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Medical journals, academia and industry sponsored clinical trials

Posted by plosmedicine on 30 Mar 2009 at 23:42 GMT

Author: Valeria Frighi
Position: Dr
Institution: Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK
Submitted Date: May 22, 2005
Published Date: May 23, 2005
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

Sadly, I fully agree with the opinions expressed by Richard Smith on many medical journals having become marketing offices of pharmaceutical companies. What is even worse is that few people actually seem to realize and I know many respectable, and respected academics, who would wholeheartedly dispute these views. I have seen the "psychology of gift" producing great returns to the pharmaceutical industry, via clinical scientists who are totally in denial to the situation they are in, as Jerome Kassirer describes very clearly in his recent book(1).

What is happening is also extremely serious because the taunted trials we are offered make evidence based medicine an almost farcical enterprise. Again, something that not many people realize.

I think the lateral suggestion of journals publishing the critique rather than the results of the trials is very interesting indeed.

However, about publicly funded trials: how are we going to get them given the current financial climate ? A second best could be to play one pharmaceutical company against the other in head-to-head trials, an approach that can help retain independence and that has been used to this purpose.

Another strategy would be a demand from either the regulatory authorities or the academic review boards to the pharmaceutical companies that whenever a new drug is tested in a phase III or phase IV trial, this always be done not only against placebo but also against the drug the condition is generally treated with. This active comparator must be used at the appropriate dose, namely neither too low (in order to avoid the tested drug spuriously to seem more effective)nor too high (in order to avoid the tested drug spuriously to seem more safe). Moreover, should there be different but biologically equivalent versions of the old drug against which the new compound is to be tested(for instance patented, branded generic or generic versions), then the cheapest formulation should be chosen.

These strategies could possibly help produce results which might be more reliable from the scientific point of view, as well as more friendly to health systems which seem to be cracking under the costs of drugs.

Lastly, I hope Richard Smith will go straight into the lion's den and send his thoughts for publication not only to the similarly minded people of PLoS Medicine but to some of the journals who are the most culpable of the policy he is exposing.

1) Kassirer JP. On the take: how medicine's complicity with big business can endanger your health. Oxford University Press, 2004.

No competing interests declared.