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How Tightly Do Ties Between Doctor and Drug Company Bind?


Published: July 27, 2004

David Klein

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Drugs (Pharmaceuticals)


My patient scanned the prescription I had handed her, then idly glanced at the elegant ballpoint pen I had used to sign it. The same drug brand name appeared on both.

She said nothing, but I knew just what she was thinking.

I had the same thoughts a few months before, listening to a researcher at a medical conference present the results of a new treatment combination for hepatitis C. The data were unambiguous: The drugs were mediocre at best. Still, the researcher methodically minimized the drugs' problems and urged us all to begin prescribing them.

"I wonder whose pocket he's in," I muttered to myself.

Earlier this month, consumer groups raised exactly the same issue when they questioned a federal panel's recommendation that Americans at risk for heart disease sharply lower their cholesterol levels. Most of the panel members had financial ties to pharmaceutical companies that make statins, powerful cholesterol-lowering drugs whose use will soar with the new guidelines. Were the panelist's recommendations truly impartial, or was their integrity suspect? The consumer groups also criticized the press, including this newspaper, for not explicitly addressing the financial links. However, resolving these apparent conflicts of interest is far from easy. It is becoming one of the biggest medical challenges of the 21st century. Sometimes drug company ties taint a doctor's or researcher's judgment. Often though, they do not. How is it all to be sorted out?

What Sinclair Lewis admiringly described 80 years ago as "the cold, clear light" of medical science - a single-minded impartial commitment to truth and human welfare transcending all external influence - is becoming hard to find. Instead, we often see only a refracted spectrum of partisan interests that can be impossible to reassemble into truth.

Is the nice pen I accept from a drug company an implicit promise that I will prescribe the drug whose name is etched on its barrel, or is it just a pen? Does the grant money a researcher receives from a pharmaceutical company indicate that the research will be subtly prejudiced, or is it just money? And even when financial issues are not involved, what about all the other less tangible factors that may sway scientific judgments, from the philosophical convictions of interest groups to individual researchers' determination to enhance their own reputations?

These questions have escalated in our time, experts say, because our society increasingly forces us to trust the expertise of professionals who are strangers to us.

"We are now much more dependent on the judgment of others, much less able to evaluate their judgment decision by decision, and indeed generally know much less about those individuals than we would have even 50 years ago," wrote the philosopher Michael Davis in a 2001 book, "Conflict of Interest in the Professions."

In medicine, the problem has been compounded by the increasing public distrust of the pharmaceutical companies, as controversy about drug pricing mounts. Meanwhile, the fraction of biomedical research sponsored by the pharmaceutical and other for-profit industries has soared, rising to 62 percent in 2000 from 32 percent in 1980, as government research support declines.

As medical research and business jostle ever closer, medical journals are devoting quantities of editorial commentary to the question of whether financial ties create partisan research and, if so, what to do about it.

The problem appears real. One study, published in 1998, examined dozens of articles about calcium-channel blockers, a controversial family of blood pressure medications that some doctors feel are dangerous for certain patients. Authors who championed the drugs' safety proved far more likely to have financial relationships with the manufacturers than did the critics. A similar study linked authorship of articles discounting the dangers of passive smoking with financial ties to the tobacco industry.

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