It’s 2003. The American Academy of Pediatric Dentistry accepts a $1 million donation from Coca-Cola. That same year, the group announces that “scientific evidence is certainly not clear on the exact role that soft drinks play in terms of children’s oral disease.” This statement, according to a report from the Center for Science in the Public Interest, directly contradicts the AAPD’s previous stance: “Consumption of sugars in any beverage can be a significant factor that contributes to the initiation and progression of dental caries.”
Yes, I guess it could be purely coincidental that the AAPD decided to contradict what every parent with even a tiny shred of common sense already knows – at the very same time they’ve just inked the $1 million Coca-Cola deal.
But really? Seriously?
In another report called Heads They Win, Tails We Lose, The Union of Concerned Scientists helps to explain how corporations can corrupt the integrity of science by implementing marketing-based strategies. For example:
Ghostwriting scientific articles
“Corporations corrupt the integrity of scientific journals by planting ghostwritten articles. Rather than submitting articles directly, corporations recruit scientists or contract research organizations to publish articles that obscure the companies’ involvement. Scientists have been compensated $3,000 to $5,000 to place their name and title on an article and submit it for publication (McGarity and Wagner 2008). In some cases, these scientists have had limited involvement in the study design, research, or analysis.
“While the exact extent to which ghostwriting occurs is difficult to measure, confirmed instances reveal that it is abundant. One analysis found that articles on 33 of 44 industry-initiated clinical trials exhibited evidence of ghostwriting (Goetzsche et al. 2007).
- Litigation revealed that Merck employees wrote 20 articles about its now discredited pain drug Vioxx. Of those, 16 listed an external scientist as the primary author, despite the fact Merck personnel had drafted the articles, complete with analysis, before the outside academics even became involved (Ross et al. 2008).
- From 1998 to 2007, Pfizer discreetly facilitated the publication of 15 case studies, six case reports, and nine letters to the editor to boost off-label use of Neurontin, a drug prescribed to treat seizures in people who have epilepsy and nerve pain (McGauran et al. 2010). The number of patients taking the drug rose from 430,000 to 6 million, making it one of Pfizer’s most profitable products (Egilman and Druar 2011). But an investigation found that Pfizer had failed to publish negative results, selectively reported outcomes, and excluded specific patients from analysis (Dickersin 2008). Pfizer failed to note that the drug increased the risk of suicide (Egilman and Druar 2011).
- The Tobacco Institute founded the faux journal Reports on Tobacco and Health Research in 1960 to spread uncertainty about the link between smoking and lung cancer. The journal, circulated to doctors, scientists, and the media, included articles such as “Cancer Personality Pattern Is Reported to Begin in Childhood,” “Lung Specialist Cites 28 Reasons for Doubting Cigarette-Cancer Link,” “Inhalation Tests Fail to Cause Lung Cancer; Virus Suggested,” and “Psychological, Familial Factors May Have Roles in Lung Cancer” (Michaels 2008). In 2003, Merck replicated that strategy, setting up the fake medical journal they called Australasian Journal of Bone and Joint Medicine to publish articles sympathetic to Merck products, and distributing it to 20,000 doctors (Krimsky 2009).”
“Corporations selectively publish positive results while under-reporting negative results. They have also published duplicate articles, made negative reports harder to locate, and made positive reports more accessible. While not directly corrupting science itself, these publishing and reporting biases skew the body of evidence.
- One review found publishing and reporting bias regarding 50 drugs or medical devices used to treat 40 medical conditions. For example, of 74 trials of antidepressants, all 38 with positive results were published, while 22 of 36 trials with questionable or negative results were not published (McGauran et al. 2010).
- An investigation found that multiple articles on the efficacy of Risperdal, an anti-psychotic medication, were based on limited research. For instance, the results of one trial appeared in six publications under different authorship (Deyo 2010).
- Pharmaceutical companies have written and published meta-analyses – overviews of results from multiple research projects – which are important in establishing scientific consensus. A study of 691 meta-analyses of anti-hypertension drugs found that those produced by individuals with ties to drug companies were significantly more likely to report results in the companies’ favor. (Yank, Rennie, and Bero 2007).”
Downplaying evidence and playing up false uncertainty
“As scientific understanding of the negative health effects of products and substances such as tobacco, lead, and particulate emissions emerge, companies attack the science and spread doubt about the dangers, undermining regulatory will to protect the public.
- In response to evidence that cigarette smoke increased the risk of lung cancer, R.J. Reynolds argued that “statistical studies cannot prove cause-and-effect relationship between two factors,” “mice are not men,” and “no experimental evidence exists to show that any cigarette smoke constituent is carcinogenic to human lung tissue at the level present in cigarette smoke” (Bohme, Zorabedian, and Egilman 2005).
- The lead industry consistently underplayed scientific reports showing that exposure to lead had serious health effects, especially in children. Lead company officials denied that lead emissions posed any public health risk (Rosner and Markowitz 2002). In response to studies showing that children exposed to lead had developmental problems, a public relations firm argued that the poisoned children had been “sub-normal to begin with” (Michaels and Monforton 2008).”
- The tarnished reputation of university research
- Medical journals: “information-laundering for Big Pharma”?
- Big Pharma’s remarkable powers of persuasion
- Big Tobacco’s lessons for Big Food
- “Sugar is good for you!” – and for the people who sell sugar
- Bioethical journal: “How drug marketing corrupts every part of the scientific and medical network”
- Warning: clinical trials funded by drug companies may appear more truthful than they actually are
- Partners in Slime: Why medical ghostwriting is so alarming
*sigh* One of my massive pet peeves, schlock research.
