Why you can't trust medical journals anymore

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Why you can't trust medical journals anymore

Doctors Without Borders

 

By Shannon Brownlee

Source: Washington Monthly

 

With financial ties to nearly two dozen drug and biotech companies, Dr. Charles

B. Nemeroff may hold some sort of record among academic clinicians for the most

conflicts of interest. A psychiatrist, a prominent researcher, and chairman of

the department of psychiatry and behavioral science at Emory University in

Atlanta, Nemeroff receives funding for his academic research from Eli Lilly,

AstraZeneca, Pfizer, Wyeth-Ayerst--indeed from virtually every pharmaceutical

house that manufactures a drug to treat mental illness. He also serves as a

consultant to drug and biotech companies, owns their stocks, and is a member of

several speakers' bureaus, delivering talks--for a fee--to other physicians on

behalf of the companies' products.

 

But it was just three of Nemeroff's many financial entanglements that caught the

eye of Dr. Bernard J. Carroll last spring while reading a paper by the Emory

doctor in the prominent scientific journal, Nature Neuroscience. In that

article, Nemeroff and a co-author reviewed roughly two dozen experimental

treatments for psychiatric disorders, opining that some of the new treatments

were disappointing, while others showed great promise in relieving symptoms.

What struck Carroll, a psychiatrist in Carmel, Calif., was that three of the

experimental treatments praised in the article were ones that Nemeroff stood to

profit from--including a transdermal patch for the drug lithium, for which

Nemeroff holds the patent.

 

Carroll and a colleague, Dr. Robert T. Rubin, wrote to the editor of Nature

Neuroscience, which is just one of a family of journals owned by the British

firm, Nature Publishing Group, pointing out the journal's failure to disclose

Nemeroff's interests in the products he praised. They asked the editor to

publish their letter, so that readers could decide for themselves whether or not

the author's financial relationships might have tainted his opinion. After

waiting five months for their letter to appear, the doctors went to The New York

Times with their story--a move that sparked a furor in academic circles, and

offered the public yet another glimpse into conflict of interest, one of the

most contentious and bitter debates in medicine.

 

In his defense, Nemeroff told the Times he would have been happy to list his

(many) relationships with private industry--if only the journal had asked. " If

there is a fault here, " he said, " it is with the journal's policy, " which did

not require authors of review articles to disclose their conflicts of interest.

 

And that is pretty much where the debate over conflict of interest in medical

journals stands: Should research scientists who have financial stakes in the

products they are writing about be forced to disclose those ties? To which the

average person might reasonably respond, of course they should. But the more

pertinent question is why scientists with financial stakes in the outcome of

scientific studies are allowed anywhere near those studies, much less reviewing

them in elite journals.

 

The answer to that question is at once both predictable and shocking: For the

past two decades, medical research has been quietly corrupted by cash from

private industry. Most doctors and academic researchers aren't corrupt in the

sense of intending to defraud the public or harm patients, but rather, more

insidiously, guilty of allowing the pharmaceutical and biotech industries to

manipulate medical science through financial relationships, in effect tainting

the system that is supposed to further the understanding of disease and protect

patients from ineffective or dangerous drugs. More than 60 percent of clinical

studies--those involving human subjects--are now funded not by the federal

government, but by the pharmaceutical and biotech industries. That means that

the studies published in scientific journals like Nature and The New England

Journal of Medicine--those critical reference points for thousands of clinicians

deciding what drugs to prescribe patients, as well as for

individuals trying to educate themselves about conditions and science reporters

from the popular media who will publicize the findings--are increasingly likely

to be designed, controlled, and sometimes even ghost-written by marketing

departments, rather than academic scientists. Companies routinely delay or

prevent the publication of data that show their drugs are ineffective. The

majority of studies that found such popular antidepressants as Prozac and Zoloft

to be no better than placebos, for instance, never saw print in medical

journals, a fact that is coming to light only now that the Food and Drug

Administration has launched a reexamination of those drugs.

 

Today, private industry has unprecedented leverage to dictate what doctors and

patients know--and don't know--about the $160 billion worth of pharmaceuticals

Americans consume each year. This is an unsettling charge that many (if not a

majority) of doctors and academic researchers don't want to acknowledge. Once

grasped, however, the full scope and consequences of medical conflict of

interest beget grave doubts about the veracity of wide swaths of medical

science. As Dr. Drummond Rennie, deputy editor of The Journal of the American

Medical Association (JAMA), puts it, " This is all about bypassing science.

