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Doctors Without Borders
Why you can't trust medical journals anymore.
By Shannon Brownlee
source: Washington
Monthly, April 2004
With financial ties to nearly two dozen drug and biotech
companies, Dr. Charles B. Nemeroff may hold some sort of record
among academic clinicians for the most conflicts of interest. A
psychiatrist, a prominent researcher, and chairman of the
department of psychiatry and behavioral science at Emory
University in Atlanta, Nemeroff receives funding for his academic
research from Eli Lilly, AstraZeneca, Pfizer, Wyeth-Ayerst--indeed
from virtually every pharmaceutical house that manufactures a drug
to treat mental illness. He also serves as a consultant to drug and
biotech companies, owns their stocks, and is a member of several
speakers' bureaus, delivering talks--for a fee--to other physicians
on behalf of the companies' products.
But it was just three of Nemeroff's many financial entanglements
that caught the eye of Dr. Bernard J. Carroll last spring while
reading a paper by the Emory doctor in the prominent scientific
journal, Nature Neuroscience. In that article, Nemeroff and a
co-author reviewed roughly two dozen experimental treatments for
psychiatric disorders, opining that some of the new treatments were
disappointing, while others showed great promise in relieving
symptoms. What struck Carroll, a psychiatrist in Carmel, Calif.,
was that three of the experimental treatments praised in the article
were ones that Nemeroff stood to profit from--including a
transdermal patch for the drug lithium, for which Nemeroff holds
the patent.
Carroll and a colleague, Dr. Robert T. Rubin, wrote to the editor of
Nature Neuroscience, which is just one of a family of journals
owned by the British firm, Nature Publishing Group, pointing out
the journal's failure to disclose Nemeroff's interests in the products
he praised. They asked the editor to publish their letter, so that
readers could decide for themselves whether or not the author's
financial relationships might have tainted his opinion. After waiting
five months for their letter to appear, the doctors went to The New
York Times with their story--a move that sparked a furor in
academic circles, and offered the public yet another glimpse into
conflict of interest, one of the most contentious and bitter debates in
medicine.
In his defense, Nemeroff told the Times he would have been happy
to list his (many) relationships with private industry--if only the
journal had asked. "If there is a fault here," he said, "it is with the
journal's policy," which did not require authors of review articles
to disclose their conflicts of interest.
And that is pretty much where the debate over conflict of interest in
medical journals stands: Should research scientists who have
financial stakes in the products they are writing about be forced to
disclose those ties? To which the average person might reasonably
respond, of course they should. But the more pertinent question is
why scientists with financial stakes in the outcome of scientific
studies are allowed anywhere near those studies, much less
reviewing them in elite journals.
The answer to that question is at once both predictable and
shocking: For the past two decades, medical research has been
quietly corrupted by cash from private industry. Most doctors and
academic researchers aren't corrupt in the sense of intending to
defraud the public or harm patients, but rather, more insidiously,
guilty of allowing the pharmaceutical and biotech industries to
manipulate medical science through financial relationships, in
effect tainting the system that is supposed to further the
understanding of disease and protect patients from ineffective or
dangerous drugs. More than 60 percent of clinical studies--those
involving human subjects--are now funded not by the federal
government, but by the pharmaceutical and biotech industries. That
means that the studies published in scientific journals like Nature
and The New England Journal of Medicine--those critical reference
points for thousands of clinicians deciding what drugs to prescribe
patients, as well as for individuals trying to educate themselves
about conditions and science reporters from the popular media who
will publicize the findings--are increasingly likely to be designed,
controlled, and sometimes even ghost-written by marketing
departments, rather than academic scientists. Companies routinely
delay or prevent the publication of data that show their drugs are
ineffective. The majority of studies that found such popular
antidepressants as Prozac and Zoloft to be no better than placebos,
for instance, never saw print in medical journals, a fact that is
coming to light only now that the Food and Drug Administration has
launched a reexamination of those drugs.
Today, private industry has unprecedented leverage to dictate what
doctors and patients know--and don't know--about the $160 billion
worth of pharmaceuticals Americans consume each year. This is an
unsettling charge that many (if not a majority) of doctors and
academic researchers don't want to acknowledge. Once grasped,
however, the full scope and consequences of medical conflict of
interest beget grave doubts about the veracity of wide swaths of
medical science. As Dr. Drummond Rennie, deputy editor of The
Journal of the American Medical Association (JAMA), puts it, "This
is all about bypassing science. Medicine is becoming a sort of
Cloud Cuckoo Land, where doctors don't know what papers they
can trust in the journals, and the public doesn't know what to
believe."