Thanks for another great post, Carolyn, even if the info is so alarming. And Happy Valentine’s Day.
Thanks Kathi – sorry about mucking up your Valentine’s Day celebrations with this post! Next time …. more hearts and flowers, okay? 😉
Carolyn, fear not. I had a colonoscopy yesterday, so clearly, I gave up on the whole romance thing. No flowers from the gastroenterologist, that’s for sure!! LOL
What? No flowers?!? 😉
I know!! The nurse, however, did make me a bowl of oatmeal afterwards…
Carolyn, thank you again for keeping a focus on how health research has been corrupted by industry interests.
Perhaps nothing is more illustrative of this phenomenon than the global acceptance of lipid-lowering drugs (i.e. statins) as the preferred means of preventing and treating cardiovascular disease (CVD).
I was surprised to see that the Cochrane Collaboration recently published a review favoring the use of statins for primary prevention — meaning, the prescribing of statins to reduce LDL cholesterol in people with no history of CVD. Please see: “Statins for the primary prevention of cardiovascular disease: updated“, F Taylor et al, January 31, 2013.
To date, there doesn’t appear to be much critical response to this Cochrane Review. However, a number of reservations are expressed in the following post from the EVIDENTLY COCHRANE blog out of the UK Cochrane Centre. Please see: “Statins save lives in patients undiagnosed with heart disease“, February 1, 2013.
I look forward to hearing your thoughts on the foregoing.
Thanks so much for sending these links. A couple thoughts, specifically on: “All trials were fully or partially funded by pharmaceutical companies, which is something to bear in mind. Research by Als-Nielsen and colleagues in 2003 demonstrated that pharmaceutical industry sponsored trials were more likely than non-industry funded trials to report results that favour the drug over placebo”.
Although the Cochrane reviewers described the overall quality of the trials as “good”, there remains the known credibility issue of studies that are bought and paid for by industry. Heard an interesting analogy the other day: if Big Tobacco paid physicians (as they certainly have in the past) to cite “research” that claims to show cigarette smoking is harmless, how credible would you consider those claims?
The other red flag for me is the fact (caught by the second report) that in 14 of the 19 trials studied, participants included those with “cardiovascular risk factors such as raised cholesterol, diabetes and high blood pressure.” These are not and never would be considered low risk adults even though they have not had a cardiac event – YET!
Finally, an independent Health Canada-funded report called Evidence For Caution: Women and Statin Use in 2008 found: “The evidence base for prescribing statins for women, especially for primary prevention, is weak yet Canadian data suggest that half of all prescriptions are for women. Safety meta-analyses do not disaggregate for women; do not consider female vulnerability to statin-induced muscle problems, and women-centred concerns such as breast-cancer, miscarriage or birth defects are under-researched. Many trials have not published their non-cardiac serious adverse event data. These factors suggest that the standards of full-disclosure, informed consent, evidence-based prescribing and gender-based analysis are not being met and women should proceed with caution.”
You might want to seriously consider putting a button on your page linking to this site:
You can see what that link on a website looks like here:
And, pick up a copy of Ben Goldacre’s new book “Bad Pharma” if you haven’t already done so.
Thanks for the tip on the AllTrials link – just tried embedding it on my site, but got a 404 error message back; have contacted AllTrials about this. Yep, my Bad Pharma book is on order.
Did Alltrials ever get back to you about the embedding problem?
Yes, they did. Couldn’t solve the embedding issue but they did send me the graphic and I just posted it as a widget with a live link attached. Thanks for asking.
Scrolled down and saw it. Thanks. You might want to consider highlighting it through a full post on your site? Goldacre is going to need all the allies he can get. I think he summarizes the situation well when he said this in a recent interview:
“The intention of the pharmaceutical industry in my view is simply to delay the public becoming aware of the problem and professionals and policymakers addressing the problem and they will defend what they believe is their right to withhold unflattering clinical trial data. They will defend that harder than they defend anything else. You watch.
“Marketing, payments to doctors, all of that stuff, they’ll fight on it but to hide the unflattering results in clinical trials, they will fight viciously, tooth and nail, because that is more important to them than anything else. If you can poison the well of medical evidence, then you are made.”
via Pharmagossip (who has been giving Goldacre and the book a lot of coverage. 1boringoldman – cannot recommend that site enough – has also been covering alltrials a fair amount).
Some other relevant links worth the time to read:
Because it lays out just how sophisticated an argument he is making.
I actually think he is altogether too optimistic about the overall impact of medications. I also think that broader access to patient level data is very important, and not included in the main thrust of alltrials. I also think he oversells the promise of data mining through electronic health (health care renewal, which you might want to think about adding to your blog roll – I’m full of suggestions today – speaks eloquently to the challenges inherent in that).
So, I’m not a fan of everything he is saying.
But, Goldacre seems to speak clearly about just how savage a fight this is going to be. And, he’s actually fighting it. And, fighting it damn well.
We really need him to win, at least on some real levels.
Because, there is simply NO way for patients and clinicians to compensate on an individual level for this absence of data.
“because that is more important to them than anything else”
Is it to the rest of us?
There is an enormous amount of potential loss of money at stake for a handful of companies.
There is some benefit spread across an enormous number of people. But, it’s hard to know for any one person when the trickle down impact of that information (well, lack of information) is going to come into play.
So maybe not.
People might need a reminder about ethics. Ethics of the highly highly practical kind.
Perhaps need to be nagged about it.
You could do worse than convince every reader of your blog to read the book and sign on to the campaign.
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