Medicine is becoming a sort of Cloud Cuckoo Land, where doctors don't know what

papers they can trust in the journals, and the public doesn't know what to

believe. "

 

Clinical trial and error

 

How did we get to this point? What effect is industry influence having on the

treatment of patients? And why are the medical journals not more vigilant to

weed out papers that have been distorted by conflict of interest? The answers to

these questions begin, oddly enough, with an amendment to U.S. patent law called

the Bayh-Dole Act. Passed in 1980, Bayh-Dole for the first time permitted

universities to commercialize products and inventions without losing their

federal research funding, the seed money for innovative research. The brainchild

of George Keyworth II, President Reagan's science advisor, who was watching the

United States get beaten in world markets by the Japanese, Bayh-Dole was

intended to stimulate advanced technological invention and speed its transfer

from university labs into private industry, where it could be put to work

spurring U.S. productivity.

 

It seemed like a win-win proposition. Indeed, Bayh-Dole has helped launch the

biotech industry and has propelled several life-saving products to market. The

basic research behind Gleevec, for instance, an incredibly effective new

anti-cancer drug, was done by a university scientist. The drug's manufacturer,

Novartis, stepped in and provided additional funding for development. In 1984,

private companies contributed a mere $26 million to university research budgets.

By 2000, they were ponying up $2.3 billion, an increase of 9,000 percent that

provided much needed funds to universities at a time when the cost of doing

medical research was skyrocketing.

 

That's the upside. The downside is that Bayh-Dole has also fostered increasingly

cozy relationships between the academics upon whom the nation depends for

unbiased medical information and Big Pharma, private companies whose main goal,

let's face it, is making a profit. And we're talking serious money here. In

addition to the salaries built into company-sponsored research grants, academic

clinicians at medical schools can pad their already decent incomes with

$1,000-a-day consulting contracts with pharmaceutical companies, patent

royalties, licensing fees, and big-payoff stock options. Nemeroff stood to reap

as much as $1 million in stock from a company that manufactured one of the

products in his Nature Neuroscience paper. At many of the top research

universities and medical schools around the country, a substantial percentage of

the faculty enjoys the perks of industry relationships. At MIT, 31 percent of

the science and engineering faculty has outside income; at Stanford Medical

School, it's 20 percent.

 

What's in it for the pharmaceutical companies? Simple economics. It's Marketing

101. By penetrating the wall that once existed around academic researchers, drug

companies have gained access to the " thought leaders " in medicine, the big names

whose good opinion of an idea or a product carries enormous weight with other

physicians. Companies target academic KOLs, or Key Opinion Leaders, in the

lexicon of marketing, and woo them with invitations to sit on scientific

advisory committees, or to serve as members of speakers' bureaus, which offer

hefty fees for lending their prestige to a company and touting its products at

scientific meetings and continuing medical education conferences. Of course,

KOLs must be convinced of their own impartiality, says Carl Elliott, a moral

philosopher at the University of Minnesota and author of Better Than Well:

American Medicine Meets the American Dream. " If they understood that they were

being used as industry mouthpieces, they would probably pull the

plug on the whole enterprise. " Drug companies encourage their KOLs to consult

for multiple companies so the appearance of objectivity can be maintained. But

the drug industry's most powerful means of boosting the bottom line is funding

research, which allows companies to control, or at least influence, a great deal

of what gets published in the medical journals, effectively turning supposedly

objective science into a marketing tool.

 

" These are not benign people who are interested in helping people with their new

wonder drugs, " says Drummond Rennie. " The drug companies are run by hard-nosed

marketers, not by the physicians and the scientists. They use what works, and

money works. " Rennie, who has a thatch of unkempt white hair and remnants of the

accent of his native Leeds, England, got a clear picture of the extent to which

drug companies will go to control the results of studies they fund in 1993, when

a colleague at University of California San Francisco tried to publish a paper

in JAMA in 1993 on the metabolic activity of four different forms of thyroid

hormone. Betty J. Dong, a pharmacologist, had been contracted in 1987 by Flint

Laboratories to run a clinical trial comparing Synthroid, Flint's synthetic

version of thyroid hormone, to that of three competing formulations. At the

time, Synthroid was the market leader and the most expensive drug in its class.

Dong and Flint signed a lengthy agreement detailing

the design of the study, and both sides fully expected the results would show

that Synthroid was superior.

