In June, the New England Journal of Medicine, one of the most respected medical journals, made a startling announcement. The editors declared that they were dropping their policy stipulating that authors of review articles of medical studies could not have financial ties to drug companies whose medicines were being analyzed.
The reason? The journal could no longer find enough independent experts. Drug company gifts and "consulting fees" are so pervasive that in any given field, you cannot find an expert who has not been paid off in some way by the industry. So the journal settled for a new standard: Their reviewers can have received no more than $10,000 from companies whose work they judge. Isn't that comforting?
This announcement by the New England Journal of Medicine is just the tip of the iceberg of a scientific establishment that has been pervasively corrupted by conflicts of interest and bias, throwing doubt on almost all scientific claims made in the biomedical field.
The standard announced in June was only for the reviewers. The actual authors of scientific studies in medical journals are often bought and paid for by private drug companies with a stake in the scientific results. While the NEJM and some other journals disclose these conflicts, others do not. Unknown to many readers is the fact that the data being discussed was often collected and analyzed by the maker of the drug involved in the test. An independent 1996 study found that 98 percent of scientific papers based on research sponsored by corporations promoted the effectiveness of a company's drug. By comparison, 79 percent of independent studies found that a new drug was effective. This corruption reaches from the doctors prescribing a drug to government review boards to university research centers.
There have long been worries about the advertising and promotional gifts given to doctors to influence which drugs they prescribe. But it turns out that even deeper financial ties extend to the medical experts setting nationwide professional guidelines for treating conditions ranging from heart disease to diabetes. Surveys have found that nine out of ten experts writing such guidelines have financial ties to the pharmaceutical industry, yet those ties are almost never disclosed in the treatment guidelines, which are often published in medical journals and endorsed by medical societies.
The Food and Drug Administration, for reasons similar to those of the medical journals, routinely allows researchers with ties to the industry to sit on drug approval advisory committees. In many cases, half the panelists on such committees have a financial stake in the outcome, through links to the drug manufacturer or to a competitor.
Increasingly, the industry has converted academic research centers into subsidiaries of the companies. The billions of dollars of academic government funding essentially pays to flush out negative results, while private industry gets to profit from any successful result. Industry now provides 7 percent of university research funding, but they are manipulating the system to gain a far more substantial benefit. At the University of California at Berkeley, Novartis agreed to pay $25 million to the campus in exchange for the first right to patent a range of basic plant research produced by the university.
Where once university research was oriented to producing independent knowledge that any other researcher could access and improve upon, university research is increasingly being locked up in patents. What's more, scientists at universities are often allowed to have stock options in companies benefiting from the research they are conducting. As Dr. Marcia Angell, a former 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 in a physician."
And the results are expensive and sometimes tragic for the public. Experimental clinical drug trials are hazardous to participants and, more broadly, critical to those with life threatening conditions who need to know which treatments are fruitless to pursue. Yet researchers on industry payrolls end up pressured to suppress negative results.
At the most basic level, researchers who defy their corporate sponsors know they may lose their funding. When one Toronto scientist revealed in 1998 a serious side effect of deferiprone, a drug for a blood disorder, her contract was terminated. More dramatically, when a number of researchers concluded that Remune, an anti-AIDS therapy, was of little benefit to patients, the company funding their research, the Immune Response Corporation, sued the scientists in 2001 for $10 million for damaging its business.
And these are the examples of scientists who spoke out. Many others just go along with the demands of their corporate sponsors and suppress negative evidence. In the early 1990s, a pharmacologist at the University of California at San Francisco, Betty Dong, found that a generic thyroid hormone worked as well as Synthroid, the brand-name drug made by the funder of the research. According to the Washington Post, the company, Knoll Pharmaceuticals, successfully blocked publication of the findings for seven years. Only in 1997 was this fraud discovered, and in 1999 Knoll had to pay 37 states $42 million to settle a suit for consumer fraud in promoting the superiority of its drug.
This pattern of suppression means that medical knowledge is being stunted and delayed, as other researchers aren't informed of dead ends that might have helped steer their own research. And by locking up knowledge produced at academic centers in patents, what should be free knowledge for the public (free in both the intellectual and economic sense) instead feeds the profit margins of the pharmaceutical industry.
Universities once opposed patents for any academic research. Yale University's 1948 policy on patents stated, "It is, in general, undesirable and contrary to the best interests of medicine and the public to patent any discovery or invention applicable in the fields of public health or medicine." That policy was later abandoned and Yale now holds a key anti-AIDS drug patent jointly with Bristol Myers. Facing massive global protest, Yale last year agreed to relax its patent rules, but the fact that universities routinely now balance who will live and die against their own profit motive is a degradation of their public purpose.
This corruption of academic science is pervasive and the costs are extremely clear, but what is remarkable is how easy it would be to end. Federal and state governments still supply the overwhelming percentage of university research funding. If all such funding was conditioned on ending non-disclosure agreements and on barring the licensing of government-funded results to private industry, the public would benefit both scientifically and financially. We've paid for the knowledge once. We shouldn't have to do so again in increased costs of medicine and increased deaths due to suppressed knowledge.