article that ostensibly reported the
results of Merck's study didn't even mention either the cardiovascular or
the overall dangers of Vioxx," Abramson wrote. "Instead, it reported only
selective data on heart attacks and strokes, allowing Merck to claim that
Vioxx wasn't a risk to people without a history of these problems ...
Doctors were left with the impression that Vioxx was safer than naproxen
when exactly the opposite was true."

Abramson also said in his Los Angeles Times op-ed article that commercial
bias in research studies has led him to the conclusion that "...most of the
evidence in what doctors believe to be 'evidence-based medicine' is more
infomercial than dispassionate science."


Why peer review is broken
One might wonder how prominent, peer-reviewed medical journals could be
fooled into printing such biased studies. After all, the very idea behind
peer reviewing is to weed out inaccurate work by having experts approve
scientists' work prior to publication. According to Abramson, a vocal critic
of commercial bias in medical reporting, the problem largely stems from the
fact that, "At present, journal editors and peer reviewers typically are not
allowed unrestricted access to the data from commercially sponsored
research." Not even the drug companies' own researchers, who generally write
the articles that appear in medical journals, are allowed complete access to
all of the funding company's data.
And to compound the problem further, most medical journalists aren't trained
in the scientific or statistical fields necessary to sift through the
corporate propaganda rampant in today's medical studies. In a critical 2003
"Watchdog" article that appeared in Harvard University's Nieman Reports,
Abramson called for a much-needed middle ground between today's standard of
scientific reporting -- "simply passing on sensationalized,
commercially-generated versions of 'breakthroughs' in medical science" --
and shouldering long, drawn-out investigative reports to unravel
corporate-spun data.

Abramson also delved into medical reporters' difficulties in properly
reporting the results of scientific studies. He offered this advice to aid
medical journalists: "When financial ties exist between researchers and the
medical industry, the results of a study are 3.6 times more likely to be
pro-industry. Be suspicious ... With many millions, even billions of dollars
at stake, the drug and device industries hire the best and the brightest
researchers, writers, business people, and public relations firms to spin
research findings to their advantage."

And therein lies the rub. Research findings can be spun any number of ways
to suit any number of corporate aims. The statistics are telling: Eighty
percent of studies paid for by the drug firm making the tested drug come out
positive, but only 30 percent of the studies paid for by drug companies
testing a competitor's drug come out positive.

What do these statistics tell the consumer? An obvious argument is that drug
companies shouldn't be funding their own studies, given the suspiciously
high success rate in such cases. However, what the public should take away
from the results of the Beth Israel study is that no scientific study funded
by any drug company can be trusted to be accurate. "Most clinical research
is fundamentally commercial activity -- albeit cloaked in the guise of
public service -- designed to maximize corporate profits," Abramson wrote in
his Watchdog article.

What, then, can the public do to protect itself from such fraudulent, often
dangerous pseudo-science? The answer offered by Sidney Wolfe of Public
Citizen is to completely remove pharmaceutical company funding from the
picture. Wolfe says the government should be footing the bill for drug
research because public programs pay so much for the medications that come
from that research.

However, since Big Pharma's pockets are far deeper than Uncle Sam's, it
seems unlikely that the government will step in anytime soon. In the
meantime, medical journalists -- including the editors of scientific
journals -- must probe deeper into the possible biases of drug research, and
must verify all data received from drug companies prior to publication,
which is considered verification by readers of those journals. However, as
Abramson says, "Whether this is an achievable goal -- within the customary
practices of journalism today -- is another story."