 

But all four drugs turned out to be essentially equivalent. In 1990, as Dong

prepared a paper for JAMA, the company that was at first so eager to solicit her

help, launched a vigorous campaign to discredit the study. Flint then rushed its

own paper into press at a less prestigious journal, concluding--surprise!--that

Synthroid was superior. After numerous attempts to address the company's

criticisms, Dong finally submitted her paper to JAMA, only to withdraw it three

months later when the firm threatened to sue for breach of contract. It took the

FDA and U.S. Department of Health and Human Services to get the company to back

down. Dong's paper did not see print in JAMA until 1997.

 

In this case, it might seem as if the only real harm to the public during the

seven years that elapsed from the time Dong completed her study to its

publication was higher prices to patients and insurers. To Rennie's way of

thinking, the Dong imbroglio and others like it have a more insidious effect by

sending a chilling message to scientists, namely, don't bite the hand that feeds

you. In a recent survey of clinical researchers, nearly 20 percent of

respondents admitted to delaying publication of their results by more than six

months at least once in the last three years to allow for patent application,

protect their scientific lead, or to slow the dissemination of results that

would hurt sales of their sponsor's product--often without overt pressure from

the company. " If you're getting a lot of money from a corporate sponsor, it's

easy to get the impression that you'll get even more for future research if you

don't write up the negative results, " says Rennie--and that your funds

will dry up if you do.

 

The bottom line is that articles appearing in medical journals contain a lot of

happy talk about medical products. At least eight studies have shown that

industry-sponsored research that gets published tends to produce pro-industry

conclusions, according to a review by Yale University researchers that appeared

last year in JAMA. By reanalyzing data from eight separate studies of the effect

of conflict of interest on 1,140 published scientific papers, the researchers

found that papers based on industry-sponsored research are significantly more

likely to reflect favorably on a sponsoring company's drug or device than

research that is supported by a non-profit entity or the federal government.

 

How can this be? Isn't science, well, scientific, an objective search for the

truth? That's what many academic clinicians, especially those who are mixed up

with corporate sponsors, would have the public believe. A typical comment comes

from Niels Reimers, an early promoter of industry-university ties, who told the

Hartford Courant, " You may think I'm a Pollyanna or something, but most people

are honest. It's sort of the ethos of academic research. " Here's Dr. Irwin

Goldstein, a Boston University urologist who has consulted for at least seven

companies developing impotence therapies: " Science is science. It comes down to

the bottom line. What the data shows, the data shows. "

 

Such statements reflect the ideal of science, not the reality, says Dr. Marcia

Angell, former editor in chief of The New England Journal of Medicine. Public

protestations aside, she says, " Clinicians know privately that results can be

jiggered. You can design studies to come out the way you want them to. You can

control what data you look at, control the analysis, and then shade your

interpretation of the results. " Even the most careful research can be fraught

with murky results that require sifting and weighing, a measure of judgment that

the researcher hopes will bring him closer to the truth. Was this patient's

headache caused by the antibiotic you gave her, or does she have a history of

migraines? Is that patient's depression lifting because of the drug you are

testing, or because a kindly doctor is actually listening to him?

 

Sometimes there isn't much that journal editors can do to separate good science

from that which has been weighed, sifted, and jiggered according to a corporate

sponsor's needs. Increasing numbers of studies that get published are actually

written by PR firms, " medical communications " specialists, who then go out and

recruit an academic willing to put his name on the paper, for a fee. Other

studies simply omit data that detract from the sponsor's message. In September

2000, for example, JAMA published a paper comparing the prescription painkiller

Celebrex to over-the-counter ibuprofen. The manufacturer of the prescription

drug, known as a selective Cox-2 inhibitor, launched the study in order to show

that Cox-2 inhibitors, a class that also includes the prescription drug Vioxx

and was already worth $3.5 billion a year, cause fewer instances of bleeding in

the stomach and intestine than either aspirin or ibuprofen. The huge study,

which looked at six months of data from more than 8,000

patients, produced unambiguous results: There were fewer side effects among

patients on the Cox-2 drug.

 

A year later, news surfaced that patients had actually been followed for 12-15

months at the time the JAMA paper came out, not six, and that during the second

half of the study, the group taking the Cox-2 drug suffered higher rates of

gastrointestinal side-effects than patients on the over-the-counter painkiller.

