Take the latest heavily promoted, super-dooper relaxant tablet if necessary and lie back, get comfortable and imagine, if you can, the implications for a public health system if much of the evidence that governed treatment decisions by doctors was based on a carefully selected release of studies designed and funded by the companies trying to bring their latest treatments to market. No problem you say.

Okay, now also imagine that these same companies could actually evaluate the results of those studies before deciding whether to complete them or publish them in medical journals. If they found that their new and expensive treatment was no better than an older and cheaper treatment, or caused more side-effects, what do you imagine that they might do with the results if there was no compulsion to bring them to the public’s view?

Ponder further and imagine what may happen if 17 similar studies were done by a company to evaluate its new treatment and only one study, probably by chance alone, showed that the new expensive treatment was superior and the other 16 showed it was equivalent or inferior. Imagine that this single study was the only one of the 17 to be published and that this company could fund vast amounts of advertising of this “great breakthrough” in many of the world’s medical journals and could call on an army of paid medical “advisors” and “key opinion leaders” and secretly-funded patient advocacy groups to spread the word to all corners of the health-care earth.

And what if the doctors who will need to be convinced to prescribe this “exciting new breakthrough” treatment could also be “educated” at lavish events fully funded by this company at exotic locations … no questions asked except a pesky non-verifiable requirement for self-reporting and self-regulation?

Stretch your mind even further and just begin to dream that this same company could outspend all other businesses in lobbying politicians to make this “essential new and life-saving breakthrough” government-funded as a matter of urgency? (And even better if it was an election year). Oh what “free-market” bliss! 

Well, some recent high-profile publications indicate that this scenario may be true. A research study just published in The Oncologist by Dr. Scott Ramsey and his postdoctoral researcher Dr. John Scroggins at the Fred Hutchinson Cancer Research Center in Seattle downloaded the complete list of clinical cancer trials in the National Institutes of Health’s registry. They then searched to see how many had reported their results in peer-reviewed journals. They found that only 17.6%, or 1 in 5, of studies reported their findings. They found that trials sponsored by independent clinical trials networks (CTNs) published the greatest proportion of registered studies (59%) and studies sponsored by industry the fewest (5.9%).

Then they analysed the proportion of these studies that reported positive versus negative results. Of published studies overall, 65% were positive for the intervention being evaluated, with 50% of CTN and 75% of industry studies being positive. There are many possible and valid reasons for this serious publication bias and the ‘disappearance’ of some of these studies, but it is difficult to avoid the perception that negative studies, which bring no glory to the researcher or the journal and perhaps most importantly, no sales boost to any sponsoring company, are being systematically kept from the public. They contain vital information on efficacy, toxicity and possible gross waste of public monies as “the great majority of industry-sponsored studies contain patented compounds, many of which are in clinical use.”

They also represent the sacrifices of many patients who agreed to participate. They need to be seen.

If we also consider the report in the prestigous New England Journal of Medicine this week by Robert Steinbrook that since 2006 the health sector in the USA, as a microcosm of the western world, has spent more money on lobbying than any other sector of the economy ($379.8m in 2006 and up 20% to $450.7m in 2007), with the large majority coming from drug and device makers, then we may begin to feel our lovely dream is morphing into our children’s nightmare.

Mix in Choice’s report, “Pushing Pills”, in May this year, that the biases in some pharmaceutical advertising make it a poor source of information for doctors and the reports in the BMJ in June this year that the pharmaceutical industry provides most doctor education now, and our ‘dream’ scenario for pharmaceutical companies, with all “boxes ticked”, may also dramatically increase the demand for the latest blockbuster headache pills and sleeping tablets for the next generation of taxpayers and public health policy makers.

Peter Fray

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