In my last post (Pharma tricks - "key opnion leaders") I commented on an article in the British Medical Journal (1) about pharmaceutical companies hiring leading medical specialists to front for them. The fact that this article appeared in a major medical journal shows that doctors are getting concerned about the undue influence of the pharmaceutical industry on medical practice. The general public should be even more concerned, since we are the guinea pigs. Unfortunately, too many people are unaware of this cosy arrangement between the pharmaceutical industry and the medical establishment.

Just how substantial pharmaceutical "consulting fees" can be was revealed in a June 8, 2008 article in the NY Times (2). The report concerned a group of Harvard child psychiatrists, two of whom were paid at least $1.6 million and the third at least $1 million, from 2000 to 2007. What prompted this exposé was the fact that none of these prominent medical doctors declared their outside incomes to Harvard as required by university conflict-of-interest rules. Lying about their nice fat cheques from drug makers also violated the conflict-of-interest rules of the U.S. National Institutes of Health (NIH) which partially funded their work.

These facts came to light as the result of a U.S. Congressional investigation into the relationship between the pharmaceutical idustry and the medical establishment. Drug companies have replaced the U.S. federal government as the major source of research funding, and law makers have become concerned about the undue influence of industry money on the integrity of medical research.

Obviously, both the drug companies and the medical doctors participating in this scam want to keep this financial arrangement quiet. The whole purpose of this subterfuge is to give the appearance of scientific objectivity, which is obviously out the window once the scale of these payments becomes known. Drug makers cannot hide their involvement in clinical trials; they sponsor these trials, and it is their drugs that are tested. However, the amount of money that is paid to outside researchers speaks volumes about the credibility of the results. Compensation for time spent is one thing, and apparently annual outside revenues of less than $10,000 dollars needn't be reported to universities. But one simply has to believe that payments of a million dollars or more over a period of seven years buy a good deal more than just time.

What did drug money buy in this case? Apparently it bought a whole new pharmaceutical market. These Harvard researchers "discovered" that a large number of children and adolescents suffer from dipolar disorder, a mood problem formerly thought to be confined to adults. They promoted the aggressive diagnosis and treatment of this condition with anti-psychotic drugs. Conveniently, it wasn't even necessary to develop new drugs — anti-schizophrenic drugs are prescribed for this newly discovered disease.

The result of all this was a huge increase in diagnoses and prescriptions for this condition. According to the same NY Times article, "Some 500,000 children and teenagers were given at least one prescription for an antipsychotic in 2007, including 20,500 under 6 years of age, according to Medco Health Solutions, a pharmacy benefit manager." (2)

Not all researchers agree with the Harvard trio on childhood dipolar disorder. Some consider the clinical studies "proving" the condition poorly designed and the results inconclusive. The biggest problem in this field is the fact that assessment of symptoms is subjective; it is difficult to prove the diagnosis or to disprove the success of pharmaceutical intervention. What better "health" field could you find if you wanted to invent a disease to make money?

"The price we pay for these kinds of revelations is credibility, and we just can't afford to lose any more of that in this field", another researcher is quotes as saying. "In the area of child psychiatry in particular, we know much less than we should, and we desperately need research that is not influenced by industry money." (2)

How credible are the findings of researchers who lie about their financial links to the drug companies sponsoring their studies? And it is unlikely that problems of this sort are restriced to the field of child psychiatry. So much for "evidence-based" medicine.

Sources:

1. Key opinion leaders: independent experts or drug representatives in disguise? R. Moynihan. Brit Med J 2008;336:1402-1403. [Full Text]
2. Researchers fail to reveal full drug pay. Gardiner Harris and Benedict Carey. NY Times June 8, 2008. [Full Text]