Boston Globe: Even doctors should read the fine print

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The Boston Globe

(http://www.boston.com/news/globe/)

DR. MICHAEL HOCHMAN | MY PERSPECTIVE

Even doctors should read the fine print

By Dr. Hochman | May 19, 2008

Throughout my medical training, I have been taught to read medical research

with a skeptical eye. My professors in medical school relentlessly emphasized

the importance of carefully reviewing the methods section of every study to

look for sources of bias. And the doctors I have worked with during my

residency training have taught me to interpret study results carefully in the

context of real-world patients.

Recently, however, I (and many of my colleagues) have begun to wonder

whether even this degree of scrutiny is sufficient.

I first developed concerns three years ago when news media reports suggested

that the pharmaceutical giant Merck misled the public by concealing data

suggesting that its blockbuster pain-relieving medication Vioxx might be linked

to heart attacks and strokes.

After the Vioxx scandal, several well publicized studies were released

showing that research funded by the pharmaceutical industry - which represents

the

vast majority of clinical research in the United States - is considerably

more likely to show favorable results compared with studies not funded by

industry.

My concerns were cemented, however, by the recent publication of three

alarming studies. In January, a study in the New England Journal of Medicine

found

that industry-funded trials of antidepressant medications showing negative

results were frequently not published at all. When the researchers tallied the

results of all antidepressant trials, both published and unpublished, they

came upon a remarkable result: Just half of all studies involving

antidepressants were actually favorable.

I found this study particularly alarming not only because it suggested that

antidepressants might not be as effective as we once thought, but also

because it showed that pharmaceutical companies have the ability to easily

conceal

negative data about their products. This type of bias, of course, can't be

detected even by the most careful review of the literature.

Then, last month, the Journal of the American Medical Association published

two studies showing just how far pharmaceutical companies are willing to go

to stack the odds in favor of their products. In the first, researchers showed

that many of the initial trials attesting to the safety of Vioxx - which has

since been removed from the market - were actually written by industry

representatives and attributed to academic researchers in an attempt to lend

credibility to the results. In the second study, researchers presented strong

evidence suggesting that Merck representatives fudged data in order to hide

results suggesting that Vioxx might be linked to cardiovascular complications.

These disturbing findings have caused some doctors to rethink the way they

view medical studies, particularly those funded by the pharmaceutical

industry. One of the more experienced doctors I work with, for example, told me

that

he no longer views industry-funded research as an unbiased source of

information but rather treats these studies like advertisements for

pharmaceutical

products.

Similarly, I am now more hesitant to prescribe newer medications that have

been supported largely by industry-funded research (these medications include

supposedly life-saving cholesterol drugs known as statins and the blood

thinner clopidogrel - or Plavix - which is dispensed as if it were a fountain

of

youth for patients with cardiovascular disease).

While I of course want to give my patients the best available therapies, I

fear that many of these drugs are not all they're made out to be by the

existing research.

Many within the medical community have also begun calling for firm steps to

remedy the situation. An editorial accompanying the recent JAMA studies

proposed that all industry-funded investigations be carried out solely by

academic

researchers.

A number of experts, such as former New England Journal of Medicine editor

Marcia Angell, have also called upon the National Institutes of Health to

increase funding for clinical studies so that researchers will be less reliant

on

industry money and will be able to advance their careers without accepting

company grants. While NIH-funded research may also contain biases, these

biases are likely to be less significant since the NIH presumably does not have

financial stakes in the results.

Finally, a handful of medical schools - including the Boston University

School of Medicine - have begun implementing policies that prevent doctors from

accepting gifts from industry representatives. Many of these policies also

restrict doctors from giving out free medication samples provided by drug

companies in an effort to advertise their products. (A recent study by

researchers

at my hospital showed that these samples often go to wealthy patients who

have health insurance rather than poor patients who can't afford their

medications.)

Until these reforms are implemented, however, I plan to rely less heavily on

studies funded by pharmaceutical companies when making decisions about my

patients. And when I do read industry-funded studies, I will use the skeptical

mindset I developed during my medical training not only to evaluate the study

methods but also to consider the motives of the researchers involved.

Dr. Hochman is a second year internal medical resident at the

Cambridge Health Alliance.

© _Copyright_ (http://www.boston.com/help/bostoncom_info/copyright) 2008 The

New York Times Company

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[Guest guest]

The legislation stops short of criminal penalties for " influence " -

but everyone seems to be on notice that changes are in the wind.

And, what a shame that good docs are surrounded in this institution by

those who forgot why they went into medicine in the first place.

>

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> The Boston Globe

>

>

>

> (http://www.boston.com/news/globe/)

> DR. MICHAEL HOCHMAN | MY PERSPECTIVE

> Even doctors should read the fine print

> By Dr. Hochman | May 19, 2008

> Throughout my medical training, I have been taught to read medical

research

> with a skeptical eye. My professors in medical school relentlessly

emphasized

> the importance of carefully reviewing the methods section of every

study to

> look for sources of bias. And the doctors I have worked with during my

> residency training have taught me to interpret study results

carefully in the

> context of real-world patients.