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Ex-editor of NEJM tells how Big Pharma has corrupted academic institutions

In the May/June issue of the Boston Review, Dr. Marcia Angell, former editor-in-chief of the New England Journal of Medicine, details the sordid story of how corporate dollars have corrupted research and education at academic medical centers — including at her current place of employment, the Harvard Medical School.

The article is adapted from a talk she gave at Harvard last December. Angell, of course, has written about this topic many times before, most notably in her 2004 book, “The Truth About the Drug Companies.”

Writes Angell:

The boundaries between academic medicine — medical schools, teaching hospitals, and their faculty — and the pharmaceutical industry have been dissolving since the 1980s, and the important differences between their missions are becoming blurred. Medical research, education, and clinical practice have suffered as a result.

The article provides plenty of examples of exactly why health consumers should worry about this money-driven blurring of missions. Here are some highlights (but do read the entire article):

  • “To a remarkable extent … medical centers have become supplicants to the drug companies, deferring to them in ways that would have been unthinkable even twenty years ago. Often, academic researchers are little more than hired hands who supply human subjects and collect data according to instructions from corporate paymasters. The sponsors keep the data, analyze it, write the papers, and decide whether and when and where to submit them for publication. In multi-center trials, researchers may not even be allowed to see all of the data, an obvious impediment to science and a perversion of standard practice.”
  • “[Drug] manufacturers typically prefer to work with academic medical centers. Doing so increases the chances of getting research published, and, more importantly, provides drug companies access to highly influential faculty physicians — referred to by the industry as ‘thought leaders’ or ‘key opinion leaders.’ These are the people who write textbooks and medical-journal papers, issue practice guidelines (treatment recommendations), sit on FDA and other governmental advisory panels, head professional societies, and speak at the innumerable meetings and dinners that take place every day to teach clinicians about prescription drugs.”
  • “Medical centers increasingly act as though meeting industry’s needs is a legitimate purpose of an academic institution…. Academic leaders, chairs, and even deans sit on boards of directors of drug companies. Many academic medical centers have set up special offices to offer companies quick soup-to-nuts service.”
  • “Increasingly, industry is setting the research agenda in academic centers, and that agenda has more to do with industry’s mission than with the mission of the academy. Researchers and their institutions are focusing too much on targeted, applied research, mainly drug development, and not enough on non-targeted, basic research into the causes, mechanisms, and prevention of disease.”
  • “[D]rug companies often contract with academic researchers to carry out studies for almost entirely commercial purposes. For example, they sponsor trials of drugs to supplant virtually identical ones that are going off patent…. There’s a high scientific opportunity cost in serving the aims of the pharmaceutical industry. For example, new antibiotics for treating infections by resistant organisms are an urgent medical need, but are not economically attractive to industry because they are not likely to generate much return on investment.”
  • “In addition to distorting the research agenda, there is overwhelming evidence that drug-company influence biases the research itself. Industry-supported research is far more likely to be favorable to the sponsors’ products than in NIH-supported research.”
  • “Conflicts of interest affect more than research. They also directly shape the way medicine is practiced, through their influence on practice guidelines issued by professional and governmental bodies and through their effects on FDA decisions.” Angell offers several examples, including this one: “[I]n 2004, after the NIH National Cholesterol Education Program called for sharply lowering the acceptable levels of ‘bad’ cholesterol, it was revealed that eight of nine members of the panel writing the recommendations had financial ties to the makers of cholesterol-lowering drugs.”
  • “Drug companies support educational programs even within our best medical schools and teaching hospitals, and are given virtually unfettered access to young doctors to ply them with gifts and meals and promote their wares. … This is marketing masquerading as education. … But doctors do learn something from all the ostensible education they’re paid to receive. Doctors and their patients come to believe that for every ailment and discontent there is a drug, even when changes in lifestyle would be more effective. And they believe that the newest, most expensive brand-name drugs are superior to older drugs or generics, even though there is seldom any evidence to that effect because sponsors don’t usually compare their drugs with older drugs at equivalent doses.”

Angell offers several recommendations for reforming the current, broken system:

  • Medical schools that conduct clinical trials “should not accept any payments from drug companies except research support, and that support should have no strings attached.”
  • Doctors “should not accept gifts from drug companies, even small ones, and they should pay for their own meetings and continuing education.”
  • Finally, “academic medical centers that patent discoveries should put them in the public domain or license them inexpensively and non-exclusively.”

