Saturday 8 May 2009
In Australia a fascinating court case has been playing out around some people who had heart attacks after taking the Merck drug Vioxx. This medication turned out to increase the risk of heart attacks in people taking it, although that finding was arguably buried in their research, and Merck have paid out more than £2bn to 44,000 people in America, although they deny any fault. British users of the drug have had their application for legal aid rejected, incidentally: health minister Ivan Lewis promised to help them, but FOI documents obtained by The Guardian last week showed that within hours, Merck launched an expensive lobbying effort that convinced him to back off.
This is a shame, because court cases can be fun.
The first fun thing to come out in the Australian one is email documentation showing that staff at Merck made a “hit list” of doctors who were critical of the company, or of the drug. This list had words like “neutralise”, “neutralised” and “discredit” next to the names of various doctors. “We may need to seek them out and destroy them where they live,” said one email, from a Merck employee. Gosh okay, see you at mine later.
They’re also alleged to have used other tactics, like trying to interfere with academic appointments, and dropping hints about how funding to institutions might dry up. Institutions might think about whether they, in turn, wish to receive money from a company like that.
But bigger, and better, is the publication Merck paid academic journal publisher Elsevier to produce.
Now the relationship between big pharma and publishers is a perilous one. Any industry with global revenues of $600bn can afford to buy quite a lot of adverts, and pharmaceutical companies also buy glossy expensive “reprints” of the trials it feels flattered by. As we saw in this column two months ago, from the data on what gets published where, there is evidence that all this money distorts editorial decisions.
But this time Elsevier Australia went the whole hog: they gave Merck an entire publication to themselves, which looked like an academic journal, but in fact only contained reprinted articles, or summaries of other articles. In issue 2, for example, 9 of the 29 articles were about Vioxx, and 12 of the remaining were about another Merck drug, Fosamax. All of these articles presented positive conclusions, and some were bizarre: like a review article containing just 2 references.
In a statement to The Scientist magazine, Elsevier initially said that the company “does not today consider a compilation of reprinted articles a ‘Journal’”. I would like to expand on this statement. It was a collection of academic journal articles, published by the academic journal publisher Elsevier, in an academic journal shaped package. Perhaps if it wasn’t an academic journal they could have made this clearer in the title which, I should have mentioned, was: The Australasian Journal of Bone and Joint Medicine.
Since then things have deteriorated. It turns out that Elsevier actually put out six such journals, sponsored by industry, and Elsevier Chief Executive Michael Hansen has now issued a statement admitting that they were made to look like journals, and lacked proper disclosure. “This was an unacceptable practice and we regret that it took place.”
The pharmaceutical industry, and publishers, as we have repeatedly seen, have serious difficulties in living up to the high standards needed in this field, and bad information in the medical literature leads doctors to make irrational prescribing decisions, which ultimately can cost lives, and cause unnecessary suffering, not to mention expense.
It’s been estimated that it would take 700 hours a month to read the thousands of academic articles relevant to being a GP alone: so doctors skim, they take shortcuts, they rely on precis, or worse. We could do better at giving them information, but for now, it will often be “actually, I think I’ve seen at least two studies on that, and in different journals”.
But the real tragedy is that the cost of distorted information, and irrational prescribing, is far greater than the cost of the research that could prevent it. In a sensible world, the health systems which pay for these drugs – state-funded in almost every single developed country – would band together and pay for comparative outcome research themselves, and the free, open distribution of the resulting information, to prevent all this nonsense. We do not live in a sensible world.