'How big pharma is holding medicine hostage' | India News

An interesting article in the British Medical Journal about the illusions of evidence-based medicine prompts me to revisit this topic. In the article, co-authors Jon Jureidini and Leemon McHenry state — as I have said in the past — that evidence-based medicine has been corrupted by corporate interest, failed regulation and commercialisation of academia.The medical community relies on evidences from data stemming from clinical trials. But most clinical trials are conducted by the pharmaceutical industry and reported in the name of senior academics. One needs to look without bias into the results of such clinical experiments. Unfortunately, as the BMJ article emphasises, the financial interests of large corporations trump the common good. medium90918519I remember doing a clinical trial for a new drug in the market, where after years of painstaking research and data collection, we finally concluded that the new drug was no better than the existing treatments. This research was never published, despite our best efforts.This is precisely the point that Jureidini and McHenry make — scientific progress is thwarted because the industry not only suppresses negative trial results but also fails to report adverse events. Moreover, the industry does not share raw data with academic research committees and, ultimately, patients die because of the adverse impact of commercial interest on the research agenda. medium90918525Lack of funds for research has been a problem through the ages, so pharma companies funding their own clinical trials is now commonplace. In the bargain, research bodies and universities become puppets of the industry through pharma’s control of the research agenda.Medicine is an ever-changing science. As I always tell my students, becoming a good doctor is easy; remaining a good doctor is a difficult mission. One needs to be constantly up-to-date with happenings and literature in the real world.In medicine, those who succeed in academics tend to be key opinion leaders (KOL), whose careers are advanced through opportunities provided by the pharma industry. These KOLs present data from trials, instead of being independent, disinterested scientists who critically evaluate the data. They, in fact, become product champions. medium90918535 Regulators also receive fundings from the industry and use industry-performed trials to approve drugs. This is akin to a student correcting his own homework.The other problem with evaluation is that one tries to apply standards and mathematical formulae to a science that is actually more of an art. Monica Angell, former editor of the prestigious New England Journal of Medicine, pointed out that there is a heavy bias towards positive studies — of 1,000 trials, two are positive and are likely to be published while the other 998 never see the light of day.Another interesting, tongue-in-cheek essay in the BMJ, titled HARLOT (How to achieve positive results without actually lying to overcome the truth), wittily explains how the industry can make their drugs appear good. It would be called good marketing in these times. Richard Smith, BMJ's former editor, even claimed that all journals are bought — or at least cleverly used — by the pharma industry. medium90918541In 2003, drug companies spent $448 million in advertising in medical journals and the estimated return of such ads is estimated to be between $2.22 and $6.86 on every dollar spent. Medical journal editors also estimate that 95% of academic medicine specialists who assess patented treatment have some financial relationship with pharma companies.How then must the wise physician or the naive patient negotiate his way? The wise physician must know that all databases of evidence are collected from databases of experience and he must use his own experience to advise his patient. As I have repeatedly told successive generations of students, the thought “What’s in it for me” must never surface in the mind of a dedicated physician.To the naive patient, I can only suggest seeking out a reliable, empathic, human and dedicated doctor.Dr Altaf Patel writes on good medicine and age-old common sense. The views expressed are the author's own. medium nocaption909289731. Low self-esteem? This doctor has some advice2. Can we stop feeling guilty about masturbation?3. When is it okay to work out after Covid medium90918576