Science, Industry, and You
By Pat Racimora on May 18, 2009 at 9:30 AM in Current Affairs, Health Care
Biomedical researchers are under no ethical obligation to find a cure for every physical affliction. That goal remains unreachable by even the best scientsts. However, they are obligated to hold the patients’ welfare paramount and to minimize every risk possible.
It was with great concern, then, that I read a press release of an article due to be published next month in the scholarly journal Cancer. The findings are upsetting, especially for anyone who is struggling with a cancer diagnosis within their circle of loved ones or themselves.
Nearly one-third of cancer research published in high-impact journals disclosed a conflict of interest, according to a new study from researchers at the University of Michigan Comprehensive Cancer Center.
The most frequent type of conflict was industry funding of the study, which was seen in 17 percent of papers. Twelve percent of papers had a study author who was an industry employee.
Up front it is important to point out that it is unethical to fail to disclose a conflict of interest, and that is not what is at issue here. Rather, the question is when a researcher is being paid by an entity that clearly favors a given outcome—that is, their drug or treatment will work better than anything else on the market—can that researcher remain 100% objective?
The most stunning finding with the University of Michigan’s analysis of over 1,500 cancer studies published in prestigious journals is that randomized trials reported by researchers who had a conflict of interest were more likely to have positive findings.
Aside from outright data fabrication (and no one is making such an allegation here), other more subtle sources of conscious or unconscious bias may be operating. The study design itself may contain a flaw that will favor a particular outcome. For example, perhaps sicker patients end up in the control group, making it more likely to get positive results for the experimental treatment. Researchers may be able to rationalize dropping data that would have remained in the final analysis had it been processed objectively. Perhaps studies with unwanted findings do not get submitted for publication, so no one ever knows of a negative outcome.
My friend, Dr. K., who sent me this article, also added his moving comment about what this study means to you and me.
When you think of people struggling with cancer and of all their relatives and loved ones, often riding a roller coaster of good and bad news, not knowing when and if the cancer will take their life, this kind of business is hard to understand in light of how it may be a powerfully confounding variable in the research.
The University of Michigan study suggests that biomedical research would be better funded and directed by sources other than an industry that has a stake in how the research turns out. Yet where such funds would come from any time soon is unclear. Nevertheless, my cartoon suggests an unhealthy alliance that impacts on medicine, cancer patients, and ultimately our society.
(Release: November 13)
on sale for only $16.95.
has a spatula.)
8% Off at $11.95, with a rare five-star ranking by 294 customers: 
And check out these: 
("This crazy redhead is on to something. Her pink Rambler story alone is worth the price of the book," writes 
- “Richard Sale’s reportage on Washington, the CIA, the American armed forces, and foreign intrigue has created a perfect background for this account of the steady growth of President Clinton as a master of the game of nations.”--W. Patrick Lang, former head of Middle East Operations, DIA
"Anne C. Heller's stunning biography of Ayn Rand" uses a "plethora of newly unearthed research and fresh insight."
Never take advice from somebody who is trying to sell you something. A “medical researcher” who is paid by a drug company must be presumed to be trying to sell to you the drug company’s product. This may not always be true, but the UMich analysis supports the proposition.
Thanks! This is a very important point to make about all the new drugs on the market. Some of them are doing amazing things–e.g., the newer arthritis drugs have helped my husband so much. But the reports of over prescribing and advertising new drugs that turn out to be a little more than useless are now a common occurrence. The reports of new drugs to attack symptoms without worrying about trying to find causes of the symptoms are also occurring more frequently.
For women, I think of all the drugs designed to cure the fact that we are female. Let’s attach menopause, for instance, as if it were an illness. It never made sense to me. Now it appears drug companies may have done more to harm women with those drugs than help them.
Is that a beer or lemonade in the white jacketed person’s hand? ha. I think it is common practice, that is, for there to be potential conflicts of interest, in research in general, without regard to medicine. But I think it is also a predicament that doctors receive benefits from drug companies as well. Is it possible that some patients might be prescribed medicines, with a doctor’s unconscious or conscious bias or consideration of the generosity of the drug company? Thank you Pat for mentioning the findings, though it is disconcerting to be sure. Again, I love your cartoons.