To make matters worse, patients on the Cox-2 developed serious heart problems

three times more often than those on ibuprofen. The authors of the paper--all of

them either consultants to the manufacturer or employees " defended their decision

to report only the first, positive, half of their study, saying several patients

who weren't taking the Cox-2 drugs dropped out after six months, making the

statistics more difficult to analyze. But Dr. Catherine D. DeAngelis, JAMA's

editor in chief, told The Washington Post: " I am disheartened. We are

functioning on a level of trust that was, perhaps, broken. "

 

Disheartened? Not furious? No, because DeAngelis could not know for certain

whether or not the authors held back half the data in order to make their

sponsor's drug look better " no matter how likely that explanation may seem. When

researchers submit papers to a journal, the editor has little choice but to

trust the authors have employed a ruthless skepticism when viewing their own

results, that they have bent over backwards to minimize self-delusion. Editors

and peer reviewers can ferret out sloppy reasoning, look at how an author has

designed and executed a study, and correct faulty statistics, but as Angell

remarked, " We don't put bamboo slivers under their nails. If they wanted to lie,

they could lie. "

 

Articles of faith

 

Dr. Arnold Relman began worrying about this problem way back in 1977, when he

became editor-in-chief of The New England Journal. That year, Relman got a call

from a reporter about a paper that was due to appear in the next issue,

discussing serious side effects--including lowering a man's testosterone and

sperm counts--of a popular antacid. The reporter wanted to know what Relman

intended to do about the fact that Wall Street analysts had acquired early

copies of the paper and now the stock of the company that made the drug was

falling.

 

Relman, who began practicing medicine in the 1950s and calls himself a " relic, "

says before that reporter's call, it had never occurred to him that medical

research could have financial consequences for industry. But the more he thought

about it, he told me recently, " The more I became convinced that the

commercialization of medical practice and medical research, and the use of the

information for commercial purposes, was a major threat to the integrity of the

whole system. " He recognized that medical researchers, being only human, would

have trouble applying that ruthless skepticism that was so necessary to good

science when there was money at stake.

 

The obvious solution to Relman and Angell, who was by then a deputy editor at

The New England Journal of Medicine, was disclosure. Forcing authors to tell the

world they were taking industry money, the editors reasoned, would prompt a

little soul-searching among researchers who might otherwise be inclined to turn

a blind eye to negative results or shade conclusions in favor of a corporate

sponsor. It would put them on notice that readers would be watching. The editors

also figured that disclosure would help readers judge the validity of an

author's conclusions. " They could evaluate the data for themselves, " Relman told

me recently. " But the discussion, the interpretation by the author can be

slanted . . . it was still important for readers to know when articles were

sponsored by industry. " JAMA, largely at Rennie's urging, followed suit soon

after.

 

Six years later, Relman upped the ante by barring researchers with conflicts of

interest from writing editorials or review articles--like the one penned in

Nature Neuroscience by Charles Nemeroff " because they carry great weight with

doctors in private practice. Angell explains their decision like this: " Imagine

a judge who has before him a case involving two companies suing each other--and

he owns one of the companies. And he says, 'Not to worry. I'm a judge and I

learned how to evaluate things in a dispassionate way.' He'd be laughed out of

court. " She and Relman argued that just as judges must recuse themselves from

cases in which they have financial ties to a litigant, editorialists and review

authors with conflicts of interest should refrain from offering medical

opinions.

 

Angell was still defending that decision a decade later, as editor in chief at

the Journal, when she wrote in 2000 that disclosure was not sufficient to

preserve the integrity of the science that appeared in her journal's pages: " We

believe that a policy of caveat emptor is not enough for readers who depend on

the opinion of editorialists. " Why was it necessary to defend the Journal's

policies? Partly because authors were ignoring them. In 1997, when Sheldon

Krimsky, a professor of public policy at Tufts University, surveyed 61,134

articles in some 181 journals, he found that only 0.5 percent disclosed a

conflict of interest related to the topic of the article, an impossibly low

number given the fact that a quarter of biomedical researchers at the time were

receiving funding from industry. The reason for this low rate of disclosure, as

Krimsky notes dryly in his book, Science in the Private Interest, is that

" author compliance is not especially high. "

 

" Lots of eminent people took great offense at being accused of being

influenced, " Relman told me recently. " 'What an insulting thing to say. I value

my reputation; doctors and scientists know best. Trust us.' I spent the first 25

years of my career doing clinical research and being one of them, and I know the

feeling. " As Harvey Lodish, professor of biology at MIT, huffed to Technology

Review in 1984, when Relman first required disclosure at the Journal,

" Scientists have all kinds of private consulting arrangements with biotechnology

companies and many own stock in these companies, but that's nobody's business.