Clinical trial and error
How did we get to this point? What effect is industry influence
having on the treatment of patients? And why are the medical
journals not more vigilant to weed out papers that have been
distorted by conflict of interest? The answers to these questions
begin, oddly enough, with an amendment to U.S. patent law called
the Bayh-Dole Act. Passed in 1980, Bayh-Dole for the first time
permitted universities to commercialize products and inventions
without losing their federal research funding, the seed money for
innovative research. The brainchild of George Keyworth II,
President Reagan's science advisor, who was watching the United
States get beaten in world markets by the Japanese, Bayh-Dole was
intended to stimulate advanced technological invention and speed
its transfer from university labs into private industry, where it
could be put to work spurring U.S. productivity.
It seemed like a win-win proposition. Indeed, Bayh-Dole has
helped launch the biotech industry and has propelled several
life-saving products to market. The basic research behind Gleevec,
for instance, an incredibly effective new anti-cancer drug, was
done by a university scientist. The drug's manufacturer, Novartis,
stepped in and provided additional funding for development. In
1984, private companies contributed a mere $26 million to
university research budgets. By 2000, they were ponying up $2.3
billion, an increase of 9,000 percent that provided much needed
funds to universities at a time when the cost of doing medical
research was skyrocketing.
That's the upside. The downside is that Bayh-Dole has also
fostered increasingly cozy relationships between the academics
upon whom the nation depends for unbiased medical information
and Big Pharma, private companies whose main goal, let's face it,
is making a profit. And we're talking serious money here. In
addition to the salaries built into company-sponsored research
grants, academic clinicians at medical schools can pad their
already decent incomes with $1,000-a-day consulting contracts
with pharmaceutical companies, patent royalties, licensing fees,
and big-payoff stock options. Nemeroff stood to reap as much as $1
million in stock from a company that manufactured one of the
products in his Nature Neuroscience paper. At many of the top
research universities and medical schools around the country, a
substantial percentage of the faculty enjoys the perks of industry
relationships. At MIT, 31 percent of the science and engineering
faculty has outside income; at Stanford Medical School, it's 20
percent.
What's in it for the pharmaceutical companies? Simple economics.
It's Marketing 101. By penetrating the wall that once existed around
academic researchers, drug companies have gained access to the
"thought leaders" in medicine, the big names whose good opinion
of an idea or a product carries enormous weight with other
physicians. Companies target academic KOLs, or Key Opinion
Leaders, in the lexicon of marketing, and woo them with invitations
to sit on scientific advisory committees, or to serve as members of
speakers' bureaus, which offer hefty fees for lending their prestige
to a company and touting its products at scientific meetings and
continuing medical education conferences. Of course, KOLs must
be convinced of their own impartiality, says Carl Elliott, a moral
philosopher at the University of Minnesota and author of Better
Than Well: American Medicine Meets the American Dream. "If they
understood that they were being used as industry mouthpieces, they
would probably pull the plug on the whole enterprise." Drug
companies encourage their KOLs to consult for multiple companies
so the appearance of objectivity can be maintained. But the drug
industry's most powerful means of boosting the bottom line is
funding research, which allows companies to control, or at least
influence, a great deal of what gets published in the medical
journals, effectively turning supposedly objective science into a
marketing tool.
"These are not benign people who are interested in helping people
with their new wonder drugs," says Drummond Rennie. "The drug
companies are run by hard-nosed marketers, not by the physicians
and the scientists. They use what works, and money works."
Rennie, who has a thatch of unkempt white hair and remnants of the
accent of his native Leeds, England, got a clear picture of the extent
to which drug companies will go to control the results of studies
they fund in 1993, when a colleague at University of California San
Francisco tried to publish a paper in JAMA in 1993 on the
metabolic activity of four different forms of thyroid hormone. Betty
J. Dong, a pharmacologist, had been contracted in 1987 by Flint
Laboratories to run a clinical trial comparing Synthroid, Flint's
synthetic version of thyroid hormone, to that of three competing
formulations. At the time, Synthroid was the market leader and the
most expensive drug in its class. Dong and Flint signed a lengthy
agreement detailing the design of the study, and both sides fully
expected the results would show that Synthroid was superior.
