Observations Medicine and the Media

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

BMJ 2008; 337 doi: http://dx.doi.org/10.1136/bmj.a930 (Published 23 July 2008) Cite this as: BMJ 2008;337:a930

Authors' response

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: No competing interests
05 August 2008
Jeanne Lenzer
medical investigative journalist
Shannon Brownlee
New York, USA 12401
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