Thanks for the compliment and for making a good point about doctors and possible undue influence in their decison-making.
As for the glass contents, I thought an injection would be too unpleasant-looking, and I needed to introduce some yellow into the mix to brighten the illustration up a bit.
Great art and great points Pat.\
(my best Homer voice) Mmmmmm-Medical Beeeer.
The missuses works for a university affiliated medical center, I never wanted for pens when the drug companies were allowed to distribute them and other gifts. Alas , it is no more, I have to buy my pens now because the center put in new strict gift policies. They take this very seriously now and so do other medical centers and hospitals.
I wonder if this is the norm now for other members of the health care profession?
Thanks for an important post. And what you metion about negative studies not being published – that’s very true. Researchers are less likely to submit them, and publishers are less likely to publish them – which is so wrong. Without them in the literature, our “empiricism” is crippled, and meta-analyses are biased at inception.
Any bias in many of these studies may even be unintended and introduced unconsciously.
Stan Davis
Lakewood, CO
Good point Stan. I think sloppiness, not adequately monitoring research assistnats and the like introduces error into many research projects (not just when there is a potential conflict-of-interest).
Stan Davis! (a old familiar name) What ever happened to (Gen) Wesley K Clark and his wonderful family?
I’m so glad he got OFF the Bambi band wagon early.
Or so it seems. I couldn’t BARE watching him blather on like some of these phonies do about BHO. It’s embarrassing.
Good to see your still blogging around.
Peace
ok that’s
GOOD to see your SHINING self and GOOD to see you’re still blogging around!
This goes back to the ban on stem cell research. YOu know the one barry is for, but yet allowed the ban to continue behind closed doors.
Taking pills is not a cure. Biomedical is not the same as Biotechnology. Biotechnology is the cure. Unfortunately, the pharmaceutical industry will pay any cost to keep this technology suppressed. They use religion to do so, funding extreme pro-life groups. In all aspects, its the modern day inquisition.
hail all by myself (it seems) I keep those businesses a float!!
They need not worry.
Something that needs to be considered is the fact that a great deal of funding for research was cut from the government, starting back in Clinton’s administration. And when there’s no govt. funding for research, alot of valuable and valid work would not be done without outside funding such as that provided by drug companies. At one time some research grants with 94% ratings still did not get funded.
That said, I worked in a lab which did drug testing for certain SSRI’s. Our project was funded by a Japanese drug company: Takeda. We were given the compounds with only a number, a molecular weight, and possible solubility properties. We set up the tests and submitted the results back to the company. There was no bias since we didn’t know which compounds we tested. But I can tell you this: one of the most prescribed antidepressants today was included in that study. If not for that private funding, this drug might not be on the market now.
I know there are scientists who do not adhere to the high standard of ethics expected in research, but please don’t paint them all with the same brush. I can say with certainty scientists do not go into research for the money. It’s the curiosity to address a problem, answer a question, and offer a better solution.
I agree, Portia Elizabeth, that most scientists are in it for the right reasons. I chose to do this toon and story, however, because in my life outside of my favorite avocation working for No Quarter (using a different name here from the one I use professionally), medical and behavioral science ethics is my beat.
My latest research was disconcerting. 86% of a large sample of over 2,500 biomedical researchers reported having seen or knew about some type of scientific wrongdoing committed by colleagues, post docs, or assistants. This was not limited to fabrication, falsification, or plagiarism and included carelessness, incompetence, and other acts that could corrupt the scientific record. (As soon as the embargo is lifted, I will do a toon on this work!)
Having said that, there are precautions that need to be taken in this kind of research–and the randomzied trial, double-blind deisgn is one. The problem can be that there is always someone at the top who knows who’s who and what’s what. We must rely on the objectivity of that person.
Now, having said that, you are right that there are insufficient funds to do needed research from public money. That is the reality, which I hope that I did convey in the last paragraph.
