Also, if you have a scroll wheel on your mouse, you can hit CTRL and roll the wheel to zoom in and out in most windows applications (though not all)

Again, my point was that in the end, the consumer (taxpayer) pays. However, I think your underlying assertion is that private companies provide better value for money than academia. I’m agonistic on this, in that I still believe there is a role for both.

I agree that the standard of academic research can be poor, but it can also be excellent. Pharma research may (or may not) be to a higher standard, but Pharma has been caught out manipulating results in a variety of fascinating ways. I’m afraid that I may see the worst of it, working as I do in mental health. I do accept as well that academic research is also sometimes less than ethical and that there is always an agenda that may distort publications.

In the end however, I think governments owe it to their electorates to commission independent trials to check those of private companies. So yes, governments should commission trials – where prudent.

As for drug reps, I think the comparison to BMW salesmen is perfect.

and Henryk also said:
“I can’t see why trials should not be abandoned once they are clearly not showing the desired results”:

In both sentences you have used the phrases ‘positive results’ and ‘desired results’ and it is clearly this search for positive results that is the root of pharmaceutical companies engaging in presenting their results in the best light… after all it is just marketing.

Examine the exclusion criteria for many RCTs and then see how many people are excluded because of their potential to mess up a neatly arranged row of pharmaceutical company ducks.

Genuine scientific inquiry does not have an endpoint that only looks for ‘positive’ or ‘desired’ results. The negative results are frequently more revealing but when seeing only fulsome high praise for a newly manufactured and presented preparation, my index of suspicion is raised.

Thalidomide, Cerivastatin, Atorvastatin/Torcetrapib or Vioxx anyone?

Please see if you can find anything in the literature that supports the reduction of moderate essential hypertension by whatever pharmaceutical means you care to name? I am not talking about the actual reduction by the drug concerned. I am talking about the science behind the rationale for the reduction of blood pressure in cases of moderate essential hypertension.

I don’t think Ben can necessarily say that the proportion of positive trials from BigPharma is due to skulduggery of some sort. It could be that once trials clearly are not going to produce positive results, they just get abandoned. What needs to be analysed is if a particular drug is goes through a trial whose results do not get published, and then subsequently a trial using the same drug is published and shown in a positive light.

I can’t see why trials should not be abandoned once they are clearly not showing the desired results as that would be throwing good money after bad. However whatever results that have been found should be published in a summary form. Perhaps journals could have a section for abandoned trial summaries which let people know why the trial was abandoned. Randi.org

Again, this is silly, it seems to be a revelation for the person who earlier said:

‘If pharma companies do not fund clinical trials in future, then who should fund them exactly? The taxpayer?’

“Bit of a stretch this allegation, and it is an allegation that Grundy is corrupt. Think sensibly and where’s the dangerous corruption here?”

Bit of a stretch? How many statin producing drug companies paying on clinician, does it take to skew the benefits of statins? I have not found the relevant conflict of interests declaration in the NCEP annual report but Grundy calimed that he only received $100,000 for his consultant work that year, although he was also awarded 3 separate research grants.

You may feel this an unwarranted smear but it appears to me that his wholehearted recommendation of statins is not based in science but based in pecuniary gain. for now, my question is this, how do you become an asset to your employers while not doing what they ask?

If Grundy was a genuine expert in statins, he would counsel every clinician to stop prescribing them immediately. Indirect or direct corruption is the same to my mind. The semantic game of one form of corruption being better than another is for those who have no wish to acknowledge the truth. If you are being rewarded by a drug company it is because they see benefit in your endorsement not because they like to throw away money to no good purpose.

The links with the pharmaceutical are a canker in the practice of medicine and I have never heard a valid reason for the close ties that exists between clinicians like Grundy and the masters he serves so well.

The first line was… “Gosh, sorry I have been missed, I have been out toiling in the service of medicine.”

As a psychologist, who pays your salary? Oh. The taxpayer. In fact, the taxpayer pays for all the infrastructure of the country out of his or her tax £, and for all other discretionary goods out of what they have left.

Wow. We are all paid for by our customers, either directly or indirectly. That’s a revelation.

Medicine in thrall to empty promises, huh? What could it be that is extending our life expectancy then? Better diet? Less poverty? More exercise? LOL. We are not saints in white coats nor are we snake oil salesmen. In all disciplines (R&D, manufacturing and sales and marketing) there are those who are more interested in solving intellectual problems than in saving lives. Get real. I do think there is a lot of altruism in this business. In fact there attractive careers because we combine altruism with intellectual interest and the chance of a decent salary. The people I’ve met in over 20 years in this business? Yes there are a few dipsticks like everywhere else, but generally there is integrity and a sense of commitment to making somebody’s else’s life better.

jcmacc is right about the doctors who get paid by pharma companies, they are generally very respected doctors who are given small grants (a few hundred $) to attend conferences or maybe asked to review our scientific direction at an advisory board. Or else they act as clinical trial investigators. We pay their modest, economy-class expenses and give them a very modest recompense for their valuable and highly-trained time. If you want to check the rules, see:
http://www.abpi.org.uk/press/press_releases_05/051116b.asp

Would you advise a company for free? Why should they? We are very constrained now, can’t give so much as a pen and some post-it notes to a doctor in some countries. We sponsor conferences without being able to choose or brief the speakers, we provide lunch in order to get busy doctors to attend seminars so we can talk to them about the latest research. What villains we are!

