bmj.com Customised @lerts: Editor's Choice for Saturday, 03 August 2002
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 BMJ 2002;325 ( 3 August )


Editor's choice

Western medicine: a confidence trick driven by the drug industry?

Might Western medicine be a confidence trick driven by the drug industry,
wonders Minerva (p 288). She is quoting Phil Hammond[---]doctor,
broadcaster, stand up comedian, satirist, and trainee guru. Any who are
offended by the impertinence of the question might do well to reflect on
the value of satirists. Long after 99.9% of 18th century Dublin physicians
have been forgotten, the writings of their theological colleague Jonathan
Swift are known across the world. "Satire," wrote Swift, "is a sort of
glass, wherein beholders do generally discover everybody's face but their
own."

Those interested by Hammond's question can reflect on relevant evidence in
this week's journal. Silvio Garattini and Vittorio Bertele' review 12
anticancer drugs approved in the past six years by the European Medicines
Evaluation Agency (p 269). They conclude that the benefits offered by the
drugs are trivial but the costs enormous. Some are 350 times more costly
than existing drugs.

Ray Moynihan describes "the blaze of publicity" sparked in the United
States by football star Ricky Williams revealing that he has social anxiety
disorder but has benefited from the drug Paxil (paroxetine) (p 286). Not
all the media reports disclosed that Williams was being paid by
GlaxoSmithKline, which last year earned US$2.7bn from sales of paroxetine.
"Celebrity selling" is the rage. Unfortunately "shy people" or those with a
"public speaking problem" may be encouraged to think of themselves as
"diseased" and to take drugs of limited effectiveness with established side
effects.

But the influence of the pharmaceutical industry extends beyond the
American mass media into the science published in the BMJ. Lise Kjaergard
and Bodil Als-Nielson have taken advantage of the fact that for some years
the BMJ has required the authors of studies to give their source of funding
and disclose competing interests (p 249). They find that those authors who
have financial competing interests are more likely than those who do not to
favour experimental interventions in randomised controlled trials. This was
true of both pharmacological and non-pharmacological trials. Could this
finding be true only for the BMJ? They authors can't see why and point out
that the other major general journals publish a far higher proportion of
trials funded by the pharmaceutical industry than the BMJ.

Competing interests were a major debating point in the court case that
concluded this week in which more than 100 women sued the manufacturers of
third generation contraceptive pills because they failed to warn of the
increased risk of thromboembolic disease (p 237). The judge ruled that
there was no increased risk, which conflicts with the conclusion of a
systematic review published in the BMJ (2001;323:131)[Abstract/Full Text].
It seems unlikely that this judgment will end the controversy, and we hope
to publish an editorial next week.





Footnotes

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