Pat — I hope you don’t think my comments were in any way a criticism of your essay. Not at all. I was addressing the community in general because it seemed there were some who think ties between research and industry border on unethical. You are absolutely right that there are rogues in the field.
A funny and almost tragic story involved two scientists who worked for a biotech company affiliated with Baylor College of Medicine. Their competition grew so fierce and full of animosity that one actually accused the other of putting carcinogens in his nasal spray to try to kill him. The joke was the second scientist was arrested while at the drugstore buying Afrin.
Oh no, I didn’t take your point as criticism as all–it was an excellent comment, as are many here.
Oh my, that story is a good one. My “best” awful story occurred between two scientists who got so angry at each other than one set the other’s lab rats loose in the university’s botanical gardens!
LOL! Is it any wonder some scientists have a reputation as f**ked-up misanthropes?
I knew of one who injected beta-mercaptoethanol into the car (through the gasket around the door) of her nemesis. (For those not in science, 2ME is one of the strongest, worst smells ever and impossible to get rid of.)
I guess the message here is don’t piss off a science nerd.
But Portia, I think you’re talking about what we would call an efficacy study – which is done in the lab. Many drugs or procedures work well during efficacy studies (when all extraneous variables are ruled out), but not so well during effectiveness studies (out in the real world).
But the point I meant to make is about psychological medicine -the lab people are in contact with the patients. While neither knows which med the patient is taking, both can be clued in by the changed behavior of the patient, and the tech’s reaction to the knowledge may affect how well s/he carries out the rest of the study, which confounds its internal validity. You can be left with results not so clear now, because confounding variables may have interacted with the experimental treatment to produce the final effect.
Thank you Pat. So true.
Cancer, unfortunately, is a great money making business. That is the sad truth.
Tamoxifen is a drug that has had a lock on the market for several decades as the drug for Estrogen positive breast Cancer. It is not a drug for breast cancer, it is a drug to stimulate ovulation that they found redirects the estrogen from the breast area and serves as a hormone like boost, without ADDING estrogen, and redirects it to the reproductive area. It is used around ovulation only, a few times a month for only some months.
So they decided to rework their studies. They claimed years ago that it improved breast cancer patients chances of it not coming back by aprox 36 percent. Yet, the studies done in Europe (drug maker is American) was only around 26 percent improvement.
Well, as this became a better business, the druge maker has had many more studies. They can skew the study group to have milder or stronger cases. Milder cases are more likely ok without the drug. And then they changed the chance of recurrence by 40 something percent, which allowed Doctors to now claim “almost 50 percent improvement”.
And what that really means in drug lingo is, if your chances of dying from breast cancer is 2 out of 100, taking this supposed breast cancer drug, every single day for 5 years gives them an incredible amount of money, I mean, would change your chance of dying from 2 out of 100 to 1.3 out of 100…not even a full person more????
But, as cancer is a great money making business, it increases your chane for developing another cancer, liver, stomach, ovarian or uteran. And, like me, I was put on Estrogen only as a treatment (which most likely caused the cancer as at min. 30 percent of HRT takers develops breast cancer and I found out AFTER I decided not to take Tamoxifen, that my cancer, tubular carcinoma is directly linked to HRT) that increases your chances of uteran cancer by 440 percent.
We become a human cash machine for pharmaceuticals and I know I had to draw the line and keep my fingers crossed.
Like I’ve said repeatedly. With this money making business over the health of citizens and wiping out disease, I’m SURE if we had to come up with a vaccine for Polio now, the pharmaceutical industry would say, I have the perfect drugs to treat your pain and other side effects, instead of halting the virus.
sorry for typos…ie druge s/b drug and skew s/b sku
Thanks for that story, I’m a Linda Too. Another thing that bothers me is that drug companies often go for symptom relief rather than cures. If we were all well, after all, they would be out of business!
Exactly.