Why would we ban drug reps? Why is it worse for a drug company to talk to a doctor about its product than for a car salesman to talk to you about buying a new beemer? Why shouldn’t trained professional people be able to help you understand the features of the products you want to use? Doctors don’t know overything (Oh Noes!) and sometimes it does them good to have their memories refreshed about the tools they are employing on our bodies and minds. Is that inherently wrong?

And rim groper. Many companies do make drugs available for patients to continue at the end of a clinical trial. It is called compassionate use. But no, we are not charities and sooner or later a fair price for what we have made would be nice.

Trouble is, these little pills look so simple, don’t they, like M&Ms? You have no idea that you are swallowing more high technology than you’ll ever find in your i-phone. But you are.

Bit of a stretch this allegation, and it is an allegation that Grundy is corrupt. Think sensibly and where’s the dangerous corruption here? If he was paid by one company and he pushed their drug alone, I could see the issue. That could be a company paying a medic to advise people to buy their drug.

The fact loads of Pharma pay him consultancy fees tends to imply he’s an genuine expert in Statins and they are happy to pay to access his guidance.

It takes a bizarre mindset to see Abbott, for example, paying someone to “push” a drug class in general when more than 12 of their competitors sell their own versions. It’s pretty indirect corruption.

For instance: We could ban the drug company sponsoring of conferences and we could ban drug reps. This could all be done directly and perhaps in the process drive down the cost of conferences. Too radical? We could make sure that registration of trials is mandatory, not self-regulated. We could make business leaders directly responsible for corporate crimes. We can certainly make things work better within a capitalist system.

Yes there is a lot wrong with the way that research is produced and disseminated. We want to improve the system in many ways, but it’s not really within our power to overthrow the capitalist way of doing business.

I’d prefer to treat people like Veronica, who I disagree with but welcome her input, with more respect. Otherwise a forum like this just becomes a rabid rant against big pharma and nobody actually discusses anything.

Sorry to moan. What do others think?

Yes, they are motivated by profit maximisation. Luckily, by maximising their profits, they are benefiting mankind (through drug provision and development), this is nothing new – I wrote essays on this back in university. The existence of imperfections does not equal a broken system.

I also beg you to look at the Oil and Banking industries for record level profits, both outstrip big pharma. JP Morgan alone controls over $88tn in assets, over 120 times the global spending on prescription drugs. A measely average one percent return on its assets would account to profit in excess of global prescription drug -revenues-. Big pharma… small fry.

I too have been wined and dined, with no expense spared, back in the days when I thought that clinical research was all that mattered. I believed that I had the best of motivations but really, it was all merely another aspect of the sometimes subtle marketing and I was supposed to be a pliant tool of the pharmaceutical companies concerned.

Extended stays in hotels at £600 per night in Geneva, first class flights in small private jets to anywhere required, international travel as a perquisite of the research. the only time I was happy with my published research was when it appeared as novel research in a high impact journal and I only had to give my time to the project. No money or external influences were at risk.

It is a mealy-mouthed argument to state that drug companies don’t choose their business model. Of course they do. They don’t CHOOSE to do anything for the benefit of mankind, unless it is profitable. Not for nothing are drug companies the world’s leader in profit making. No other business enterprise comes anywhere near the vast profits made by drug companies.

I know of one particular patient who was actually deriving benefit and life extension from a particular treatment and when the clinical trial ended so did the treatment. Distraught relatives wanted to pay the drug company to have a chance to continue the treatment and the drug company’s answer was… “we are not a charity”, so the patient was consigned to die.

Nice ethics.

who said: “We should however make a distinction between the marketing people and the research people. Certainly more altruism in the later even if they work for the same company.”

qv http://www.medpagetoday.com/MeetingCoverage/AHA/7267

Dr. Grundy disclosed possible conflicts of interest with Abbott Laboratories, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Fournier, GlaxoSmithKline, Kos Pharmaceuticals, Merck & Co., Merck/Schering-Plough, Schering-Plough Pharmaceuticals, Pfizer, Sankyo, and sanofi-aventis.

Dr Scott Grundy is a leading light of both the AHA and the NCEP and he recommends statins while being paid by all of the pharmaceutical companies that produce or sell statins.

Altruisim of research people? You are most definitely having a rather large laugh.

Mute witness is the perennial catfight among the junior clinicians, who fight to publish any old tat just to get their name on worthless pieces of paper, which they attempt to dignify with the ascription, research.

At Grundy’s level it is about his status and the perception that he is an opinion former (albeit wrong) and the largesse that accompanies that status… from speaker’s fees, research grants, free holidays (scientific conferences) and lab equipment (personal toys). To pretend otherwise is avert one’s gaze from the trough in which many clinicians actively seek to become embroiled.

Certainly this is not the aim of every clinician nor every research clinician but the rewards that accompany success in the field of medical research are sufficiently attractive as to override all other considerations for a large number of aspiring clinicians.

I don’t object to people making money however they choose. I do object to the notion that their research is worth reading.