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Healthy Skepticism Library item: 1920

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: Journal Article

Vitry AI, Hurley E.
The road to consensus: considerations for the safe use and prescribing of COX-2-specific inhibitors.
Med J Aust 2002 Nov 18; 177:(10):572-3
http://www.mja.com.au/public/issues/177_10_181102/vitry_181102.html


Abstract:

Openness by guideline developers about potential conflicts of interest is not enough. 65% of the members of the Australian COX-2 Specific Inhibitor Prescribing Group declared current financial links with Pfizer and Merck, Sharp and Dohme, the two companies marketing COX-2 inhibitors in Australia. The Prescribing Group can be viewed at best as a tight collaboration between healthcare professionals and drug companies. At worst their statement can be seen as the ‘happy end’ of a successful marketing campaign. Members of the group disregarded the industry bias on the basis that some form of bias is inevitable. However, numerous studies have shown that industry-sponsored drug information overemphasises benefits of drugs and minimises risks. Data on the US FDA website show that celecoxib is not better than diclofenac or ibuprofen in terms of ulcer complications, the prespecified primary outcome of the trials. There was also no significant difference between celecoxib and diclofenac for the combined outcome of complicated and benign ulcers. Results previously published in JAMA for celecoxib were flawed and had been manipulated. The wide distribution of the JAMA article as part of intensive marketing campaigns contributed to huge sales for celecoxib. Between August 2000 and June 2002, celecoxib cost Australian taxpayers more than A$288 m through the Pharmaceutical Benefits Scheme (PBS), more than five times the cost for all other NSAIDs. The PBS blow-out observed after the launch of COX-2 inhibitors is at least partly due to their use outside their approved indications. The Prescribing Group did not give any indication for use and did not consider cost. The position statement appeared to be an evidence-based review, but it promotes misinformation from the pharmaceutical industry. We invite readers to look at sources of drug information that are truly independent of drug companies, such as the Australian Medicines Handbook (www.amh.net.au), Australian Prescriber (www.australianprescriber.com) and Therapeutic Guidelines (www.tg.com.au).

Keywords:
Bias (Epidemiology) Conflict of Interest* Consensus Cyclooxygenase Inhibitors/adverse effects Cyclooxygenase Inhibitors/therapeutic use* Drug Industry* Drug Utilization Review Evidence-Based Medicine Humans Isoenzymes/antagonists & inhibitors* Practice Guidelines/standards* Prescriptions, Drug/standards* Prostaglandin-Endoperoxide Synthase Safety

 

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Far too large a section of the treatment of disease is to-day controlled by the big manufacturing pharmacists, who have enslaved us in a plausible pseudo-science...
The blind faith which some men have in medicines illustrates too often the greatest of all human capacities - the capacity for self deception...
Some one will say, Is this all your science has to tell us? Is this the outcome of decades of good clinical work, of patient study of the disease, of anxious trial in such good faith of so many drugs? Give us back the childlike trust of the fathers in antimony and in the lancet rather than this cold nihilism. Not at all! Let us accept the truth, however unpleasant it may be, and with the death rate staring us in the face, let us not be deceived with vain fancies...
we need a stern, iconoclastic spirit which leads, not to nihilism, but to an active skepticism - not the passive skepticism, born of despair, but the active skepticism born of a knowledge that recognizes its limitations and knows full well that only in this attitude of mind can true progress be made.
- William Osler 1909