Tainted medicine

Last month, our trust in the objectivity of medical research was violated. The New York Times reported that a study showing that annual CT scans of smokers for lung cancer could remarkably reduce deaths from the disease was surreptitiously paid for by the tobacco industry. The 2006 study, published in the New England Journal of Medicine, was in part funded by an obscure charity, the Foundation for Lung Cancer, which, it turns out, got its money from the parent company of Liggett Group Inc., a cigarette manufacturer. A critic's designation of this funding as "blood money" quickly crisscrossed the country.

The potentially tainted lung cancer study raises a question that should give us a painful knot in our collective abdomen. What don't we know about clinical research in the U.S. that could be bad for our health?

With federal funding for research declining, private industry has stepped forward to fill the money vacuum, and many clinical investigators have eagerly accepted the largesse.

We usually think of "industry" in terms of pharmaceutical companies. But research is also paid for by food companies, disease-oriented organizations such as the American Diabetes Assn. and foundations with impressive but ambiguous names whose motives are as obscure as their titles.

The episode that first highlighted how financial conflicts of interest might be harmful to patients' health involved Jesse Gelsinger, an 18-year-old with a mild form of a genetic disorder that made him deficient in a protein essential for metabolism. Still, he was healthy because he could manage his condition through diet and medication.

In 1999, he volunteered for a research study at the University of Pennsylvania. The scientists conducting the study replaced the gene responsible for Jesse's protein deficiency by attaching it to a common cold virus and then infecting him with the "harmless" virus. In four days, Jesse was dead.

It was subsequently disclosed that the virus-carrier technique used to treat the teenager had been patented, and that both the study's lead scientist and the medical center where it was conducted held stock in the company that owned the patent.

The scientist denied that his use of the gene therapy technique was premature. But critics wondered whether his financial interests and those of the medical center had influenced the decision to push the experiment forward before there was sufficient evidence of the technique's lack of toxicity.