But all four drugs turned out to be essentially equivalent. In 1990,
as Dong prepared a paper for JAMA, the company that was at first
so eager to solicit her help, launched a vigorous campaign to
discredit the study. Flint then rushed its own paper into press at a
less prestigious journal, concluding--surprise!--that Synthroid was
superior. After numerous attempts to address the company's
criticisms, Dong finally submitted her paper to JAMA, only to
withdraw it three months later when the firm threatened to sue for
breach of contract. It took the FDA and U.S. Department of Health
and Human Services to get the company to back down. Dong's
paper did not see print in JAMA until 1997.
In this case, it might seem as if the only real harm to the public
during the seven years that elapsed from the time Dong completed
her study to its publication was higher prices to patients and
insurers. To Rennie's way of thinking, the Dong imbroglio and
others like it have a more insidious effect by sending a chilling
message to scientists, namely, don't bite the hand that feeds you. In
a recent survey of clinical researchers, nearly 20 percent of
respondents admitted to delaying publication of their results by
more than six months at least once in the last three years to allow
for patent application, protect their scientific lead, or to slow the
dissemination of results that would hurt sales of their sponsor's
product--often without overt pressure from the company. "If you're
getting a lot of money from a corporate sponsor, it's easy to get the
impression that you'll get even more for future research if you don't
write up the negative results," says Rennie--and that your funds will
dry up if you do.
The bottom line is that articles appearing in medical journals
contain a lot of happy talk about medical products. At least eight
studies have shown that industry-sponsored research that gets
published tends to produce pro-industry conclusions, according to a
review by Yale University researchers that appeared last year in
JAMA. By reanalyzing data from eight separate studies of the effect
of conflict of interest on 1,140 published scientific papers, the
researchers found that papers based on industry-sponsored research
are significantly more likely to reflect favorably on a sponsoring
company's drug or device than research that is supported by a
non-profit entity or the federal government.
How can this be? Isn't science, well, scientific, an objective search
for the truth? That's what many academic clinicians, especially
those who are mixed up with corporate sponsors, would have the
public believe. A typical comment comes from Niels Reimers, an
early promoter of industry-university ties, who told the Hartford
Courant, "You may think I'm a Pollyanna or something, but most
people are honest. It's sort of the ethos of academic research."
Here's Dr. Irwin Goldstein, a Boston University urologist who has
consulted for at least seven companies developing impotence
therapies: "Science is science. It comes down to the bottom line.
What the data shows, the data shows."
Such statements reflect the ideal of science, not the reality, says Dr.
Marcia Angell, former editor in chief of The New England Journal
of Medicine. Public protestations aside, she says, "Clinicians know
privately that results can be jiggered. You can design studies to
come out the way you want them to. You can control what data you
look at, control the analysis, and then shade your interpretation of
the results." Even the most careful research can be fraught with
murky results that require sifting and weighing, a measure of
judgment that the researcher hopes will bring him closer to the
truth. Was this patient's headache caused by the antibiotic you gave
her, or does she have a history of migraines? Is that patient's
depression lifting because of the drug you are testing, or because a
kindly doctor is actually listening to him?
Sometimes there isn't much that journal editors can do to separate
good science from that which has been weighed, sifted, and
jiggered according to a corporate sponsor's needs. Increasing
numbers of studies that get published are actually written by PR
firms, "medical communications" specialists, who then go out and
recruit an academic willing to put his name on the paper, for a fee.
Other studies simply omit data that detract from the sponsor's
message. In September 2000, for example, JAMA published a paper
comparing the prescription painkiller Celebrex to over-the-counter
ibuprofen. The manufacturer of the prescription drug, known as a
selective Cox-2 inhibitor, launched the study in order to show that
Cox-2 inhibitors, a class that also includes the prescription drug
Vioxx and was already worth $3.5 billion a year, cause fewer
instances of bleeding in the stomach and intestine than either aspirin
or ibuprofen. The huge study, which looked at six months of data
from more than 8,000 patients, produced unambiguous results:
There were fewer side effects among patients on the Cox-2 drug.
A year later, news surfaced that patients had actually been
followed for 12-15 months at the time the JAMA paper came out,
not six, and that during the second half of the study, the group taking
the Cox-2 drug suffered higher rates of gastrointestinal side-effects
than patients on the over-the-counter painkiller. To make matters
worse, patients on the Cox-2 developed serious heart problems
three times more often than those on ibuprofen. The authors of the
paper--all of them either consultants to the manufacturer or
employees"defended their decision to report only the first, positive,
half of their study, saying several patients who weren't taking the
Cox-2 drugs dropped out after six months, making the statistics
more difficult to analyze. But Dr. Catherine D. DeAngelis, JAMA's
editor in chief, told The Washington Post: "I am disheartened. We
are functioning on a level of trust that was, perhaps, broken."
