Doctors join forces to fight the profit motive

BY CARLYN ZWARENSTEIN

A group of medical researchers is raising concerns about what they say is an increasingly cozy relationship between profit-minded businesses and the institutions that rely on them for funding.

Doctors for Research Integrity (DRI), composed of workers at the University of Toronto and its affiliated hospitals and institutions, hope to sever academic freedom from the profit motive and turn it into a major public policy issue.

The small, ad-hoc group was originally formed to support the Hospital for Sick Children's Dr. Nancy Olivieri in her fight against Apotex and U of T. Olivieri went public with Apotex-funded research showing that one of the company's drugs may have harmful side effects.

At DRI's first fundraiser in November, the star panelists were Dr. David Healy, whose case also stirred up controversy at U of T, and Olivieri. Apotex, the generic drug company that funded Olivieri's clinical drug trials for the Hospital for Sick Children, terminated her work and threatened legal action if she warned her patients or published her research showing potential health risks associated with the drug.

The so-called Olivieri Report -- the result of an independent inquiry commissioned by the Canadian Association of University Teachers -- concluded that her academic freedom was violated by the drug company, and that U of T did not provide her with effective support.

Healy, director of North Wales Department of Psychological Medicine, was recruited and persistently wooed by U of T's department of psychiatry and the U of T-affiliated Centre for Addiction and Mental Health. A year ago, the institutions revoked their job offer following a lecture he gave to a conference at CAMH.

"I had a nice view," Healy says wistfully, the day after DRI's fundraiser. He had been given a corner office in CAMH and was already picking out the furniture, having accepted the job offer nearly a year before. But then he spoke at the conference about his findings that the anti-depressant drug Prozac may actually cause some patients to commit suicide.

"Everything appeared to change in the course of that one day," Healy says now of his "un-hiring."

Eli Lilly Pharmaceutical Company, which makes Prozac, later donated $1.5 million to CAMH. There has been at least one previous case, in the U.S., in which Eli Lilly revoked funding to an institution when staff raised questions about the drug.

The pharmaceutical industry is big business, and legal drugs are the biggest business of all. Olivieri says the U.S. pharmaceutical industry received a 19 per cent return on revenues in 1999, while the banking industry came second in profits at 16 per cent.

According to Healy, there are about 100 million people on selective serotonin re-uptake inhibitors, the class of anti-depressant that includes Zoloft, Prozac and Paxil, and the industry reaps $10 billion annually from the drugs.

DRI, which wants to see increased government funding of research along with clear restrictions on the influence drug companies can gain from their financial support, warns that medical students are plied with gifts and donations from pharmaceutical companies throughout their education.

A recent study comparing students at McMaster University's med school -- which has banned such gift-giving -- with the highly corporate U of T reveals that students who receive even small gifts and perks are less skeptical prescribers of drugs once they begin to practice medicine.

"The question that now is being addressed for the first time," says Arthur Schafer, director at the University of Manitoba's Centre for Professional and Applied Ethics, "is whether the price to be paid for this [reliance on corporate funding] may be the subordinating of judgment."

In 2000, American drug companies spent $400 million marketing their products to doctors, while the industry spends over $20,000 per Canadian doctor annually on gifts and promotions in addition to the millions "donated" to hospitals and university departments.

It remains to be seen whether the outspoken doctors of DRI will be able to influence the way things are being done. U of T President Robert Birgeneau, for example, was not present at the DRI fundraiser to hear Olivieri claim that things have not changed since he took over from Robert Prichard, head of the university during the controversy around her case.

Still, there is hope. In response to mounting studies showing that research funded by pharmaceutical companies tends to overstate the benefits and downplay the risks of new drugs, major medical journals like the Lancet, the New England Journal of Medicine and the Canadian Medical Association Journal are changing their editorial policies.

According to the authors of a recent article in CMAJ, university dependence on corporate research funding is like "dancing with porcupines."