Doctors on the take: a patient’s guide to fine print in research

5 Aug

by Carolyn Thomas @HeartSisters

I was doing a little light reading in the Archives of Internal Medicine the other day. A study reported there looked at what researchers have dubbed the Eco-Atkins Diet, which replaces the low-carb, high-saturated fat meat protein of the old Atkins Diet with low-carb, low saturated fat vegetable-based protein – such as soybeans, legumes and nuts.

The more I read, the better I liked what I was reading. The study showed that the vegetable-based protein-eating participants not only successfully lost weight on this new Eco-Atkins Diet, but they showed greater reductions in their LDL (bad) cholesterol levels than the control group.

Isn’t this fabulous news for those of us wanting to lose weight as well as improve our heart health?

Well, maybe not.  

It was the disturbing conflict of interest disclosures in fine print down at the bottom of the journal article that floored me.  This (very fine) print revealed that the “study was supported by Solae, a soy food company”, and the study’s lead author was a physician who served on the scientific advisory boards or had received cash from corporations including:

  • Unilever (makers of Eco-Atkins-friendly products like Bertolli olive oil, Becel Omega 3 margarine, and Breyers ‘Carb Smart’ ice cream)
  • The Sanitarium Company (makers of Eco-Atkins-friendly So Good soymilk, Vegie Delights™ soy sausages and lentil patties, Nutrolene® roasted nut loaf, and Rediburger® vegetarian ground round soy products)
  • Barilla (makers of Eco-Atkins-friendly Barilla PLUS™ high-protein pasta made from egg whites, lentils and chickpeas)
  • The Almond Board of California (and he also served on their Speakers Panel)
  • Solae (world leader in production of Eco-Atkins-friendly soy products for food, feed and industrial use. Solae soy is used in over 80% of the world’s clinical research on soy proteins. It’s a subsidiary of the chemical giant Dupont, and a partner with Monsanto in “a new line of soy protein developed with Monsanto’s ‘plant breeding’ technology” which I guess is what they’re calling genetic engineering these days).

As if I weren’t feeling disillusioned enough by then, I learned that two of the study’s co-authors are actually current or former full-time employees of Solae.

Here’s a question for medical journals like the Archives of Internal Medicine:

How on earth did this “study” get accepted for publication when at least two of the authors are clearly identified as paid industry shills?

So let me spell this out for you:  a big money, peer reviewed, academically published research study recommending increased consumption of nuts, legumes and soy products is funded by companies that produce nuts, legumes and soy products.

It’s brilliant marketing strategy, really. Imagine that you are the CEO of Solae, or Unilever, or Barilli, or the Almond Board of California, and you are looking for ways to boost sales and make your shareholders happy. A good move would be to fund “research” in which - quelle surprise! – researchers who are actually on your payroll determine that the products you manufacture are not only good for the waistline but – even better! – now good for the heart.

With heart disease the #1 killer of both men and women in North America, you’d have a ready-made and eager target market of Baby Boomers to pitch your products to.  And you would apparently do this with a straight face.

Don’t get me wrong, my heart sisters: getting people to eat more almonds or soy burgers in spite of tainted research may seem pretty harmless.  

But it’s a short stretch of road between that and convincing those same people to use drugs or devices based on equally tainted research.

Become an educated and curious consumer. Find out who’s paying for the research you are reading about. Always assess those conflict of interest disclosure statements at the end of published journal articles (when they’re available – appallingly, not every medical journal requires study authors to let readers know who has paid for their opinions!)

These admitted conflicts of interest tell you if you should take this research with a skeptical grain of salt.

For expert help in deciphering potentially misleading research results, try bookmarking resources like Health News Review, particularly their Journalist Toolkit page on Things You Should Know About Medical Research Studies. HNR uses a simple 1-5 star system to rate research report flaws like ‘disease mongering’ - which means ‘framing risk factors as a disease’ or ‘medicalization of normal human variants’.

My very favourite resource – particularly for assessing the credibility of drug studies – is TheNNT. This site comes from physicians working in Emergency Medicine who have developed a framework and rating system to evaluate both therapies and diagnostic tests based on their patient-important benefits and harms. Unlike many of the published studies they study, this group accepts no outside funding or advertising.

Medical experts with their greedy fingers in the wallets of corporations are not new, of course.

Consider the physicians hired by Big Tobacco decades ago to undertake research “proving” that cigarettes were not dangerous to our health. In 1969, Post-Keyes-Gardner, the ad agency for tobacco giant Brown & Williamson, relied on the testimony of their hired gun physicians for a new campaign “to set aside in the minds of millions the false accusations that cigarette smoking causes lung cancer or other diseases.” (Handbook of Public Relations, Heath & Vasquez, 2004).

hospital pills colorfulAn independent 1996 study found that 98% of scientific papers based on research funded by drug companies promoted the effectiveness of that company’s drug. When the Canadian Medical Association Journal reviewed 19 previously published cardiac studies on drug eluting coronary stents, all seven of the studies that were sponsored by the stent manufacturers recommended continued widespread use of this device, compared to just three of 12 non-sponsored independent studies.

