Please remember to credit the BMJ as source when publicising
an
article and to tell your readers that they can read its full text on
the
journal's web site (http://bmj.com).
If your story is posted on a website please include a link back to
the source BMJ article (URL's are given under titles).
(2) DRUG
TREATMENT LIKELY TO BE BASED ON
BIASED EVIDENCE
(3) WEEKLY
CONTACT WITH DRUG REPS LINKED
TO UNNECESSARY
PRESCRIBING
(4) MEDICAL
PROFESSION ATTEMPTS TO "CLEAN
UP" RELATIONS
WITH DRUG INDUSTRY
(5) RELATIONS
BETWEEN THE DRUG INDUSTRY
AND PATIENT
GROUPS SHOULD BE OPEN
(1) CONCERN THAT
RESEARCH SPONSORED BY
DRUG COMPANIES IS BIASED
(Pharmaceutical industry sponsorship
and research
outcome and quality: systematic
review)
http://bmj.com/cgi/content/full/326/7400/1167
Research funded by drug companies is more
likely to
produce results that favour the sponsor's
product than
research funded by other sources, claim
researchers in
this week's BMJ.
They reviewed 30 studies that analysed
research
sponsored by a pharmaceutical company.
Research
funded by drug companies was less likely
to be
published than research funded by other
sources. Studies
sponsored by drug companies were also
more likely to
have outcomes favouring the sponsor than
studies with
other sponsors.
However, none of the 13 studies that analysed
methods
reported that studies funded by industry
were of poorer
quality.
These results apply across a wide range
of diseases,
drugs, and drug classes, over at least
two decades and
regardless of the type of research being
assessed, say
the authors. This suggests that there
is some kind of
systematic bias to the outcome of published
research
funded by the pharmaceutical industry.
Possible explanations include the selection
of an
inappropriate comparator to the product
being
investigated and publication bias, they
conclude.
Contact:
Joel Lexchin, Associate Professor, School
of Health
Policy and Management, York University,
Toronto,
Canada
Email: joel.lexchin@utoronto.ca
(2) DRUG TREATMENT
LIKELY TO BE BASED ON
BIASED EVIDENCE
(Evidence b(i)ased medicine ± selective
reporting from
studies sponsored by pharmaceutical
industry: review of
studies in new drug applications)
http://bmj.com/cgi/content/full/326/7400/1171
Drug treatment is likely to be founded
on biased
evidence because drug companies tend to
publish studies
with more favourable results, suggest
researchers in this
week's BMJ.
They identified 42 studies submitted to
the Swedish drug
regulatory authority to secure marketing
approval for five
antidepressant drugs. These studies were
then compared
with studies actually published between
1983 and 1999.
They found evidence of three sources of
bias: duplicate
publication, selective publication, and
selective reporting.
For instance, 21 studies contributed to
at least two
publications each, and three studies contributed
to five
publications. Studies showing significant
effects of a drug
were published as stand alone publications
more often
than studies with non-significant results.
The tendency to
report the more favourable results only,
in studies
actually published, was a major cause
for bias.
These results should not be used to dispute
the value of
analysing the medical literature, say
the authors.
However, they are likely to be valid for
other classes of
drugs, so for anyone who relies on published
studies
alone to choose a specific drug, they
should be a cause
for concern.
Without access to all studies (positive
as well as
negative, published as well as unpublished)
any attempt
to recommend a specific drug is likely
to be based on
biased evidence, they conclude.
Contact:
Hans Melander, Senior Biostatistician,
Medical Products
Agency, Uppsala, Sweden
Email: hans.melander@mpa.se
(3) WEEKLY CONTACT
WITH DRUG REPS LINKED
TO UNNECESSARY PRESCRIBING
(Characteristics of general practitioners
who frequently
see drug industry representatives:
national cross sectional
study)
http://bmj.com/cgi/content/full/326/7400/1178
General practitioners who see drug industry
representatives at least once a week are
more likely to
express views that will lead to unnecessary
prescribing
then those who report less frequent contact,
finds a study
in this week's BMJ.
Over 1,000 general practitioners randomly
selected from
200 practices in England completed a questionnaire
about their personal and practice characteristics,
and
their prescribing attitudes and behaviour.
After analysing the responses, the research
team found
that frequent contact with a drug industry
representative
was significantly associated with a greater
willingness to
prescribe new drugs and to agree to patients'
requests to
prescribe a drug that is not clinically
indicated.
Those who reported frequent contact were
also more
likely to be dissatisfied with consultations
ending in
advice only, and were more receptive to
drug
advertisements and promotional literature
from drug
companies.