Disheartened? Not furious? No, because DeAngelis could not know
for certain whether or not the authors held back half the data in
order to make their sponsor's drug look better"no matter how likely
that explanation may seem. When researchers submit papers to a
journal, the editor has little choice but to trust the authors have
employed a ruthless skepticism when viewing their own results,
that they have bent over backwards to minimize self-delusion.
Editors and peer reviewers can ferret out sloppy reasoning, look at
how an author has designed and executed a study, and correct faulty
statistics, but as Angell remarked, "We don't put bamboo slivers
under their nails. If they wanted to lie, they could lie."
Articles of faith
Dr. Arnold Relman began worrying about this problem way back in
1977, when he became editor-in-chief of The New England
Journal. That year, Relman got a call from a reporter about a paper
that was due to appear in the next issue, discussing serious side
effects--including lowering a man's testosterone and sperm
counts--of a popular antacid. The reporter wanted to know what
Relman intended to do about the fact that Wall Street analysts had
acquired early copies of the paper and now the stock of the
company that made the drug was falling.
Relman, who began practicing medicine in the 1950s and calls
himself a "relic," says before that reporter's call, it had never
occurred to him that medical research could have financial
consequences for industry. But the more he thought about it, he told
me recently, "The more I became convinced that the
commercialization of medical practice and medical research, and
the use of the information for commercial purposes, was a major
threat to the integrity of the whole system." He recognized that
medical researchers, being only human, would have trouble
applying that ruthless skepticism that was so necessary to good
science when there was money at stake.
The obvious solution to Relman and Angell, who was by then a
deputy editor at The New England Journal of Medicine, was
disclosure. Forcing authors to tell the world they were taking
industry money, the editors reasoned, would prompt a little
soul-searching among researchers who might otherwise be inclined
to turn a blind eye to negative results or shade conclusions in favor
of a corporate sponsor. It would put them on notice that readers
would be watching. The editors also figured that disclosure would
help readers judge the validity of an author's conclusions. "They
could evaluate the data for themselves," Relman told me recently.
"But the discussion, the interpretation by the author can be slanted .
. . it was still important for readers to know when articles were
sponsored by industry." JAMA, largely at Rennie's urging, followed
suit soon after.
Six years later, Relman upped the ante by barring researchers with
conflicts of interest from writing editorials or review articles--like
the one penned in Nature Neuroscience by Charles
Nemeroff"because they carry great weight with doctors in private
practice. Angell explains their decision like this: "Imagine a judge
who has before him a case involving two companies suing each
other--and he owns one of the companies. And he says, 'Not to
worry. I'm a judge and I learned how to evaluate things in a
dispassionate way.' He'd be laughed out of court." She and Relman
argued that just as judges must recuse themselves from cases in
which they have financial ties to a litigant, editorialists and review
authors with conflicts of interest should refrain from offering
medical opinions.
Angell was still defending that decision a decade later, as editor in
chief at the Journal, when she wrote in 2000 that disclosure was
not sufficient to preserve the integrity of the science that appeared
in her journal's pages: "We believe that a policy of caveat emptor
is not enough for readers who depend on the opinion of
editorialists." Why was it necessary to defend the Journal's
policies? Partly because authors were ignoring them. In 1997, when
Sheldon Krimsky, a professor of public policy at Tufts University,
surveyed 61,134 articles in some 181 journals, he found that only
0.5 percent disclosed a conflict of interest related to the topic of the
article, an impossibly low number given the fact that a quarter of
biomedical researchers at the time were receiving funding from
industry. The reason for this low rate of disclosure, as Krimsky
notes dryly in his book, Science in the Private Interest, is that "author
compliance is not especially high."
"Lots of eminent people took great offense at being accused of
being influenced," Relman told me recently. "'What an insulting
thing to say. I value my reputation; doctors and scientists know
best. Trust us.' I spent the first 25 years of my career doing clinical
research and being one of them, and I know the feeling." As Harvey
Lodish, professor of biology at MIT, huffed to Technology Review
in 1984, when Relman first required disclosure at the Journal,
"Scientists have all kinds of private consulting arrangements with
biotechnology companies and many own stock in these companies,
but that's nobody's business. It has nothing to do with the quality of
their research."
