ONLY 9% OF American adults think the pharmaceutical industry is trustworthy, according to a recent Harris poll. That means that the makers of lifesaving and life-enhancing drugs rank just above tobacco companies in the public's esteem.
How could this happen? Easily. Despite efforts to reform the Food and Drug Administration after its scandalous failures to police drug-safety standards in the cases of Vioxx and other dangerous drugs, the FDA still does not have clear safety policies and can be too slow in responding to danger signals, according to a report released Monday by the Government Accountability Office.
The GAO report comes on the heels of other indications that medical knowledge itself is being corrupted by self-interested or faulty research conducted by or for industry. Although the headlines target drug companies, a larger danger is hidden from view: American taxpayers no longer are funding the majority of clinical research. With two-thirds of clinical trials and three-quarters of the papers published in the top medical journals commercially funded, the drug industry has gained unprecedented leverage over what doctors and patients know -- and don't know -- about drugs.
The recent case of drugs known as atypical antipsychotics is instructive. These new and expensive drugs, with sales of about $10 billion annually, are used to treat serious mental illnesses such as schizophrenia. Earlier this year, the American Journal of Psychiatry published an analysis of 30 separate trials involving head-to-head comparisons of five drugs. Nine out of 10 times, the drug made by the company that funded the study came out on top. When Eli Lilly, the maker of Zyprexa, funded five studies of its drug, Zyprexa was found superior in all five. But when Janssen, the maker of Risperdal, ran its studies, Risperdal came out ahead.
Researchers scoff at the notion that that their scientific integrity is for sale. Certainly most researchers aren't corrupt, but their institutions are guilty of allowing the drug industry to manipulate medical science.
Meanwhile, industry-funded research is failing to provide the clinically useful answers physicians and patients need in order to pick the best treatment. Which drug is right for which patient? What are the risks? Are the added benefits of a new, expensive drug worth the cost? If not, should insurance companies and Medicare be paying for them?