It has nothing to do with the quality of their research. "

 

" They actually believe that they aren't influenced, " says Angell. Aside from the

fact that it's not in physicians' self-interest to acknowledge the effects of

corporate money, they may have a hard time seeing the problem for the same

reason fish don't know they're swimming in water: Doctors are surrounded by

conflicts of interest almost from the moment they arrive at medical school.

Pharmaceutical companies begin wooing young doctors with small tokens at first,

pens and coffee mugs emblazoned with drug logos, then escalating to pizza night

for medical residents, dinners at expensive restaurants and tickets to sporting

events. Most schools offer a class in medical ethics, but there's no requirement

that they discuss conflict of interest. Besides, a few lectures can't outweigh

the message young doctors absorb every day, as they watch the icons in their

profession--their professors, visiting lecturers, heads of departments--taking

gifts, speaking on behalf of companies, flying

first-class to medical meetings in Paris and Honolulu. By the time medical

residents enter private practice or the lab, the gifts from industry no longer

seem like gifts, but entitlements " just another way to be compensated for all

those brutal, slogging years of lousy pay and long nights.

 

A journalist friend of mine recently told me about the day his then-girlfriend,

who was a neurosurgeon, received a check for several hundred dollars in the

mail, along with a note from a drug company representative. It seemed his

girlfriend had made favorable mention of a particular drug during a lecture she

delivered a few days earlier, and the money was just a little thank you from the

manufacturer. When my friend told her she could not in good conscience cash the

check--that it was a conflict of interest--she looked at him, he said, as if he

were speaking in some unintelligible language.

 

This deafness to the power of money to corrupt medical science leads physicians

and scientists to display an arrogance and a remarkable naïvete, both of which

were very much in evidence in a snippy editorial entitled, " Avoid Financial

'Correctness,' " written in 1997 by the editors at Nature. They derided

disclosure as a waste of time, writing, " This journal will persist in its

stubborn belief that the research as we publish it is indeed research, not

business. " The Nemeroff case has not changed the editors' view substantially,

although they did alter their policy after it broke. Nature Publishing now

requires editorial and review writers, along with the authors of original

research papers, to inform readers whether or not they have conflicts of

interest, or to say they decline to declare. Charles Jennings, executive editor

of Nature, says they have no intention of following the New England Journal in

barring editorialists who have conflicts. " I flatly disagree with that policy, "

he

told me. " That would exclude many of the leading experts. You don't want a

policy that prevents Thomas Edison from writing about the future of electricity.

Our position is for readers to decide for themselves about whether an author is

biased. "

 

Of course, most readers, especially practicing physicians, don't have the

expertise or the resources to decide for themselves--to know how the studies

might have been constructed differently, whether the conclusions have been

shaded to favor the author's sponsor, or which data the author decided

conveniently to leave out of the article. Knowing that an author might be biased

doesn't aid in determining the extent and nature of the bias. It's not as though

there will be two articles, one by a biased writer and one by an unbiased

writer, published side by side to allow readers to identify the differences.

Besides, conflicts of interest are now so pervasive, says Rennie, many readers

scarcely take note, even when they're disclosed.

 

Race for the cure?

 

It's tempting to wonder what medical research would look like if universities

and medical associations and editors of journals stopped talking about how to

manage conflict of interest and started thinking about how to expunge it. Just

say no. Proponents of Bayh-Dole will object, claiming the pace of medical

advances will slow to a crawl, but bear with me for a moment and just imagine a

different universe. Let's start with the medical schools " those temples of higher

learning. They would be the first to cast out the drug merchants. Hospitals

would pay their medical residents a decent wage so they can afford to buy their

own beer and pizza. FDA advisory panelists who have a financial stake in the

drug being considered would not be allowed to vote. And if the journals stopped

publishing papers and editorials penned by academic clinicians with conflicts of

interest, authors would be forced to choose between taking scientific credit and

taking the money.

 

Of course, that's not going to happen unless academic clinicians somehow decide

there's something wrong with the status quo. In Sheldon Krimsky's view, the only

way to deter conflict of interest is for academics to feel shame. Maybe so, but

as a journalist who has spent a decade and a half peering at medicine from the

outside, nose pressed to the glass, I'm struck more than anything by the

apparent lack of shame among clinicians when it comes to this issue.

