Information from drug companies and opinion leaders. Conflict of interests can be many-sided...
In a recent Editorial on BMJ (1), Liberati and Magrini referred to a “predefined strategy aimed at challenging unwelcome results” from the ALLHAT study. Such a strategy would be a kind of conspiracy between “pharmaceutical companies and some opinion leaders”, aimed at denigrating ALLHAT on national journals read by practitioners or policy makers, while international journals “substantially praised the strengths” of that study.
The Editorial includes some wrong statements that must be brought to the readers’ attention because they may give them an idea of the methodology used by the authors in dealing with this matter.
First, Drs. Liberati and Magrini accused me, among others, of adopting a “double standard” of information. In fact, I have expressed my view on ALLHAT in one article only (how can this be “double standard”?), i.e. the Editorial on Ipertensione e Prevenzione Cardiovascolare(2) of which I have now provided the English version at http://www.unibs.it/~castell/IPCenglish.pdf, so that the readers of BMJ may actually read what I have written and not what Liberati e Magrini wanted them to read.
Second, Liberati and Magrini write that in the Journal of Hypertension ALLHAT received only favourable reports. This is false because highly critical commentaries on ALLHAT were published both in this and in other European and American Journals, including BMJ(3).
For those interested, I have provided a link (http://www.unibs.it/~castell/IPCenglish.pdf) with a list of them. I hope Liberati and Magrini will consult it and avoid in the future the sin they accuse other people of, i.e. selective suppression of information.
Third, Liberati and Magrini were wrong in stating that in ALLHAT 55% of the patients were controlled by monotherapy; in fact, it has been clarified that 63% of the patients required two or more drugs(4). In addition, they were also clearly wrong in stating that heart failure was “a totally validated end-point”; in fact, there was no independent Event Committee and a “soft” end-point such as heart failure was checked post-hoc in only a small sample of hospitalized cases.
I fully agree that doctors must not be influenced in any biased or unfair way by drug companies and that patients should be given the best possible treatment for their disease, based on scientific evidence. I’m also convinced, however, that bias may also come from health providers and that this type of conflict of interest, namely that of Drs. Liberati and Magrini, cannot be sublimated just by defining it as a “struggle for truly independent information”.
References
1. Liberati A, Magrini N. Information from drug companies and opinion leaders. BMJ 2003;326: 1156-1157. (31 May.)
2. Agabiti Rosei E. Quali nuovi insegnamenti dallo studio ALLHAT per il trattamento dell’ipertensione arteriosa. Ipertensione e Prevenzione Cardiovascolare 2002; 9:133-135. or [English translation: http://www.unibs.it/~castell/IPCenglish.pdf]
3. Williams B. Drug treatment of hypertension. BMJ 2003;326: 61-62. (11 January)
4. Cushman W.C. et al – Success and Predictors of Blood Pressure Control in Diverse North American Settings: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). J Clin Hyp 2002; 4: 393-404
Competing interests:
EAR has received research grants, fees for consulting and reimbursements for attending symposiums from many different pharmaceutical companies as well from public institutions. He believes that this fact does not influence his view of scientific data
Rapid Response:
Information from drug companies and opinion leaders. Conflict of interests can be many-sided...
In a recent Editorial on BMJ (1), Liberati and Magrini referred to a “predefined strategy aimed at challenging unwelcome results” from the ALLHAT study. Such a strategy would be a kind of conspiracy between “pharmaceutical companies and some opinion leaders”, aimed at denigrating ALLHAT on national journals read by practitioners or policy makers, while international journals “substantially praised the strengths” of that study.
The Editorial includes some wrong statements that must be brought to the readers’ attention because they may give them an idea of the methodology used by the authors in dealing with this matter.
First, Drs. Liberati and Magrini accused me, among others, of adopting a “double standard” of information. In fact, I have expressed my view on ALLHAT in one article only (how can this be “double standard”?), i.e. the Editorial on Ipertensione e Prevenzione Cardiovascolare(2) of which I have now provided the English version at http://www.unibs.it/~castell/IPCenglish.pdf, so that the readers of BMJ may actually read what I have written and not what Liberati e Magrini wanted them to read.
Second, Liberati and Magrini write that in the Journal of Hypertension ALLHAT received only favourable reports. This is false because highly critical commentaries on ALLHAT were published both in this and in other European and American Journals, including BMJ(3).
For those interested, I have provided a link (http://www.unibs.it/~castell/IPCenglish.pdf) with a list of them. I hope Liberati and Magrini will consult it and avoid in the future the sin they accuse other people of, i.e. selective suppression of information.
Third, Liberati and Magrini were wrong in stating that in ALLHAT 55% of the patients were controlled by monotherapy; in fact, it has been clarified that 63% of the patients required two or more drugs(4). In addition, they were also clearly wrong in stating that heart failure was “a totally validated end-point”; in fact, there was no independent Event Committee and a “soft” end-point such as heart failure was checked post-hoc in only a small sample of hospitalized cases.
I fully agree that doctors must not be influenced in any biased or unfair way by drug companies and that patients should be given the best possible treatment for their disease, based on scientific evidence. I’m also convinced, however, that bias may also come from health providers and that this type of conflict of interest, namely that of Drs. Liberati and Magrini, cannot be sublimated just by defining it as a “struggle for truly independent information”.
References
1. Liberati A, Magrini N. Information from drug companies and opinion leaders. BMJ 2003;326: 1156-1157. (31 May.)
2. Agabiti Rosei E. Quali nuovi insegnamenti dallo studio ALLHAT per il trattamento dell’ipertensione arteriosa. Ipertensione e Prevenzione Cardiovascolare 2002; 9:133-135. or [English translation: http://www.unibs.it/~castell/IPCenglish.pdf]
3. Williams B. Drug treatment of hypertension. BMJ 2003;326: 61-62. (11 January)
4. Cushman W.C. et al – Success and Predictors of Blood Pressure Control in Diverse North American Settings: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). J Clin Hyp 2002; 4: 393-404
Competing interests:
EAR has received research grants, fees for consulting and reimbursements for attending symposiums from many different pharmaceutical companies as well from public institutions. He believes that this fact does not influence his view of scientific data
Competing interests: No competing interests