When the jury gets paid off before it renders its verdict, it is bound to raise some suspicion.
But that is exactly what is happening to a disturbing extent in the world of medicine and drug testing.
Marcia Angell, the former editor in chief of the New England Journal of Medicine, has written an essay titled: “Drug Companies and Doctors, a Story of Corruption.” Citing evidence presented in three recent books, Ms. Angell charges that physicians and medical schools are paid by pharmaceutical companies to conduct tests on new drugs that yield results that bring profits to the drug manufacturers. Her accusations are in the current issue of The New York Review of Books. The evidence seems to be everywhere -- east, west and south.
Sen. Charles Grassley, ranking Republican on the Senate Finance Committee, has revealed that one professor of psychiatry at Harvard Medical School received $1.6 million in consulting and speaking fees from the makers of drugs used by this very doctor to treat children for bipolar disorders. At Stanford University the chair of the psychiatry department, Angell reports, received more than $6 million worth of stock in a drug company that he co-founded. This company is testing a drug known as RU-486 for treating psychotic depression.
At Emory University, Sen. Grassley charges, the chairman of the psychiatry department failed to disclose he received approximately $500,000 from the drug company GlaxoSmithKline for giving talks promoting that firm's drugs.
Dr. Angell is indignant. “Most doctors,” she charges, “take money or gifts from drug companies in one way or another. Many are paid consultants, speakers at company-sponsored meetings, ghost-authors of papers written by companies or agents and ostensible 'researchers' whose contribution often consists merely of putting their patients on a drug and transmitting some token information to the company. Still more doctors are recipients of free meals and other out-and-out gifts.” We have found this to be true in our own reporting on the issue.
The Food and Drug Administration, the FDA, requires clinical trials of new drugs before approving them for use by doctors and patients. Physicians are enlisted to conduct these trials. When some physicians are paid by the very firms that benefit from the trials the built in conflict of interest seems obvious. As Angell points out, “because drug companies insist as a condition of providing funding that they be intimately involved in all aspects of the research they sponsor, they can easily introduce bias in order to make their drugs look better and safer than they are.”
This is a shocking charge. It cannot be reassuring to the public. And, indeed, President-elect Barack Obama, should put it high on his agenda. The FDA is supposed to protect Americans against abuses in medicine and, if it is making only a feeble effort in this area, that calls for drastic reforms. Angell is demanding such action, including changing the drug approval process, and “having the medical industry “wean itself from industry money almost entirely.”
'Members of medical school faculties who conduct clinical trials should not accept any payments from drug companies, except research support, and that support should have no strings attached,” Angell said.
The incestuous relationship between physicians and medical institutions and the drug manufacturers must be ended. As Angell says, the response of medical schools and professional organizations so far has been “tepid.” To end this corruption, she calls for ”a sharp break from an extremely lucrative pattern of behavior.”
We can hope the new regime in Washington will foster a new ethical climate in medicine.