Many people in and out of the medical community were shocked to read in an article published earlier this year in the medical journal the BMJ that the U.S. Centers for Disease Control and Prevention (CDC) takes funding from industry.
As Jeanne Lenzer, an independent reporter and associate editor at the BMJ, pointed out in that article, pharmaceutical and other types of companies can — and do — fund CDC projects by giving money to the CDC Foundation, a nonprofit organization created by Congress in the mid-1990s to “connect CDC to the private sector to advance public health.”
And that has raised some serious conflict-of-interest concerns.
For example, to help pay for its new “Take 3” flu-prevention campaign, the CDC, via its foundation, accepted a $193,000 donation from Roche, the company that makes the antiviral drug Tamiflu, Lenzer reported last February.
One of the central tenets of the “Take 3” campaign is the recommendation that people take an antiviral drug like Tamiflu if they develop symptoms of the flu.
That advice, however, is highly controversial. Indeed, another government agency, the Food and Drug Administration (FDA), says that the clinical trial data it has reviewed does not support the claim that Tamiflu saves lives or reduces hospitalizations, including among the elderly.
Earlier this month, Lenzer wrote again for the BMJ on CDC’s industry funding. In that article, she offers two additional examples of how controversial decisions recently made by the CDC are associated with that funding.
One involves the CDC’s recommendation that everyone born between 1945 and 1965 be screened for the hepatitis C virus.
As Lenzer details in her article, the science behind such widespread screening has been challenged. She also describes how industry’s connections with the CDC raise questions about why that screening recommendation was made:
In 2010, the CDC, in conjunction with the CDC Foundation, formed the Viral Hepatitis Action Coalition, which supports research and promotes expanded testing and treatment of hepatitis C in the United States and globally. Industry has donated over $26m to the coalition through the CDC Foundation since 2010. Corporate members of the coalition include Abbott Laboratories, AbbVie, Gilead, Janssen, Merck, OraSure Technologies, Quest Diagnostics, and Siemens — each of which produces products to test for or treat hepatitis C infection.
Conflict of interest forms filed by the 34 members of the external working group that wrote and reviewed the new CDC recommendation in 2012 show that nine had financial ties to the manufacturers.
Ties to the sugar industry
The CDC has also accepted $1.7 million from the sugar industry to fund a series of studies involving an epidemic of chronic kidney diseases among agricultural workers in Central America, particularly among young men working in the sugar fields.
The epidemic has killed more than 20,000 workers over the past two decades. As Lenzer notes, researchers have cited two interrelated factors as the most likely explanation for the epidemic: dangerous pesticides and difficult working conditions. When the men cut sugar under a hot, tropical sun, they get dehydrated, which may leave them more susceptible to the kidney damage caused by chemical toxins.
The sugar industry, on the other hand, believes there is no direct relationship between those factors and the workers’ illnesses and deaths.
The American epidemiologist who is leading the CDC studies insists a solid “firewall” exists between the funders and the researchers. But others are not so sure.
“Critics say the fact that research is being funded by the men’s employers raises concerns about how far it will probe industry’s role in the disease outbreak,” writes Lenzer.
A threatened reputation
In an e-mail response to Lenzer, the CDC’s director, Dr. Tom Frieden, indicated he was not concerned about industry’s ties with his agency.
“Public-private partnerships allow CDC to do more, faster,” he wrote. “The agency’s core values of accountability, respect, and integrity guide the way CDC spends the funds entrusted to it. When possible conflicts of interests arise, we take a hard, close look to ensure that proper policies and guidelines are followed before accepting outside donations.”
But many others in the health community believe those corporate ties are undermining the authority of the hugely influential public health agency.
“The CDC has enormous credibility among physicians, in no small part because the agency is generally thought to be free of industry bias,” Dr. Marcia Angell, a senior lecturer at Harvard Medical School’s Department of Global Health and Social Medicine and a former editor of the New England Journal of Medicine, told Lenzer. “Financial dealings with biopharmaceutical companies threaten that reputation.”
Dr. Neil Calman, president and chief executive of the Institute of Family Health, a large New York-based community health center network, agrees.
“Industry funding undermines trust and introduces a bias in the presentation of results and treatment recommendations that is deplorable for a government agency,” he said. “If the allegations of industry funding and influence are true, we will have to look very carefully at recommendations we are following now and those made in the future by the CDC.”