Widen Research Funding
Medical researchers have had to find new sources of funding as federal grants to medical schools declined and hospital-based research fell victim to managed care cost cuts. They went where the wealth is: the $93-billion-a-year pharmaceutical industry. The industry says that its profits are largely reinvested in research, which has led to America’s preeminence in the discovery and manufacture of useful new drugs. But there are growing questions about the objectivity and direction of some company-paid research.
A recent study by U.S. and Canadian researchers found that 96% of doctors who wrote scientific journal articles supporting calcium channel blockers, a class of high blood pressure medications, had financial ties with their manufacturers. Other writers, without such ties, were far more likely to be critical of the drug, which in some forms is associated with increased heart attacks. Another study, by Dr. John Ioannidis of the National Institute of Allergy and Infectious Diseases, found that positive results from drug therapies are generally published twice as fast in science journals as negative results. “Publication bias,” a tendency not to publish negative results at all, is widely criticized in academic medicine.
The industry spends about half a billion dollars a year on ads in medical journals and there is one pharmaceutical sales representative for every 15 doctors; this sales army is omnipresent at medical conferences. As Food and Drug Administration official Kenneth Feather puts it, “It’s probably shocking to people who don’t know to find the almost total control that the pharmaceutical industry has over the flow of information.”
Congress could help restore some balance by encouraging the National Institutes of Health to fund research that drug companies tend not to support: for example, looking into the long-term dangers, or lack of efficacy, of widely used medications. Congress also should consider a proposal introduced last year by now-retired Sen. David Pryor (D-Ark.) to establish a National Pharmacy and Therapeutics Committee to objectively evaluate prescription drugs. This is currently overseen by the FDA, but as medical author Thomas J. Moore documents in his forthcoming book “Prescription for Disaster,” drug companies have been allowed to manipulate the results of drug trials to highlight studies that find their medications effective.
Another important step in restoring balance would be for medical journals to strictly enforce conflict-of-interest disclosures. George Lundberg, editor of the Journal of the American Medical Assn., insists that leading journals have “adequate” financial disclosure guidelines. But the New England Journal of Medicine recently published an article downplaying the dangers of asbestos exposure, without informing readers that the author had ties to the asbestos industry. And last year, the same respected journal ran an opinion article claiming that the benefits of diet drugs outweigh the risks of heart damage, without saying that its authors were paid consultants for companies that made or marketed one of those drugs, Redux. (Redux and a similar drug were later withdrawn from the market.)
Bruce Jennings, a vice president of the Hastings Center, a bioethical think tank in New York, correctly points out that financial relationships between drug companies and medical researchers have become “a fact of life today.” Those relationships can fund and encourage good science. But they can also be corrupting. Full disclosure in medical journals and well-targeted federal funding are necessary to temper the growing influence of business on medical research.