“[A]pologists might argue that, despite its legal transgression the pharmaceutical industry is merely trying to do its primary job — furthering the interests of its investors — and sometimes it simply goes a little too far,” Angell concludes. “[But] doctors, medical schools, and professional organizations have no such excuse; the medical profession’s only fiduciary responsibility is to patients and the public.”

Comments (7)

  1. Submitted by Susan Lesch on 05/05/2010 - 11:32 am.

    Thanks again for this article. Terribly sad that much of the good in drugs is wasted on Big Pharma’s unrelenting marketing.

    Here I thanked you for another of your posts:

  2. Submitted by Nancy Hokkanen on 05/05/2010 - 03:34 pm.

    Thank you for these outquotes. I’ve read Dr. Angell’s book and also “On The Take” by another former NEJM editor, Dr. Jerome Kassirer.

    Dr. Angell has also stated elsewehre, “It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.”

  3. Submitted by Jo Marsicano on 05/05/2010 - 05:35 pm.

    Thanks for this excellent article, Susan. Further recommended reading would be anything by Dr. Peter Breggin (“Toxic Psychiatry,” “Talking back to Prozac,” “Talking back to Ritalin.”) He’s a psychiatrist who talks about the pharmaceutical takeover of the psychiatric profession.

  4. Submitted by Ilo Leppik on 05/05/2010 - 07:54 pm.

    Dr. Angell’s comment’s are nothing new and unfortunately miss much of what is really going on. I’m surprised that this was considered newsworthy. For the last 30 years I have worked closely with a number of pharmaceutical companies and the NAtional Institutes of Health in translating basic research into useful drugs. Many of the presently available medicines to treat epilepsy have been tested in Minnesota. There are many advantages to being a drug testing center. The most important is that hundreds of my severely afflicted patients have had a chance to be on better medicines years before they become generally available. Our contracts with the “evil” companies state that they will provide the drugs free of charge to patients who have improved until the drug is available by prescription. This is of great importance to my patients because it it is often many years before the Food and Drug Administration approves a new therapy. Over the years my testing programs have brought millions of dollars into the state to pay salaries of nurses, technicians and others. The only point I agree with Dr Angell is that drug companies do develop many “me too” drugs to extend patent life. However, most of this research is done outside of academic centers. Dr. Angel has been criticized by some for being hypocritical about getting funding from drug companies. The New England Journal could not survive without drug company support. I hope that before people take her comments at face value they carefully consider that we would not have the many excellent drugs to treat epilepsy and other condition without the full range of research from basic science to clinical application supported by both the NIH and drug companies. Unfortunately the article as posted is very one-sided ; I was hoping for better from this on-line news source.

  5. Submitted by Josh Beckman on 05/06/2010 - 08:22 am.

    Dr. Angell’s comments represent a “chicken-little” perspective on this issue. Of course the system is imperfect. Of course there are abuses. Of course drug companies act like a business and not a nonprofit. Despite this, is there anyone who would rather be living with the medicine of 20 or 30 years ago? Clearly not. Why? Because medical therapy for the major conditions that kill Americans is so much better now. Death rates from heart disease, stroke, cancer, lung disease, and diabetes, to name a few, are all heading down.

    Certainly improvements to the system can be made, but despite her 5 minutes of fame as a replacement editor until a new one could be found, her end of the world scenarios punctuated by the well-known occasional outrages are belied by the quiet progress that has made during this period. More progress than during any other 20 year period in history.

  6. Submitted by Paul Scott on 05/06/2010 - 02:58 pm.

    Yes folks, that’s right, there’s nothing to see here, so everyone please move along. Unless you want to return to the days of bloodletting, you have no right to ask why it is that medicine is directed by a system which requires two dollars to sell a drug for every one dollar to produce it. Anyone else struck by the reactionary tone elicited by Angell’s concerns — that private industry should not be dictating the course of medical research, instruction and practice. “Five minutes of fame”? Whattup with that?

  7. Submitted by Susan Lesch on 05/09/2010 - 01:41 pm.

    Mr. Beckman, I am very happy to be taking a 50 year old medication. It has none of the intolerable side effects of newer drugs marketed by Pfizer, Eli Lilly, AstraZeneca and others drug salesmen. That’s not to say that new drugs aren’t good, only to say that those salesmen stood in the way of my life for more than 20 years.

    Mr. Scott, I don’t understand your “five minutes of fame” question?

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