Naming names: is there an (unbiased) doctor in the house?

Authors' response

5 August 2008

We thank David JR Hutchon, Tom Jefferson, and Tammy L Boyce for their comments regarding other forms of bias besides industry bias. Central to the question about conflicts of interest is the unique role of industry bias compared to other forms of bias (personal, legal, perhaps even religious). In contrast to the multiple directions other forms of bias can take, industry bias has been consistently documented to be unidirectional: making products seem safer and more effective.1-4

What’s more, financial conflicts are subversively powerful. Everybody wants to believe he or she is above doing bad science, or touting a drug for a few thousand bucks, and the people who are consulting for industry and doing biased studies will claim their integrity is above reproach. But the evidence is clear: money talks.

The assurance that industry can use its formidable powers to trump even the best, publicly funded science is evident in the following statement by an industry insider who told the BMJ why the ALLHAT study, which was by his own admission a good study, would be easily buried by industry PR: According to Kevin Brode, (then) vice president of sales and marketing at marketRx, a firm that provides strategic marketing information to the pharmaceutical industry, “Doctors say they’ll change their prescribing habits after a negative study, but their prescription behaviour tends not to bear this out." Why not? "The reality is no one promotes a diuretic. So you’ve got one study that says yes, you should [use a diuretic], then starting the day after, you’ve got a $10 billion industry. . . and 55 promotional events . . . for an ACE inhibitor coming back in and saying ‘Here’s why my ACE inhibitor is safe and here’s why you should be using this.’ I mean, it’s promotion. Can ALLHAT stand up to that?"5

Our list was merely intended to be an additional resource of industry -independent experts for journalists who currently are inundated by industry PR, industry associations, and industry-paid KOLs or key opinion leaders. We trust our critics do not object to journalists having such an additional resource.

Nor is The List intended to “demonize” those who work for industry, as suggested by Boyce. There are plenty of superb researchers out there who have COIs with industry. We offer this list to our colleagues in the interest of giving them a way to find experts whose opinions might well agree with those who have conflicts, but who can say they came to their conclusions and they conducted their research without that particular bias. We didn’t create The List in order to exclude anyone, instead we wanted journalists to include those who too often are not consulted.

If the two of us have a bias, it is toward helping our colleagues try to balance the unidirectional influence of pharmaceutical money. We value the experts on this list not because they are anti-industry, but rather because they are skeptical, rigorous, and because those who have potential financial conflicts are willing to disclose them.

Jeanne Lenzer and Shannon Brownlee

Reference List

1. Brownlee S, Doctors Without Borders Washington Monthly. pp 2004. http://www.washingtonmonthly.com/features/2004/0404.brownlee.html

2. Stelfox HT, Chua G, O'Rourke K, Detsky AS. Conflict of interest in the debate over calcium-channel antagonists. N Engl J Med 1998;338:101- 6.

3. Turner EH, Matthews AM, Linardatos E, Tell RA, Rosenthal R. Selective publication of antidepressant trials and its influence on apparent efficacy. N Engl J Med 2008;358:252-60.

4. Bodenheimer T. Uneasy alliance--clinical investigators and the pharmaceutical industry. N.Engl.J.Med. 2000;342:1539-44.

5. Lenzer J. Marketing: Spin doctors soft pedal data on antihypertensives. BMJ 2003;326:170.

Competing interests: None declared

Competing interests: None declared

Jeanne Lenzer, medical investigative journalist

Shannon Brownlee

New York, USA 12401

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