"They actually believe that they aren't influenced," says Angell.
Aside from the fact that it's not in physicians' self-interest to
acknowledge the effects of corporate money, they may have a hard
time seeing the problem for the same reason fish don't know they're
swimming in water: Doctors are surrounded by conflicts of interest
almost from the moment they arrive at medical school.
Pharmaceutical companies begin wooing young doctors with small
tokens at first, pens and coffee mugs emblazoned with drug logos,
then escalating to pizza night for medical residents, dinners at
expensive restaurants and tickets to sporting events. Most schools
offer a class in medical ethics, but there's no requirement that they
discuss conflict of interest. Besides, a few lectures can't outweigh
the message young doctors absorb every day, as they watch the
icons in their profession--their professors, visiting lecturers, heads
of departments--taking gifts, speaking on behalf of companies,
flying first-class to medical meetings in Paris and Honolulu. By the
time medical residents enter private practice or the lab, the gifts
from industry no longer seem like gifts, but entitlements"just
another way to be compensated for all those brutal, slogging years
of lousy pay and long nights.
A journalist friend of mine recently told me about the day his
then-girlfriend, who was a neurosurgeon, received a check for
several hundred dollars in the mail, along with a note from a drug
company representative. It seemed his girlfriend had made
favorable mention of a particular drug during a lecture she
delivered a few days earlier, and the money was just a little thank
you from the manufacturer. When my friend told her she could not
in good conscience cash the check--that it was a conflict of
interest--she looked at him, he said, as if he were speaking in some
unintelligible language.
This deafness to the power of money to corrupt medical science
leads physicians and scientists to display an arrogance and a
remarkable naïvete, both of which were very much in evidence in a
snippy editorial entitled, "Avoid Financial 'Correctness,'" written
in 1997 by the editors at Nature. They derided disclosure as a
waste of time, writing, "This journal will persist in its stubborn
belief that the research as we publish it is indeed research, not
business." The Nemeroff case has not changed the editors' view
substantially, although they did alter their policy after it broke.
Nature Publishing now requires editorial and review writers, along
with the authors of original research papers, to inform readers
whether or not they have conflicts of interest, or to say they decline
to declare. Charles Jennings, executive editor of Nature, says they
have no intention of following the New England Journal in barring
editorialists who have conflicts. "I flatly disagree with that policy,"
he told me. "That would exclude many of the leading experts. You
don't want a policy that prevents Thomas Edison from writing about
the future of electricity. Our position is for readers to decide for
themselves about whether an author is biased."
Of course, most readers, especially practicing physicians, don't
have the expertise or the resources to decide for themselves--to
know how the studies might have been constructed differently,
whether the conclusions have been shaded to favor the author's
sponsor, or which data the author decided conveniently to leave out
of the article. Knowing that an author might be biased doesn't aid in
determining the extent and nature of the bias. It's not as though there
will be two articles, one by a biased writer and one by an unbiased
writer, published side by side to allow readers to identify the
differences. Besides, conflicts of interest are now so pervasive,
says Rennie, many readers scarcely take note, even when they're
disclosed.
Race for the cure?
It's tempting to wonder what medical research would look like if
universities and medical associations and editors of journals
stopped talking about how to manage conflict of interest and started
thinking about how to expunge it. Just say no. Proponents of
Bayh-Dole will object, claiming the pace of medical advances will
slow to a crawl, but bear with me for a moment and just imagine a
different universe. Let's start with the medical schools"those
temples of higher learning. They would be the first to cast out the
drug merchants. Hospitals would pay their medical residents a
decent wage so they can afford to buy their own beer and pizza.
FDA advisory panelists who have a financial stake in the drug
being considered would not be allowed to vote. And if the journals
stopped publishing papers and editorials penned by academic
clinicians with conflicts of interest, authors would be forced to
choose between taking scientific credit and taking the money.
Of course, that's not going to happen unless academic clinicians
somehow decide there's something wrong with the status quo. In
Sheldon Krimsky's view, the only way to deter conflict of interest
is for academics to feel shame. Maybe so, but as a journalist who
has spent a decade and a half peering at medicine from the outside,
nose pressed to the glass, I'm struck more than anything by the
apparent lack of shame among clinicians when it comes to this
issue.
