"Despite the ubiquitous mantra of ‘evidence-based medicine,'" notes Harriet Washington in the latest issue of American Scholar
, "a curious lack of skepticism pervades journals about experts who accept money from the makers of the products they evaluate."
The stark reality today, she concludes, is that "financial disclosure has been pressed into service as a substitute for objectivity."
Washington's excellent article, "Flacking for Big Pharma," is itself an evidence-based report on the lengths to which drug-makers commonly go to manipulate drug trials, skew evidence, and tilt doctors' and the public perception of their often-spotty products.
First, some key facts in the article:
- "Medical journals are utterly dependent upon pharmaceutical advertising, which can provide between 97 and 99 percent of their advertising revenue."
- "Medical-journal editors estimate that 95 percent of the academic-medicine specialists who assess patented treatments have financial relationships with pharmaceutical companies."
- "By 2000, drug-makers were paying physicians a total of $6 billion a year for trinkets, island ‘educational opportunities,' and financial grants for their pet projects, from golfing jaunts to clinics."
- Drug and medical-device makers annually sponsor some 300,000 seminars and training opportunities, many of them held in the Bahamas or the Caribbean.
"Not content to skew reports of clinical trials on the back end," Washington adds, "pharmaceutical companies also manipulate medical studies to generate the desired data for those reports." Common techniques include:
- Comparing their drug to a placebo.
- Comparing their drug to a competitor's medication in the wrong strength.
- Pairing their drug with one that is known to work well.
- Truncating a trial.
- Testing in very small groups.
"When physician-researchers are paid by the pharmaceutical industry," she reports, "their medical-journal findings exhibit clear bias in line with the interests of the sponsoring company."
Washington's article also spotlights the extent to which ghostwriting has infiltrated and corrupted medical journals, the subject of previous posts on this blog here and here.
"How to avoid corporate manipulation? That's an easy question," notes John Abramson, MD, author of Overdosed America: The Broken Promise of American Medicine. "Journals have to see the primary data." But when that data is withheld, salted, manipulated, or simply fabricated, the content of even our best and most-relied upon medical journals becomes, in Abramson's words, "little better than infomercials."
"All journals are bought—or at least cleverly used—by the pharmaceutical industry," adds Richard Smith, former editor of the British Medical Journal, in Washington's article. Many drug makers "agree to buy journal advertising only if it is accompanied by favorable editorial mentions of their products."
The consequence of such blatant corruption is easy to predict. "A busy pediatrician who is seeing patients until eight at night doesn't have time to figure out whether an article has been vetted," explains Eddie L. Hoover, MD. "He depends upon the journal editors to make sure he is not reading trash."
Washington's article appears here.