Doctors on the take: how to read the fine print in medical research reports

I was doing a little light reading in the Archives of Internal Medicine the other day. A study reported there looked at what researchers have dubbed the Eco-Atkins Diet, which replaces the low-carb, dangerously high-saturated fat meat protein of the old Atkins Diet with low-carb, low saturated fat vegetable-based protein - such as soybeans, legumes and nuts.

The more I read, the better I liked what I was reading. The study showed that the vegetable-based protein-eating participants not only successfully lost weight on this new Eco-Atkins Diet, but they showed greater reductions in their LDL (bad) cholesterol levels than the control group.

Isn’t this fabulous news for those of us wanting to lose weight as well as improve our heart health? Well, maybe not.  

It was the disturbing conflict of interest disclosures in fine print down at the bottom of the journal article that floored me.  This (very fine) print revealed that the “study was supported by Solae, a soy food company”, and the study’s lead author was a physician who served on the scientific advisory boards or had received cash from corporations including:

• Unilever (makers of Eco-Atkins-friendly products like Bertolli olive oil, Becel Omega 3 margarine, and Breyers ‘Carb Smart’ ice cream)

• The Sanitarium Company (makers of Eco-Atkins-friendly So Good soymilk, Vegie Delights™ soy sausages and lentil patties, Nutrolene® roasted nut loaf, and Rediburger® vegetarian ground round soy products)

• Barilla (makers of Eco-Atkins-friendly Barilla PLUS™ high-protein pasta made from egg whites, lentils and chickpeas)

• The Almond Board of California (and he also served on their Speakers Panel)

• Solae (world leader in production of Eco-Atkins-friendly soy products for food, feed and industrial use. Solae soy is used in over 80% of the world’s clinical research on soy proteins. It’s a subsidiary of the chemical giant Dupont, and a partner with Monsanto in “a new line of soy protein developed with Monsanto’s ‘plant breeding’ technology” which I guess is what they’re calling genetic engineering these days).

As if I weren’t feeling disillusioned enough by then, I learned that two of the study’s co-authors are actually current or former full-time employees of Solae.

So let me spell this out for you:  a big money, peer reviewed, academically published research study recommending increased consumption of nuts, legumes and soy products is funded by companies that produce nuts, legumes and soy products.

Imagine that you personally are the CEO of Solae, or Unilever, or Barilli, or the Almond Board of California, and you are looking for ways to boost sales and make your shareholders happy. A brilliant strategy would be to fund “research” in which - quelle surprise! – researchers who are actually on your payroll determine that the products you manufacture are not only good for the waistline but – even better! – now good for the heart.

With heart disease the #1 killer of both men and women in North America, you’d have a ready-made and eager target market of Baby Boomers to pitch your products to.  And you would apparently do this with a straight face.

Don’t get me wrong, my little nags-in-training: getting people to eat more almonds or soy burgers in spite of tainted research may seem pretty harmless.  But it’s a short stretch of road between that and convincing those same people to prescribe drugs or medical devices based on equally tainted research.

Become an educated and curious consumer. Find out who’s paying for the research you are reading about. Always assess those conflict of interest disclosure statements at the end of published journal articles (when they’re available – appallingly, not every medical journal requires study authors to let readers know who has paid for their opinions!) These admitted conflicts of interest tell you if you should take this research with a skeptical grain of salt. For expert help in deciphering potentially misleading research results, try bookmarking resources like  Health News Review, particularly their Journalist Toolkit page on Things You Should Know About Medical Research Studies.  In Canada, visit Media Doctor Canada for the same expertise in assessing Canadian media coverage of health topics.  Both use a simple 1-5 star system to rate research report flaws like ‘disease mongering’ – which means ‘framing risk factors as a disease’ or ‘medicalization of normal human variants’.

Medical experts with their greedy fingers in the wallets of corporations are not new, of course. Consider the physicians hired by Big Tobacco decades ago to undertake research “proving” that cigarettes were not dangerous to our health. In 1969, Post-Keyes-Gardner, the ad agency for tobacco giant Brown & Williamson, relied on the testimony of their hired gun physicians for a new campaign “to set aside in the minds of millions the false accusations that cigarette smoking causes lung cancer or other diseases.” (Handbook of Public Relations, Heath & Vasquez, 2004).

An independent 1996 study found that 98% of scientific papers based on research funded by drug companies promoted the effectiveness of that company’s drug. When the Canadian Medical Association Journal reviewed 19 previously published cardiac studies on the safety of drug eluting coronary stents, all seven of the studies that were sponsored by the stent manufacturers recommended continued widespread use of this device, compared to just three of the 12 unsponsored independent studies.

The drug giant GlaxoSmithKline paid $720 million last year for the commercial rights to early research on resveratrol, a substance found in red wine, thought to improve heart health. Here’s my cynical prediction:  expect to see a flurry of GSK-sponsored medical researchers “proving” the health benefits of GSK’s new resveratrol supplement pills.  If GSK can convince regulators that this supplement should be prescribed by their stable of drug-rep-educated physicians in daily practice – well, there’s the ‘money shot’, as we used to say in PR. They’ll recoup their $720 million investment in spades, while consumers line up like mindless sheep to demand and purchase their doctor-approved resveratrol pills.

Clinical researchers who depend on funding from Big Pharma are very aware that if they publish negative study results, their funding may well be yanked. This has already happened in several high-profile university labs.

Worse, surveys have found that nine out of 10 medical experts writing nationwide disease treatment protocol guidelines have significant financial ties to the pharmaceutical industry, yet those ties are almost never disclosed in the treatment guidelines, which are often published in medical journals and then implemented in daily practice.

And these are just the ones we know about.  In 2002, the well-respected New England Journal of Medicine made the startling announcement that they were dropping their editorial policy stipulating that authors of medical studies could not have financial ties to drug companies whose medicines were being analyzed. Why? They determined that there weren’t enough researchers out there who were not already bought and paid for by pharmaceutical companies.

As Dr. Marcia Angell, a former editor of The New England Journal of Medicine, noted in the Baltimore Sun:

“What would be considered a grotesque conflict of interest if a politician or judge did it is somehow not when a physician does it.”

Here’s a news flash for you physicians who have your collective heads shoved so firmly up your nether regions that you appear to be truly ignorant about how bad this looks:  I don’t care how many letters you have after your name, or how sterling your C.V. is, or how pure you claim your research methodology to be.  The fact that you are on the take from any company with any vested interest in how any of your studies turn out means that your results are suspect.

Shame on you, Doctors.

Originally published on Heart Sisters, my website about women and heart disease

© 2009 Carolyn Thomas www.myheartsisters.org

 For something even more nauseating, read this New York Times article about medical ghostwriters in drug companies.

See also:

• Medical ghostwriting: if you’re not alarmed, maybe you’re not paying attention
• What if everybody just started telling the truth about medical ghostwriting?