Money, Medications and Motives

From the New York Times, June 8, 2008

Researchers Fail to Reveal Full Drug Pay

"A world-renowned Harvard child psychiatrist whose work has helped fuel an explosion in the use of powerful antipsychotic medicines in children earned at least $1.6 million in consulting fees from drug makers from 2000 to 2007 but for years did not report much of this income to university officials, according to information given Congressional investigators."

"In the last 25 years, drug and device makers have displaced the federal government as the primary source of research financing, and industry support is vital to many university research programs. But as corporate research executives recruit the brightest scientists, their brethren in marketing departments have discovered that some of these same scientists can be terrific pitchmen."

Corruption always smells putrid.

We are in a catch-22 that is difficult to resolve. Research is expensive, very expensive. Medicine has changed to the point where big pharma has become the most significant non-government funder of research; and in many fields it is more significant than government.

There is a very, very old cliche that is still unfortunately true. He who pays the piper calls the tune.

And make no mistake about it - big pharma is BIG.

Ten seconds on google found this: "Pfizer’s U.S. operations decreased last year as competition in the cholesterol market contributed to an 8 percent decline in revenues for the firm’s flagship product Lipitor. The company’s $48.6 billion 2007 total revenue was 1 percent better than its 2006 revenue of $48.4 billion."

That's just Pfizer. You can fund a lot of research with a tiny percentage of nearly 50 billion dollars. Of course, the company would never attach strings to that funding...yeah, right.

Now consider some of their competitors. I came across this list, it's not exhaustive:

* Baxter
* Bayer HealthCare, Diagnostics Division
* BD Medical Diabetes Care
* Eli Lilly and Company
* GlaxoSmithKline
* Lifescan, Inc., a Johnson & Johnson Company
* Merck & Co., Inc.
* Novo Nordisk Inc.
* Pfizer Inc.
* sanofi-aventis
* Takeda Pharmaceuticals North America, Inc.

Do your own googling to find out the revenues for those; this may help: Fortune 500 Industry: Pharmaceuticals. Add it up and you probably exceed the combined gross domestic product of half the countries in the United Nations.

So, is it any wonder that the funding for long-term studies into non-pharmaceutical aspects of diabetes or heart treatment, such as diet, BG testing and exercise, is minuscule compared to that for medication interventions such as ACCORD and ADVANCE?

Incidentally, I didn't need to google for that list. I found it here, at the top of the page: ADA FY06 Corporate Recognition Program.

I don't wish to imply that sponsorship or research funding necessarily means that influence is exerted. Without sponsorship many of the most worthy and useful support groups in the world would disappear and without research funding many of the miracles of modern medicine would never have been discovered. However, even when a funding source has impeccable integrity there is still an inherent problem that those receiving the funds will tend to investigate or promote in particular directions, mindful of the next project and the funding needed for that. There is nothing corrupt about that - it is simply reality.

Consequently, when organisations issue guidelines, or scientists publish the results of research, one of the first sections we should read is the "Funding Acknowledgements" section to include that information in our assessment of the merits of those guidelines or the validity of that research.

Cheers, Alan