Here’s another textbook example: Dr. Mohammed Hassan Murad of Mayo Clinic reviewed* 202 published journal articles that addressed the now-recognized association between heart attack risk and the deadly diabetes drug Avandia, made by drug giant GlaxoSmithKline. Among the journal article authors who (erroneously) concluded that Avandia does NOT increase the risk of heart attack, 86% had financial relationships with GlaxoSmithKline. But among authors of articles offering unfavorable reviews of Avandia, only 18% had relationships with GSK. For more on what can happen to you if you market your drugs like this, see the New York Times report, GlaxoSmithKline Settles Investigation with Record $3 Billion Fine in Avandia Settlement

Clinical researchers who depend on funding from Big Pharma are very aware that if they publish negative study results, their funding may well be yanked. This has already happened in several high-profile university labs. See also: Does The Medical Profession Need to Wean Itself From Its “Pervasive Dependence” on Big Pharma Money?

Worse, surveys have found that nine out of 10 medical experts writing nationwide disease treatment protocol guidelines have significant financial ties to the pharmaceutical industry, yet those ties are almost never disclosed in the protocols, which are often published in medical journals and then implemented in daily practice.

And these are just the ones we know about.  In 2002, the well-respected New England Journal of Medicine made the startling announcement that they were dropping their editorial policy stipulating that authors of medical studies could not have financial ties to drug companies whose medicines were being analyzed.

Why? They determined that there weren’t enough researchers out there who were not already bought and paid for by pharmaceutical companies.

As Dr. Marcia Angell, a former longtime editor of The New England Journal of Medicine, noted in the Baltimore Sun:

“What would be considered a grotesque conflict of interest if a politician or judge did it is somehow not when a physician does it.” 

See also: NEJM Editor: “No Longer Possible To Believe Much of Clinical Research Published”  

Here’s a news flash for you physicians who have your collective heads shoved so firmly up your nether regions that you appear to be truly ignorant about how bad this looks:  I don’t care how many letters you have after your name, or how sterling your C.V. is, or how pure you claim your research methodology to be.  

The fact that you are on the take from any company with any vested interest in how any of your studies turn out means that your results are suspect.

Shame on you, Doctors.

© Carolyn Thomas www.myheartsisters.org

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* Murad MH.  Association between industry affiliation and position on rosiglitazone and cardiovascular risk: A systematic review. Preventive Medicine 2010; February 19, 2010; Washington, DC. Abstract 212694.

Read this New York Times article about medical ghostwriters in drug companies, or read these related articles from The Ethical Nag: Marketing Ethics For The Easily Swayed:

6 Responses to “Doctors on the take: a patient’s guide to fine print in research”

  1. Female Bodybuilding August 23, 2009 at 8:04 pm #

    Came across your post as I was looking for bodybuilding-related info. Very nice post. Hope to learn more from you.

    Like

  2. C.E.Thompson, M.D. August 19, 2009 at 12:59 pm #

    Your comment on my Blog was excellent and your article tells it as it is.
    I had hoped that Canadian doctors were a little less greedy than some of our American doctors and also had more ethics. I guess you have some of the same problems in your country as we do in ours.

    Like

    • Carolyn Thomas August 19, 2009 at 1:38 pm #

      Hi Dr. Thompson,
      Well, I can’t speak for Canadian doctors. The CMAJ review was of studies published in 19 medical journals around the world – not necessarily Canadian studies.

      It IS an issue of ethics that I hope will be squashed like a bug very soon!
      Thanks,
      C

      Like

  3. Lois August 16, 2009 at 10:47 am #

    This is a heavy article Carolyn. This subject I struggle with. Especially because I am now off Plavix and on a brand new blood thinner that two cardiologists recommended. I can’t even go there with the anxiety it caused me and had to just finally ‘trust’ because without going off Plavix and on this drug blood thinner I could not be on my reflux drugs. And just having seven ulcers and still feeling like I have a golf ball in my throat… I felt I had to go for it. After reading all the different women’s stories from heart sisters, now I’m a bit anxious about my lump in my throat. Boy, this never goes away! Lois

    Like

  4. Lois August 16, 2009 at 10:39 am #

    Carolyn,
    I’m not going to be able to apply for the Symposium… I have to work fulltime, I did want to go around 4 years ago, but believe I was doing so much with our American Heart Association that it did not work out. But, when you say “thank you to my heart sisters”, what and how can I get involved? I am on Team Inspire (Team Inspire subscriptions@inspire.com) is that it?
    Lois
    You can answer all my questions and comments in one email… I think I’ve written you three times this AM :)

    Like

    • Carolyn Thomas August 16, 2009 at 12:19 pm #

      Hi Lois! My ‘heart sisters’ who shared their stories with me on ‘How Does It Really Feel To Have A Heart Attack?’ are on the Inspire WomenHeart onlline community at http://www.inspire.com/inspire/group/womenheart/ Have you been there? Highly recommended for any woman with heart disease, or anybody who knows a woman with heart disease. Will respond later in an email, okay?
      cheers
      C.

      Like

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