Intended for healthcare professionals

Letters

Conflicts of interest Drug advertising corrupts journals

BMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6939.1301 (Published 14 May 1994) Cite this as: BMJ 1994;308:1301
  1. S Sussman
  1. London Psychiatric Hospital, University of Western Ontario, London, Ontario, Canada N6A 4H1
  2. Leicester LE2 1SD.

    EDITOR, - In his editorial on the ethical problem of conflicts of interest and the BMJ Richard Smith refers to the New England Journal of Medicine leading the way with “its policies on conflict of interest.”1 He states that the editors of the American journal “have said that ‘most academic institutions and journals have not gone far enough in dealing with this problem'” and that this may be “still truer on [the British] side of the Atlantic.” The 3 March issue of the New England Journal of Medicine - a 93 page publication - contained 22 pages of drug advertisements. Notwithstanding the fact that the 2 April issue of the BMJ - a 63 page issue - contained 21 pages of pharmaceutical “offerings,” the New England Journal of Medicine hardly seems to be in a position to be in the vanguard of establishing ethical-categorical imperatives regarding the submission of articles to journals that may be funded or influenced by sources that are not impartial. This strikes me as being akin to the syndrome “do as I say and not as I behave.”

    Drug companies' advertisements in medical journals may pose an even greater threat to medical practice and education than pharmaceutical funding of medical research because of the industry's use of the latest “technology” in advertising methods. Surely another mechanism to fund medical journals should be investigated.

    References

    Halcion trial wasting valuable resources

    1. S Brandon
    1. London Psychiatric Hospital, University of Western Ontario, London, Ontario, Canada N6A 4H1
    2. Leicester LE2 1SD.

      EDITOR, - I read the news item on Halcion (triazolam)1 with some surprise. It seems extraordinary to ventilate this ancient history when the manufacturer, Upjohn, is engaged in a libel trial which centres on the issues reported.

      Having read the transcript of Ilo Grundberg's case with particular attention to the psychiatric and drug history, I am astonished at her claims to have been acting “under the influence of Halcion.” Even more remarkable was Upjohn's decision to make an out of court settlement without admission of liability. Since this was purported to be a substantial sum there was inevitably a widespread assumption of culpability. It seems, however, that the company feared the adverse consequences of publicity regarding methodological deficiencies in study 321 and the massive costs of defending the case.

      The evidence presented to the Persons Appointed Committee of the Medicines Commission made it clear that study 321 of 28 long term prisoners in a high security prison was, though within the acceptable ethical and scientific standards of the day, virtually useless as a means of identifying behavioural abnormalities related to the drug, nor was it intended to do so. Neither study 321 nor other studies showed evidence of serious psychiatric complications attributable to the drug. The millions being expended on these protracted cases and inquiries would be so much better spent on high quality independent safety trials or other medical research.

      *** When we asked professor Brandon to declare conflicts of interest we received the following response.

      References

      Author considers his conflict of interest

      EDITOR, - I have recently read your editorial on conflict of interest.1 I wrote the above letter to the BMJ - rather than to the lay press - when I was irritated by the raising of those issues in the middle of the Oswald libel case and with the conviction that Upjohn's money would be better spent on proper clinical trials.

      When I was responsible for the “Man in society” course at the University of Leicester's medical school, Upjohn's education department produced an agency placement handbook each year for our new students. Some years later Leicester was a participating centre in the cross national panic disorder study - run by Upjohn - and as director I received sufficient funds to employ a research assistant who, in addition to helping with the cross national (alprazolam) study, was able to undertake an entirely independent study on the community prevalence of panic disorder. During this time either my assistant or I attended the study directors' meeting held in various parts of the world. Upjohn provided our travel and accommodation on these occasions.

      Subsequently I was asked by an American legal firm to review the papers on the Grundeberg case because a British professor (Ian Oswald) was to give evidence for Grundeberg and the lawyers wanted to match him with another “British expert.” As a result I made a careful study of the papers and was somewhat taken aback when they informed me that the matter was settled.

      Later I was paid for advising the company on their objection to the withdrawal of the product licence on triazolam and represented them at the Appointed Persons Panel. Our arguments to that panel resulted in the recommendation that the licence should be restored, but this advice was rejected by the minister.

      About three years ago I requested financial help from the company to enable one of my juniors to undertake a community study on the prevalence of anxiety disorders and the facilities that might be provided in general practice to alleviate them. They gave the department pounds sterling3000, which was used to provide stationery, postage, and computer facilities.

      Last year I was asked by a related legal firm to give evidence against Oswald in his libel suit. With some reluctance I agreed but I subsequently withdrew because I wasn't able to commit the time they required of me.

      I have written at some length because it is evident that I do have a conflict of interest but wrote my angry letter with no conscious awareness of the fact. My letter reflected the fact that I had a detailed knowledge of the Grundeberg case and was offended at the fact - as I see it - that triazolam played no part in the murder. I also had considerable sympathy with the Upjohn company, whose alleged misdemeanours were in my view a consequence of modest incompetence combined with the use of a powerful retrospectoscope to judge studies that were just about acceptable by the standards of 20 or more years ago.

      References

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