Politics As Usual

By Bonnie Jenkins, Advanced Natural Medicine Bulletin

Maybe you’ve seen the new TV commercial citing a recent Oxford study. At the end of the ad, the pharmaceutical spokesperson gently suggests that viewers talk to their doctor about the study.

Unfortunately, many people will do just that. What they won’t do is question the study. After all, who are they to doubt a prestigious university with a solid reputation in research?

But what most consumers don’t realize is that much of the research touted in drug commercials has been bought and paid for by the pharmaceutical industry. So instead of simply taking study results at face value, maybe you should ask some questions – because blind faith in the ivory towers of research just might have an adverse affect on your health.

Science for sale

Unfortunately, this isn’t a big epiphany for the research community. Pharmaceutical companies provide 70 percent of the money used for clinical trials – money that has often skewed research results. In 1998, the New England Journal of Medicine reported that researchers who published a study supporting the safety of calcium-channel blockers were more likely to have ties to the drugs’ manufacturers than studies that didn’t have industry backing. A year later, the Journal of the American Medical Association found that only five percent of industry-supported cancer studies reached an unfavorable conclusion about the cancer drugs they were studying compared to 38 percent of the studies that didn’t receive any pharmaceutical funding.

But the ties between clinical researchers and industry aren’t just limited to research funding. Pharmaceutical companies routinely romance researchers with a whole host of financial perks. Researchers are invited to serve as paid consultants to the very companies whose products they are studying. They can also join advisory boards and speakers' bureaus, enter into patent arrangements, promote drugs and devices at company-sponsored symposiums and allow themselves to be plied with expensive gifts and trips to luxurious settings. Many also have equity interest in the companies.

But researchers aren’t the only folks under the influence of drug companies. As I was cleaning out my inbox the other day, I came across a recent article in the journal Academic Medicine citing a conflict of interest among the academic experts that review clinical trials. It seems that nearly half of the medical school faculty members who serve on these review boards also serve as consultants to the pharmaceutical industry. The article, which sprang from a survey of nearly 3,000 faculty members at 125 U.S. medical schools, noted that these kinds of industry ties can lead to trade secrecy and delays in publishing research.

But, pharmaceutical companies don’t stop there.

Medical ethics: the new oxymoron

When it comes to funding studies, the drug companies don’t just hand researchers a blank check and hope for the best. They need insurance that the outcome will help them sell the drug under investigation. And what better way than for the pharmaceutical house to design the study themselves? But don’t think for a minute that these drug companies actually hire scientists to accomplish this task.

The choice of which studies are funded and how they are done is overseen by the marketing department. Yep, you read that right. So what does marketing have to do with science? If you’re a pharmaceutical company, everything. The marketing department can design a study that favors their products. They can also give medically important research the thumbs down if the results might reduce their sales of a particular drug.

When it comes to designing a study, pharmaceutical companies have several tricks up their sleeves. For example, a drug can be tested on a healthier population (younger, with fewer coexisting conditions and with a milder form of the disease) instead of subjects that might actually receive the drug. As a result, the trial may find that the drug relieves more symptoms and creates fewer adverse effects than it will in real life.

Here’s another trick: If a new drug is compared with an insufficient dose of a competing product, the new drug will appear to work better. In one report, investigators found that 48 percent of the trials they looked at used higher doses of the sponsoring company's drug and lower doses of the comparison drug.

Pharmaceutical companies also controls how a study will be published – or if it will be published at all. In fact, a substantial number of industry-funded clinical trials never see the light of day. Those that are published go through a rigorous review by the drug company before the researcher is allowed to submit it to medical journals.

In one case, a drug company held up the pre-publication review process for more than six months, then asked the researchers to make scores of detailed revisions so the study would fit with the company's official marketing position. But during the delay, the company secretly wrote a competing article on the same drug – one that was more in line with the company's viewpoint. (Pharmaceutical companies routinely use ghostwriters to write studies that make their drugs look good.)

Another researcher found that a drug he was studying caused adverse reactions. He sent his manuscript to the sponsoring company for review. The company vowed never to fund his work again and published a competing article with scant mention of the adverse effects.

Of course, the biggest losers are the millions of patients who rely on these drugs. Instead of basing their decision on solid science, doctors routinely prescribe medications based on biased research and marketing spin. As Walter Modell, the brilliant researcher who first used the double-blind trial design, once said, “Research is subordinated (not to a long-term social benefit) but to an immediate commercial profit. Currently, disease (not health) is one of the major sources of profit for the pharmaceutical industry, and the doctors are willing agents of those profits.”

One last thing . . .

The pharmaceutical industry isn’t the only industry guilty of influence peddling and conflict of interest. It’s also the standard operating procedure for many multinational food and biotech companies. Federal agencies like the FDA and USDA (which were crated to protect consumers) often behave more like branch offices of the very companies they are suppose to regulate.

In fact, a recent report by the Edmonds Institute lists the names of hundreds of people who move in and out of “revolving doors” as they easily shift from their role as a federal regulator, director or commissioner to that of drug company consultant, lobbyist or scientist. And often, after having served a stint in the pharmaceutical industry, they just as easily move back into public service. These close relationships between regulators and those they regulate are a cause for concern because the conflict of interest inevitably results in the promotion of foods and drugs that are potentially unsafe. 

Fortunately, not every regulator is on the take. And not all research is tainted. In fact, most of the studies done on dietary supplements aren’t biased, since herbs, vitamins and minerals can’t be patented or exploited the way drug research can be. Natural compounds also have the benefit of decades, sometimes centuries of use.

So the next time you see one of those slick drug ads on TV touting scientific studies, take it with a grain of salt. And remember, all that spin just might be harmful to your health.

This just in . . .

Maybe jocks aren’t so dumb after all.

Although athletes often take creatine to boost their sports performance, a new study suggests that this amino acid just might make you smarter. In the crossover trial, 45 young adult vegetarians received either 5,000 mg. of creatine or a placebo daily for six weeks. After an additional six-week washout period, the subjects switched and took the alternate treatment.

By the end of the study, the researchers found that, compared with the placebo, creatine improved both working memory and intelligence. The study’s authors concluded that increasing energy levels in the brain with creatine boosts brain power.

Although creatine is produced naturally by the body, researchers are just beginning to tap into its potential. Bear in mind that this new study used healthy young adults. But other research suggests that creatine might also benefit older, less fit folk. One preliminary study suggests that creatine supplements may help lower cholesterol levels in people with abnormally high concentrations of lipids in their blood. And a few studies of people with congestive heart failure have found that those who took creatine experienced a significant improvement in symptoms and exercise capacity compared to those who received a placebo.

But long-term safety studies haven’t been done, so most experts recommend that anyone taking creatine be monitored by their health care provider, particularly if they have diabetes, kidney problems or liver disease. That said, if you need to be sharp for an upcoming meeting, job interview or even your driving test, taking creatine a few days beforehand just might help you dazzle others with your brilliance!

References:

Barclay L. “Creatine may improve working memory and intelligence.” Medscape. 15 August 2003.

“Bias seen in drug trials paid by for-profit groups.” Reuters 20 August 2003.

Cho MK, et al. “The quality of drug studies publishd in symposium proceedings.” Annals of Internal Medicine. 1996;124:485-489.

Edmonds Institute. www.edmonds-institute.org/door.html.

“Possible conflict of interest within medical profession.” HealthScout. 15 August 2003.