Very timely information, in light of the ongoing health care reform debate. This is just one example, again as to why reform is urgently needed. I heard it on Fox this morning… another lawmaker saying we have the best health care system in the world. I would say then, define best for me. Because we don’t have the healthiest people, and we aren’t headed in that direction under the current “system”. We don’t have a system based on patient service. Spend 8 hours in an emergency room and that much is painfully clear. We don’t have the most empathetic system, try getting past the admissions people without an insurance card. We don’t give our people the best prices on drugs or medical supplies, you can buy most any prescription medicine in Mexico for 25-33% of what it costs here. What we are left with is a system. Health care is almost ancillary to the overall health of the underlying “system”. The system, is for profit and is administered by folks who count beans for a living. Folks who have good insurance, like our lawmakers and who don’t know what it is like for people who don’t have insurance and face the roulette of ruination every time they have a medical condition. The system is also controlled by drug companies whose goals are not to prevent illness, but to come up with some patentable form of something that is marketable. The system is controlled by the FDA, who wastes time classifying Cheerios as an unlabeled drug because they state on the label that eating them can contribute to normal cholesterol. Well they can, you can help this by any form of healthy diet… but you can’t say that legally. If you want to lower cholesterol, then buy one of the advertised on TV drugs. Honestly, we couldn’t treat a dog the way we treat our own people sometimes… for if we did PETA would have a fit.
Wonderful cartoon! I love the 3-D affect.
As long as we are not willing to finance science for science’s sake there will be a problem with objectivity, whether it comes from industry or even NIH. The reason is that this kind of funding requires a positive result in order to be able to obtain additional funding for the current or future projects. Proving that something does not work needs to be valued as a positive step toward what will work and not seen as a failure.
Rich
Absolutely! Very good point.
My sister is an RN and said Cancer is a big money maker for the medical field. She said when they find another incurable disease, they’ll find a cure for cancer.
As for the best health care system, it isn’t perfect but I would say by far it is the best. The majority of people are not healthy through their own piss poor lifestyle habits. They don’t exercise, they smoke, are too stressed out and they eat too much garbage. You can eat good without grazing on salads and granola bars. I love sausage but it’s almost all fat so I rarely eat it. It’s called self control. It’s not worth getting heart disease over it.
But, if you lost your health insurance coverage and couldn’t get replacement coverage, then it wouldn’t matter how advanced it is. For some reason, we always want to think we have the best of everything here, and that everybody else has it far worse than we do. As if, “relatively worse” was something that ought to be factored and considered into some sort of an equation. We have that with Obama… at least he’s not Bush. O.K. he’s not Bush, still that mediocrity argument only goes so far. I am for the single payer government system, and let the private system compete to the extent that it can, but make them do that without any government money at all. If a service is covered under a government plan, then pay nothing for that service to a non government provider. If it’s not covered, then the free market prevails. For those non covered services, removing the third party payment system will ultimately introduce some real free market competition and lower the costs of those non covered services. Right now there are only disincentives for the free market to work and it effectively does not exist today in health care.
I said “the best health care system” not health coverage. But, some of this problem lies with people who get coverage and won’t work. People who run to the Dr. for every little ailment they get. People who can afford coverage and won’t get it. People who don’t take care of themselves. All of these things run up the costs of medical insurance.
No way in hell I want government in charge of health care.
They are the same thing, if you don’t have the insurance or other means to pay for the care. Or, if you do have crappy ERISA ran insurance as an example that only pays for what they want to pay for and not what is needed. Or, if people buy one of those $10 a week plans advertised on TV for those who can’t get insurance. Try getting sick and trying to use one of those $10 a week TV insurance plans. No, our overall system includes our health insurance system, the pharmaceutical industry, and behemoth hospital purveyors. But, still throw all of that out, and just look at our diagnosis and treatment. Our current system is by no means the “best”, actually it is nominally acceptable if that.
the gov.isn’t fit to run a pig farm.