 

Here's a little thought experiment. Imagine that a medical journalist " me, for

instance " makes a tidy sum writing press releases for, say Pfizer, the

manufacturer of Viagra. I don't make a fortune, maybe just enough to cover a

year's tuition for my son's private high school. And let's say for the sake of

argument I also buy a few dozen Pfizer shares. Then I turn around and write a

story for The New York Times about several new drugs for treating erectile

dysfunction.

 

What would you think, dear reader, should my financial relationship with the

pharmaceutical company that makes one of the drugs featured in my story come to

light? Would you have reason to doubt its objectivity and accuracy? Of course

you would. Not only that, I would be ashamed to show my face in any newsroom,

and I would not be writing for the Times again. I'm not trying to claim that

journalists are paragons of virtue, but we have no illusions about our ability

to withstand temptation and avoid shading what we say when faced with a wad of

cash.

 

Not so in medical research. In that world, the author of a review article can

have direct financial relationships with the manufacturers of drugs he is

critiquing and still argue he has done nothing unsavory. What that suggests is a

sense of fiduciary responsibility is not built into the professional code of

medicine, a doctor's internal compass of right and wrong.

 

And of course there are also pecuniary reasons not to acknowledge the power of

money. The fact is, universities and doctors have become so dependent on

industry largesse they can't even imagine disentangling themselves. Repeal the

Bayh-Dole Act? Not on your life. Kick the drug representatives who wheel their

little carts filled with sample packets of drugs out of your office? Who would

pay for all those trips to medical meetings in exotic locales?

 

Company line

 

And so they try to manage it. About half of universities require that faculty

disclose their conflicts of interest. A scant 19 percent set limits on the

outside financial interests faculty may hold. Harvard University, long

considered a paragon of scientific virtue, is now considering relaxing its rules

governing industry collaborations. Now that Angell is gone, even the

once-starchy New England Journal has loosened its restrictions on editorialists

and review writers, who are now free to enjoy some corporate largesse, just not

too much. " They think it's possible to be virtuous and rich at the same time, to

take money from companies and then manage it, " says Angell. " They come up with

rules that are so complicated in order to give the appearance of worrying about

this, when what they are really worried about is the money might go away. "

 

All their managing doesn't seem to be working, and we are the ones who will

suffer the consequences. In March 2000, the FDA yanked a diabetes drug called

Rezulin off the market after it had been linked to at least 90 cases of liver

failure and 63 deaths. The withdrawal came three years after the agency had

approved the drug to great fanfare. Articles in the popular media quoted

diabetes experts who praised Rezulin, calling it " a truly novel approach, " and

the manufacturer, Warner-Lambert, enjoyed a spectacular 144 percent rise in its

stock price.

 

By the fall of 1997, however, the FDA had already begun to receive reports of

patients on Rezulin suffering liver failure, a side-effect that the agency's

advisory panel glossed over during its deliberations. A paper published in the

New England Journal also made scant reference to liver toxicity, saying the drug

was " well tolerated, and most adverse events were considered to be related to

the underlying diabetes. " Several clinicians with ties to the company

subsequently urged the FDA not to withdraw the drug, even as the body count was

rising. According to a Los Angeles Times investigation, at least 12 of 22

scientists who played a central role in the federally-funded study of Rezulin

received research funding or other compensation from Warner Lambert, while four

of the 12 voting members of the FDA advisory panel that approved Rezulin, and

kept it on the market an extra 30 months, had financial ties to the company.

 

When industry has penetrated every level of medicine from the lab bench to the

FDA advisory panels, from the pages of the medical journals to your doctor's

prescription pad, how are physicians to make decisions about treating their

patients? How are they to know whether or not expensive calcium channel blockers

are really better than over-the-counter diuretics for high blood pressure?

(They're not.) Should you take a mildly depressed teenager to a psychotherapist,

or put him on an antidepressant and risk sending him into a suicidal tailspin?

Maybe a cholesterol-lowering statin drug will prevent this patient from

suffering a heart attack, as the studies claim. Then again, maybe it will simply

cause her muscles to break down and destroy her kidneys, one of the drug's side

effects.

 

And what about us patients? What are we to do with the knowledge that much of

what passes as science in medicine is little more than gussied-up marketing?

There isn't much we can do. And so, I say if you're ill, if you are ailing, or

just sick at heart, go find a doctor who listens, who holds your hand. Just make

sure you find a doctor who looks at evidence, not opinion, and when she pulls

out the prescription pad, start asking a lot of questions.

 

Shannon Brownlee is a fellow at the New America Foundation.

 

 

 

 

 

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