One could almost hear the voice of Claude Rains in the 1941 film Casablanca upon “discovering” that gambling is taking place at the Cafe Americaine: “I’m shocked, Rick! Shocked!” That is our reaction to a recent report from experts who warn of “potential bias” among researchers who have financial ties to the pharmaceutical industry.
According to a paper published in a recent edition of the British Medical Journal, nearly 70% of all researchers who study and evaluate new drugs and medical devices receive some type of compensation or have some kind of financial interest in the very companies that manufacture the products they are evaluating. These ties include honorariums, travel expenses, speakers fees and stock ownership. When it came to positive outcomes of such studies, such financial ties between the researchers and the companies were found in 76% of the cases. The conclusion: “Financial ties of principal investigators were independently associated with positive clinical trial results. These findings may be suggestive of bias in the evidence base.”
Should we be surprised?
It should be pointed out that the findings didn’t necessarily mean that results were falsified. More likely, unfavorable data is simply not published. However, in 2005, a survey from the journal Nature, as many as one-third of scientists surveyed admitted to some breach of ethics – and 15% of them acknowledged that they had altered the design or the results of a study when pressured by a company providing the funding. At the time, one of the authors of that survey, Brian Martinson, said, “I think we’ve shown that it’s about more than just fraud, and we shouldn’t be looking for a few `bad apples.’ It may be that competition in science in this country has reached dysfunctional levels.”
It hasn’t gotten any better since then. One recent example involves Dr. Robert Califf, who oversaw a study leading to the approval of the anticoagulant Xarelto, a drug that has caused fatal hemorrhaging in patients who took it. Commissioner of the FDA since last February, Califf has received hundreds of thousands of dollars from companies that include Bristol-Meyer Squibb, Eli Lily, and Merck Pharmaceuticals. The Xarelto study of which Califf was in charge was funded by Bayer AG and Janssen Pharmaceuticals – the same companies that developed Xarelto in the first place.
Even though most medical journals require authors to disclose any financial interests, not all do. It is also an unfortunate – but not unexpected – result of a profit-driven health care system that puts revenues and stock price above human health and life. Until the profit motive is finally removed from health care, the situation will not change.