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 Hammonddoctor,broadcaster, stand up comedian, satirist, and trainee guru. Any
who are offended by the impertinence of the question might dowell to
reflect on the value of satirists. Long after 99.9% of18th century
Dublin physicians have been forgotten, the writingsof their
theological colleague Jonathan Swift are known acrossthe world.
"Satire," wrote Swift, "is a sort of glass, whereinbeholders do
generally discover everybody's face but theirown."
Those interested by Hammond's question can reflect on relevant evidence in
this week's journal. Silvio Garattini and VittorioBertele' review
12 anticancer drugs approved in the past six yearsby the European
Medicines Evaluation Agency (p
269). They concludethat the benefits offered by the drugs are
trivial but the costsenormous. Some are 350 times more costly than
existingdrugs.
Ray Moynihan describes "the blaze of publicity" sparked in the United States
by football star Ricky Williams revealing thathe has social anxiety
disorder but has benefited from the drugPaxil (paroxetine) (p
286). Not all the media reports disclosedthat Williams was being
paid by GlaxoSmithKline, which last yearearned US$2.7bn from sales
of paroxetine. "Celebrity selling"is the rage. Unfortunately "shy
people" or those with a "publicspeaking problem" may be encouraged
to think of themselves as"diseased" and to take drugs of limited
effectiveness with establishedsideeffects.
But the influence of the pharmaceutical industry extends beyond the American
mass media into the science published in theBMJ. Lise
Kjaergard and Bodil Als-Nielson have taken advantageof the fact that
for some years the BMJ has required the authorsof studies to
give their source of funding and disclose competinginterests (p
249). They find that those authors who have financialcompeting
interests are more likely than those who do not to favour
experimental interventions in randomised controlled trials. Thiswas
true of both pharmacological and non-pharmacological trials.Could
this finding be true only for the BMJ? They authors can'tsee
why and point out that the other major general journals publisha far
higher proportion of trials funded by the pharmaceuticalindustry
than the BMJ.
Competing interests were a major debating point in the court case that
concluded this week in which more than 100 women suedthe
manufacturers of third generation contraceptive pills becausethey
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 publishedin 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 nextweek.
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