Intended for healthcare professionals

Rapid response to:


FDA's counsel accused of being too close to drug industry

BMJ 2004; 329 doi: (Published 22 July 2004) Cite this as: BMJ 2004;329:189

Rapid Response:

Expert mongering

As almost every week and like an increasing number of medical papers,
the Journal (24 July, p. 189) raised the issue of conflicts of interests
between drug industry and experts of regulatory or academic bodies. It is
difficult to appreciate whether this increasing concern reflects an
ethical degradation or a simple bias resulting from a clearer awareness of
such links (related, for example, to growing pressure for a declaration of
competing interests). This notwithstanding, the issues at stake regarding
public health are undoubtedly more and more crucial in a time where the
process of transforming healthy people in permanent drugs consumers under
the pretext of “prevention” (dyslipidaemia, hypertension, menopause,
vaccination…) relies for the main on “clinical guidelines” made by such
experts; as it happens, a contemporary paper published in The Lancet
documents that experts recommendations are more obviously based upon pre-
existing belief than on epidemiological or clinical evidence(1). As an
evocative example, one might compare the intensity of controversy about
lipids-lowering agents until less than ten years ago with the current
quasi consensus on this topic whereas the epidemiological evidence is
certainly not stronger, as illustrated by the astounding succession of the
cerivastatin and the rosuvastatin stories within less than 3 years…

In such a worrying context the financial implications of which are
obvious, one important issue seems regularly overlooked in the debate
about experts independence: pharmaceutical industry has not only the power
of linking experts with money or various favours, it is also able of
creating and promoting those scholars who will eventually be chosen as
advisers by regulatory bodies or academic institutions. In a world
regulated by the 'publish or perish' rule and by the Darwinian dynamics of
quotations by peers, it is not difficult to understand how the system’s
equilibrium may be perverted by those who have the financial power of
amplifying the importance of a researcher by extensive duplication and
selective quotation of his results. Having worked with pharmaceutical
industry for more than 20 years, especially with marketing departments, I
know perfectly how it is easy to promote results deemed to be profitable
to one firm’s interests, e.g. by writing assistance (esp. for those
researchers who do not speak English), invitations to international
meetings, contacts with allied referees or editors to maximise the chances
of a publication… In addition to its obvious perversity, the efficacy of
this process of “expert mongering” is that it minimises the weight of
money in the relationship between experts and firms, replacing it by a far
more subtle debt the dissimulation of which has the guarantee of human
vanity: it is not easy for a scholar to admit (and to make explicit) that
most of his notoriety is due to undue support by industry…

1. Raine R, Sanderson C, Hutchings A, Carter S, Larkin K, Black N. An
experimental study of determinants of group judgments in clinical
guidelines development. Lancet 2004; 364: 429-437

Competing interests:
Dr Girard is an independant consultant for pharmaceutical firms

Competing interests: No competing interests

11 August 2004
Marc Girard
1 bd de la Republique 78000-Versailles (France)