Healthy Skepticism Library item: 12652

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Publish or perish
The Ottawa Citizen 2008 Jan 30

Full text:

There are few industries that more people love to hate than the pharmaceutical trade. Perhaps that would change if so-called Big Pharma stopped providing their critics with so much ammunition.

A report in a recent issue of The New England Journal of Medicine indicates that about a third of studies conducted by the makers of antidepressants such as Prozac aren’t published. The bulk of those unpublicized studies apparently reported less-than-favourable results.

An analysis of 74 clinical trials involving 12 drugs showed that 94 per cent of positive studies were published. Of those with negative or questionable results, only 14 per cent found light of day.

Mike Segar, Reuters
“Evidence-based medicine is valuable to the extent that the evidence is complete and unbiased,” the report’s authors write. “Selective publication of clinical trials — and the outcomes within those trials — can lead to unrealistic estimates of drug effectiveness and alter the apparent risk-benefit ratio.”

In other words: We need all the news, not just the good parts.

Another disturbing revelation was that in many of the trials that did make it into print, the reported conclusions were positive even when the data indicated otherwise. This is something many people don’t realize about scientific data: They can indicate very different things depending on who’s analyzing them — and, according to some critics, who’s paying for the analysis.

It’s important to remember that drug companies have done, and continue to do, much good in the world. Pharmaceutical makers have extended the lives of AIDS victims, lowered our cholesterol, eased chronic pain. One wonders how many folks who criticize the drug industry by day secretly cheer it by night after taking their Viagra.

Drug companies aren’t charities. They don’t make drugs to give them away. They have employees to pay, research to conduct, shareholders to satisfy. It is, in fact, the motivation to turn a profit that spurs innovation, which is how it should be.

Yet they have little excuse for their lack of transparency. And they should realize that when the truth comes out, as it has a tendency to do, it can cost them. A classic cautionary tale is the story of Vioxx.

Vioxx, an anti-inflammatory medication created by Merck, was used by hundreds of thousands of people to relieve pain. There was just one problem: It was also linked to heart problems. In 2004, Merck withdrew the drug. But it knew of the dangers long before.

Internal documents showed that Merck scientists were aware of the cardiovascular risks posed by Vioxx as far back as 2000. The company’s executives told them to keep quiet. When independent researchers began investigating, Merck tried to persuade them not to publish their findings.

In the end, Merck paid out $4.85 billion to settle 27,000 lawsuits. Their legal fees topped a billion, too. Of course, at the time of the settlement Merck had projected its sales for the following year to reach $20 billion. So Merck survived, even if some of its customers didn’t.

Drug companies have created products that have bettered, even saved, millions of lives. They need to be careful, however, that their business practices don’t make us ill.