Medical Scandal Even Worse Than Suspected
But we never expected to see medical scandal so deep, so egregious, that the New England Journal of Medicine itself would be compelled to report about it. Here is an excerpt from a Reuters news story about what happened.
The Journal said a team of researchers found that almost all the doctors who rushed to defend the safety of calcium channel blockers in 1995 had financial links to the drug companies that make them.
``We wonder how the public would interpret the debate over calcium-channel antagonists if it knew that most of the authors participating in the debate had undisclosed financial ties with pharmaceutical manufacturers,'' said the study team, who argued that ``the medical profession needs to develop a strong policy governing conflict of interest.''
Calcium channel blockers are used mainly to treat heart diseases marked by spasms in the organ's artery. The drugs prevent calcium from entering smooth muscle cells and cause the smooth muscles to relax and reduce muscle spasms.
The National Heart, Lung and Blood Institute warned physicians in 1995 that one particular drug -- short-acting nifedipine -- should be prescribed ``with great caution, if at all.'' It said short-acting calcium channel blockers were linked with an increased risk of death from heart attack.
The warning kicked off a major debate. The authors of the new study, led by Dr. Henry Thomas Stelfox of the University of Toronto, tried to gauge the involvement of industry-supported doctors in the calcium channel controversy by identifying articles published between March 10, 1995, and September 30, 1996, and categorizing them as supportive of the medicines, critical of them, or neutral.
Then they sent surveys to the authors of the 70 articles asking about their financial links to drug companies in general, and calcium channel blocker makers in particular.
They discovered that ``96 percent of the supportive authors had financial relationships with manufacturers of calcium-channel antagonists, as compared with 60 percent of the neutral authors and 37 percent of the critical authors.''
The researchers also wondered if the authors who were critical of calcium channel blockers had financial ties to companies making competing types of heart medicines.
``The answer was no. In fact, supportive and neutral authors were more likely than critical authors to have financial interactions with manufacturers of competing products,'' they concluded.
Only in two of the articles had the editors disclosed any potential conflict of interest for the writer.
Although the Stelfox group acknowledged that the supportive authors may have ties to drug companies because the companies seek relationships with doctors who already support their products, the researchers concluded, ``The results demonstrate a strong association between authors' opinions about the safety of calcium-channel antagonists and their financial relationships with pharmaceutical manufacturers.''
There are many ways for doctors to get support from pharmaceutical firms. Drug companies sponsor ongoing medical education programs and hire physicians to serve as consultants, perform research, or speak at symposia. Often those financial ties are not disclosed, although the editors of medical journals say they are working harder to unearth potential conflicts of interest when doctors publish in their magazines.
Whether support from the pharmaceutical industry is actually swaying the opinions of doctors ``cannot be determined by the results of our study,'' the Stelfox team said.
The American Medical Association, publisher of the Journal of American Medical Association, was stung by criticism last summer after it inked a 5-year endorsement deal to give its seal of approval to Sunbeam Corp. health care products.
The New England Journal was chastised in December 1997 because the author of a book review, who panned a book critical of the chemical industry, turned out to have ties to the industry.