I seriously doubt most hospital administrators could run a pig farm and actually make a profit. You can’t charge $1000 a day per head rental on the hog pens. The government could make a single payer system work. If I were in charge of doing it, I would look hard at expanding Medicare and the VA. Get to training doctors and nurses now, expand training and give free scholarships to students in exchange for 10 years of public service for nurses and 20 years for doctors. Plan for 10 years from now to have a totally functioning government system using the private system today as a bridge. This gives private companies 10 years to plan ahead, maybe to sell out to the government, or contract with them and the government 10 years to get it together to take control. In the interim, pass legislation mandating providers accept immediately the government reimbursement for care given every government subscriber. Grant every person having insurance today or not the right to basic government care at reduced cost, not completely free regardless of income level there needs to be some cost for using the system. This creates the single payer system using the providers we already have today. For providers, there are no options, play nice or give up your license to practice. It’s a free country after all. Maybe I might make BHO look like a choir boy in doing so, but I know this could be made to work.
wodiej wrote :”My sister is an RN and said Cancer is a big money maker for the medical field. She said when they find another incurable disease, they’ll find a cure for cancer.”
And that statement says it all, doesn’t it.
Yep, and I am not trying to pick fights here. I like wodie’s comments, and agree with them most of the time. But to quote that quote, and in the same paragraph say our system is the “best”. Yes, our system is that quote and it does sum it up nicely. It is money driven and is just a business. I am not against money or business, not at all. Neither of these belong in health care. Health care should be looked upon as a necessity for quality life itself… the same as clean air water and food… then health care. We need to quit seeing this as a business. I cringe every time somebody says health care is 16% of our economy. They say it like that is a good thing. It is not, that means we spend 16% of our economy on something the government could do for all of us for a lot less.
I agree
The founders included the words “Promote the general welfare” in the Preamble to our Constitution.
Different words, same meaning. IMO
The medicorps are good at fixing what THEY want to fix (ie, what’s profitable).
They want us to take things DAILY, not fix-it-and-forget-it. It is for this reason I don’t trust anyone beyond my primary care physician.
I started thinking, when was the last time we heard of a cure for something, instead of another drug one has to stay on for the rest of one’s life?
Rich
Good one!
Would we have had a vacine for polio in this Drug Company profit motivated Culture.
I am a big supporter of stem cell research since it is one area in which the possibility of a cure for diseases is likely instead of a lifetime of taking drugs. UC Santa Cruz is doing a great deal of work in that area.
Rich
A very important issue, and well depicted, Pat. The conflict of interest problem has a long history of confounding research results. That, along with the problem of unethical reearchers who deliberately disregard those results which are unfavorable to the outcome they want. Makes you want to question the results of most research. Perhaps only the confirming results of replicated studies by different researchers can be trusted.
Thanks Don X. You are absoutely right. But, the hell of it is that there is little to no support for replication research, and journals are less willing to publish replication studies which then gives no reward to the “publish or perish” burden that researchers (especially in academia) must cope with.
The system itself encourages misconduct.
I doubt a cure for cancer will ever be allowed to be discovered. The horrible chemo treatment is keeping all the drug companies rich. They get much richer by treating it than by curing it!
Again I concur,
Many of commenter’s today are on the same page (mind) literary speaking and glad to see it.
There may be hope for us yet!
There’s another profit-related bias affecting research: Money generally isn’t available to conduct studies of promising therapies unless they revolve around a patentable new drug.
This probably the main reason why formal clinical studies aren’t being conducted on the use of dichloroacetate (DCA) in the treatment of cancer.
http://www.newscientist.com/article/dn10971
Yes, that is right. The money is in the patents and it is all about the money right now. Drug companies aren’t looking for the easiest cures or treatments. They are looking for that next patentable chemical compound or the process for mass producing it. Drug companies extract molecules from natural plants, and test those compounds. They do this because the molecules extracted from the plants and the method to mass produce them will be patentable. Meanwhile they belittle the natural plants themselves, because they are from nature and not patentable. Where there is no money, there is no medicine. I am nobody’s socialist generally. In this case, call me a comrade because I really believe a centralized and efficiently operated government backed system could run circles around what we currently have.
Pat, in my haste to comment on comments it’s occurred to me how appropriate and revealing of your visual commentary–actually says it all in this proffit driven age.
good article Pat..