DOCS, DRUGS, DOLLARS: IS HEALTH CARE SAFETY BEING COMPROMISED BY CORPORATE QUID PRO QUO?

By Charles W. Moore
© 1998 Charles W. Moore

As governments wrestle with the deficit monster, an ever higher proportion of medical research and education is being funded by corporations. University boards are also heavily populated with corporate executives.

The operative question is, can scientists, physicians, and educational institutions accept corporate money without subtly altering their scientific and medical views? True to the axiom that "he who pays the fiddler calls the tune," mounting evidence indicates that many cannot.

On health and environmental issues, information is filtered through institutions and government agencies that have a financial and philosophical predisposition to produce data congenial to their business benefactors, with no incentive to engage in research or produce results that could potentially harm the corporate bottom line.

That this state of affairs is not in the best interest of medical patients is demonstrated in an article published in the Aug. 13 edition of The New England Journal of Medicine (NEJM), which concludes that the drug "deferiprone does not adequately control body iron burden in patients with thalassemia and may worsen hepatic fibrosis."

According to the article, deferiprone, an oral iron chelation agent, not only doesn't work properly, but can lead to liver scarring in patients with thalassemia, a genetic blood disorder. Dr. Nancy Olivieri, principal author of the NEJM article, had also signed an agreement in 1995 with Apotex Inc. of Weston, Ont. to test the drug at the Hospital for Sick Children. Dr. Olivieri and her colleagues hoped deferiprone would prove a major step forward in thalassemia treatment.

DON'T MAKE WAVES

However, by 1996 Olivieri determined that the drug was not working as it should. Apotex disputed this, arguing that doctors testing deferiprone in the U.S. and Italy had not reported similar findings.

Despite having signed a confidentiality agreement with Apotex, Dr. Olivieri believed that her patients' health interests overrode any contractual obligations and that her "ethical and moral duties" would not be discharged if the information was not made available to the Health Protection Branch and to the public, even though Apotex threatened to sue her. Shamefully, the Hospital for Sick Children refused Olivieri legal assistance at the outset, although it now claims it would have done so had Apotex not withdrawn its lawsuit threat.

The inescapable message was that doctors should not make waves that might jeopardise the flow of corporate subsidies, even if they believe the health of patients is at stake.

CONFLICTED INTERESTS

In 1995, after the National Heart, Lung and Blood Institute warned doctors that use of calcium-channel blockers to treat high blood pressure and heart disease increased the risk of heart attack, a team of researchers led by The University of Toronto's Henry Thomas Stelfox examined 70 articles on channel-blockers, classified the authors into three categories (supporters, neutral, and critical), then surveyed the authors' financial ties to drug corporations.

Ninety-six percent of doctor-authors supporting the use of calcium-channel blockers had financial relationships with the product's manufacturers, compared with 60 percent of the neutral authors, and 37 percent of the critical authors.

One hundred percent of supportive authors, compared with 67% of neutral authors, and 43% of critical authors, had financial ties to at least one pharmaceutical manufacturer. These financial ties included one or more of: funds for travel expenses; honoraria for speeches; support for educational programs; research grants; and employment or consulting compensation.

Since this study relied on self-reported data, financial ties between scientists and corporate funders were likely underestimated. In only two of the 70 articles did authors disclose their corporate connections.

The Stelfox report concluded: "The results demonstrate a strong association between authors' opinions about the safety of calcium-channel antagonists and their financial relationships with pharmaceutical manufacturers...."

"The medical profession has failed to develop and enforce strict guidelines for disclosing conflicts of interest.... Full disclosure of relationships between physicians and pharmaceutical manufacturers is necessary to affirm the integrity of the medical profession and maintain public confidence."

UNDECLARED CORPORATE ADVOCACY

Unfortunately, even prestigious medical journals like the NEJM have been tainted by undeclared corporate advocacy. In late 1997, the NEJM published an editorial by Stephen Safe, a researcher who during 1997 reportedly received $150,000 (20% of his total research budget) from the Chemical Manufacturers Association (CMA). Safe's editorial included an attack against environmentalism, asserting that: "Chemophobia, the unreasonable fear of chemicals, is a common public reaction to scientific or media reports suggesting that exposure to various environmental contaminants may pose a threat to health."

Safe himself told Boston Globe reporter Larry Tye that "I felt a little twinge" about the potential for a conflict of interest, "but it was not much of a twinge." he said. He defended himself by arguing that, "There's hardly any life scientist in the country who hasn't had funding from the industry."

"The pharmaceutical industry provides substantial financial support for research and medical education," affirms Professor Allan Detsky of the departments of health administration and medicine at the University of Toronto, physician-in-chief at Mount Sinai Hospital and the department of medicine at The Toronto Hospital. The medical establishment is consequently beholden to the pharmaceutical, chemical, and agri-food industries which fund medical schools and provide research grants.

This is not so much a formal conspiracy as a complex network of interrelated vested interests, all with a stake in maintaining the cosy symbiotic relationship between corporate industry and medicine. The question remains: how to objectify and distinguish the noble aims of medical research from the bottom-line interests of corporate benefactors? Health care consumers demand and deserve a more satisfactory resolution to this dilemma than the status quo provides.

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