General practitioners who saw drug representatives
most
often tended to be singlehanded practitioners
and
working in deprived areas.
More research on the nature of this relationship
would
help primary care trusts to adopt policies
encouraging
more cost effective prescribing, conclude
the authors.
Contact:
Chris Watkins, General Practitioner, Backwell
and
Nailsea Medical Group, Bristol, UK
Email: chris.watkins@Bristol.ac.uk
(4) MEDICAL PROFESSION
ATTEMPTS TO "CLEAN
UP" RELATIONS WITH DRUG INDUSTRY
(Who pays for the pizza? Redefining
the relationships
between doctors and drug companies.
1: Entanglement
2: Disentanglement)
http://bmj.com/cgi/content/full/326/7400/1189
As entanglement between doctors and drug
grows, a
two-part article by journalist Ray Moynihan
in this
week's BMJ explores the brewing conflicts
at one of the
world's leading medical institutions over
how to redefine
relations with big pharmaceutical companies.
Across the United States, drug companies
sponsor close
to 300,000 events for doctors every year
as part of their
promotional efforts.
Against this background, the University
of California San
Francisco (UCSF) is considering plans
to end free
lunches sponsored by drug companies and
to remove
drug representatives. Elsewhere, medical
reform groups
and student associations are also calling
for
disentanglement from drug companies and
independent
education and sources of information.
"Relationships with industry are critical,
but they need
redefining," says Professor Haile Debas,
Dean of
Medicine at UCSF. "We have to make sure
our
relationships are more appropriate."
"In some ways we are all addicts to big
pharma's
money," argues Chief Executive Officer
of UCSF
Medical Center, Mark Laret, "but we are
going to have
to wean ourselves off a dependency that
is generally
inappropriate. This relationship is one
of those things we
need to clean up. The sooner the better."
Responding to the view that drug company
funded
education is necessary, Drummond Rennie,
Professor of
Medicine at UCSF says, "Nonsense. That
argument
presupposes that some of the most well
off in our society
can't afford to pay for their lunches,
their education, or
their conference."
Many individual doctors, and their professional
associations, are facing difficult choices
about whether
they remain part of the industry's extended
promotional
machinery or seek real distance in their
relationships, to
give prescribing, teaching, and advice
that is truly
independent, writes Moynihan. Growing
moves toward
genuine separation may well make previously
acceptable
conflicts of interest untenable, he concludes.
Contact:
Ray Moynihan, Journalist, Washington DC,
USA
Email: raymond.moynihan@verizon.net
(5) RELATIONS
BETWEEN THE DRUG INDUSTRY
AND PATIENT GROUPS SHOULD BE OPEN
(Relationships between the pharmaceutical
industry and
patients' organisations)
http://bmj.com/cgi/content/full/326/7400/1208
Relationships between the pharmaceutical
industry and
patients' organisations must be at arm's
length and
transparent, and not affect the agenda
and priorities of
these groups, argues a senior doctor in
this week's BMJ.
Advertising drugs to patients in the United
Kingdom is
not allowed, so drug companies try to
inform patients
through partnerships with self help groups
and patients'
organisations, writes Dr Andrew Herxheimer
of the UK
Cochrane Centre.
The Long Term Medical Conditions Alliance
offers
guidelines to voluntary health organisations
on relations
with the pharmaceutical industry. However,
many
organisations volunteer minimal information
about their
structure and funding, and some are reluctant
to discuss
the subject.
If industry directly or indirectly funds
a large part of the
budget, say over 20%, the organisation
comes to
depend on it and this, if nothing else,
will influence
policies, he says.
Most patients' organisations are poor and
have little
independent funding. Grants and joint
projects with
pharmaceutical companies can help them
grow and be
more influential, but can also distort
and misrepresent
their agendas. Relationships must therefore
be
acknowledged and open, without public
relations
flummery, stresses the author.
Some modest public funding for patients'
organisations
should also be considered, and regulatory
agencies have
to distinguish between independent and
extensively
funded patient groups, he concludes.
Contact:
Andrew Herxheimer, Emeritus Fellow, UK
Cochrane
Centre, London, UK
Email: andrew_herxheimer@compuserve.com
FOR ACCREDITED JOURNALISTS
Embargoed press releases and articles are available from:
Public Affairs Division
BMA House
Tavistock Square
London WC1H 9JR
(contact: pressoffice@bma.org.uk)
and from:
the EurekAlert website, run by the American
Association for the
Advancement of Science
(http://www.eurekalert.org)