Here's a little thought experiment. Imagine that a medical
journalist"me, for instance"makes a tidy sum writing press releases
for, say Pfizer, the manufacturer of Viagra. I don't make a fortune,
maybe just enough to cover a year's tuition for my son's private high
school. And let's say for the sake of argument I also buy a few
dozen Pfizer shares. Then I turn around and write a story for The
New York Times about several new drugs for treating erectile
dysfunction.
What would you think, dear reader, should my financial
relationship with the pharmaceutical company that makes one of the
drugs featured in my story come to light? Would you have reason to
doubt its objectivity and accuracy? Of course you would. Not only
that, I would be ashamed to show my face in any newsroom, and I
would not be writing for the Times again. I'm not trying to claim that
journalists are paragons of virtue, but we have no illusions about
our ability to withstand temptation and avoid shading what we say
when faced with a wad of cash.
Not so in medical research. In that world, the author of a review
article can have direct financial relationships with the
manufacturers of drugs he is critiquing and still argue he has done
nothing unsavory. What that suggests is a sense of fiduciary
responsibility is not built into the professional code of medicine, a
doctor's internal compass of right and wrong.
And of course there are also pecuniary reasons not to acknowledge
the power of money. The fact is, universities and doctors have
become so dependent on industry largesse they can't even imagine
disentangling themselves. Repeal the Bayh-Dole Act? Not on your
life. Kick the drug representatives who wheel their little carts filled
with sample packets of drugs out of your office? Who would pay
for all those trips to medical meetings in exotic locales?
Company line
And so they try to manage it. About half of universities require that
faculty disclose their conflicts of interest. A scant 19 percent set
limits on the outside financial interests faculty may hold. Harvard
University, long considered a paragon of scientific virtue, is now
considering relaxing its rules governing industry collaborations.
Now that Angell is gone, even the once-starchy New England
Journal has loosened its restrictions on editorialists and review
writers, who are now free to enjoy some corporate largesse, just
not too much. "They think it's possible to be virtuous and rich at the
same time, to take money from companies and then manage it," says
Angell. "They come up with rules that are so complicated in order
to give the appearance of worrying about this, when what they are
really worried about is the money might go away."
All their managing doesn't seem to be working, and we are the ones
who will suffer the consequences. In March 2000, the FDA yanked
a diabetes drug called Rezulin off the market after it had been
linked to at least 90 cases of liver failure and 63 deaths. The
withdrawal came three years after the agency had approved the
drug to great fanfare. Articles in the popular media quoted diabetes
experts who praised Rezulin, calling it "a truly novel approach,"
and the manufacturer, Warner-Lambert, enjoyed a spectacular 144
percent rise in its stock price.
By the fall of 1997, however, the FDA had already begun to
receive reports of patients on Rezulin suffering liver failure, a
side-effect that the agency's advisory panel glossed over during its
deliberations. A paper published in the New England Journal also
made scant reference to liver toxicity, saying the drug was "well
tolerated, and most adverse events were considered to be related to
the underlying diabetes." Several clinicians with ties to the
company subsequently urged the FDA not to withdraw the drug,
even as the body count was rising. According to a Los Angeles
Times investigation, at least 12 of 22 scientists who played a
central role in the federally-funded study of Rezulin received
research funding or other compensation from Warner Lambert,
while four of the 12 voting members of the FDA advisory panel that
approved Rezulin, and kept it on the market an extra 30 months, had
financial ties to the company.
When industry has penetrated every level of medicine from the lab
bench to the FDA advisory panels, from the pages of the medical
journals to your doctor's prescription pad, how are physicians to
make decisions about treating their patients? How are they to know
whether or not expensive calcium channel blockers are really better
than over-the-counter diuretics for high blood pressure? (They're
not.) Should you take a mildly depressed teenager to a
psychotherapist, or put him on an antidepressant and risk sending
him into a suicidal tailspin? Maybe a cholesterol-lowering statin
drug will prevent this patient from suffering a heart attack, as the
studies claim. Then again, maybe it will simply cause her muscles
to break down and destroy her kidneys, one of the drug's side
effects.
And what about us patients? What are we to do with the knowledge
that much of what passes as science in medicine is little more than
gussied-up marketing? There isn't much we can do. And so, I say if
you're ill, if you are ailing, or just sick at heart, go find a doctor
who listens, who holds your hand. Just make sure you find a doctor
who looks at evidence, not opinion, and when she pulls out the
prescription pad, start asking a lot of questions.
Shannon Brownlee is a fellow at the New America Foundation.
source:
Washington Monthly, April
2004
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