Conflicts of interest plague American medical journals, medical journal says

BOSTON (January 7, 1998 11:00 p.m. EST http://www.nando.net) - Virtually all
the doctors who defended a class of drugs widely used to treat heart disease
had hidden links to the makers of the drugs, the New England Journal of
Medicine said in its Thursday issue.

The Journal said a team of researchers found that almost all the doctors who
rushed to defend the safety of calcium channel blockers in 1995 had financial
links to the drug companies that make them.

"We wonder how the public would interpret the debate over calcium-channel
antagonists if it knew that most of the authors participating in the debate
had undisclosed financial ties with pharmaceutical manufacturers," said the
study team, who argued that "the medical profession needs to develop a strong
policy governing conflict of interest."

Calcium channel blockers are used mainly to treat heart diseases marked by
spasms in the organ's artery. The drugs prevent calcium from entering smooth
muscle cells and cause the smooth muscles to relax and reduce muscle spasms.

The National Heart, Lung and Blood Institute warned physicians in 1995 that
one particular drug -- short-acting nifedipine -- should be prescribed "with
great caution, if at all." It said short-acting calcium channel blockers were
linked with an increased risk of death from heart attack. The warning kicked
off a major debate.

The authors of the new study, led by Dr. Henry Thomas Stelfox of the
University of Toronto, tried to gauge the involvement of industry-supported
doctors in the calcium channel controversy by identifying articles published
between March 10, 1995, and September 30, 1996, and categorizing them as
supportive of the medicines, critical of them, or neutral.

Then they sent surveys to the authors of the 70 articles asking about their
financial links to drug companies in general, and calcium channel blocker
makers in particular.

They discovered that "96 percent of the supportive authors had financial
relationships with manufacturers of calcium-channel antagonists, as compared
with 60 percent of the neutral authors and 37 percent of the critical
authors."

The researchers also wondered if the authors who were critical of calcium
channel blockers had financial ties to companies making competing types of
heart medicines.

"The answer was no. In fact, supportive and neutral authors were more likely
than critical authors to have financial interactions with manufacturers of
competing products," they concluded.

Only in two of the articles had the editors disclosed any potential conflict
of interest for the writer.

Although the Stelfox group acknowledged that the supportive authors may have
ties to drug companies because the companies seek relationships with doctors
who already support their products, the researchers concluded, "The results
demonstrate a strong association between authors' opinions about the safety of
calcium-channel antagonists and their financial relationships with
pharmaceutical manufacturers."

There are many ways for doctors to get support from pharmaceutical firms. Drug
companies sponsor ongoing medical education programs and hire physicians to
serve as consultants, perform research, or speak at symposia.

Often those financial ties are not disclosed, although the editors of medical
journals say they are working harder to unearth potential conflicts of
interest when doctors publish in their magazines.

Whether support from the pharmaceutical industry is actually swaying the
opinions of doctors "cannot be determined by the results of our study," the
Stelfox team said.

The American Medical Association, publisher of the Journal of American Medical
Association, was stung by criticism last summer after it inked a 5-year
endorsement deal to give its seal of approval to Sunbeam Corp. health care
products. Subsequently, the AMA backed out of the deal and the company filed a
$20 million lawsuit against the largest U.S. medical association.

The New England Journal was chastised in December 1997 because the author of a
book review, who panned a book critical of the chemical industry, turned out
to have ties to the industry. The Journal's book editor acknowledged the
problem but insisted that it was an inadvertent oversight.


By GENE EMERY, Reuters
Copyright 1998 Nando.net
Copyright 1998 Reuters

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