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Might Western medicine be a confidence trick driven by the drug industry, wonders Minerva (p 288). She is quoting Phil Hammonddoctor, broadcaster, stand up comedian, satirist, and trainee guru. Any who are offended by the impertinence of the question might do well to reflect on the value of satirists. Long after 99.9% of 18th century Dublin physicians have been forgotten, the writings of their theological colleague Jonathan Swift are known across the world. “Satire,” wrote Swift, “is a sort of glass, wherein beholders do generally discover everybody’s face but their own.”
Those interested by Hammond’s question can reflect on relevant evidence in this week’s journal. Silvio Garattini and Vittorio Bertele’ review 12 anticancer drugs approved in the past six years by the European
Medicines Evaluation Agency (p 269). They conclude that the benefits offered by the drugs are trivial but the costs enormous. Some are 350 times more costly than existing drugs.
Ray Moynihan describes “the blaze of publicity” sparked in the United States by football star Ricky Williams revealing that he has social anxiety disorder but has benefited from the drug Paxil (paroxetine) (p 286).
Not all the media reports disclosed that Williams was being paid by GlaxoSmithKline, which last year earned US$2.7bn from sales of paroxetine. “Celebrity selling” is the rage. Unfortunately “shy people” or those with a “public speaking problem” may be encouraged to think of themselves as “diseased” and to take drugs of limited effectiveness with established side effects.
But the influence of the pharmaceutical industry extends beyond the American mass media into the science published in the BMJ. Lise Kjaergard and Bodil Als-Nielson have taken advantage of the fact that for some years the BMJ has required the authors of studies to give their source of funding and disclose competing interests (p 249). They find that those authors who have financial competing interests are more likely than those who do not to favour experimental interventions in randomised controlled trials. This was true of both pharmacological and non-pharmacological trials. Could this finding be true only for the BMJ? The authors can’t see why and point out that the other major general journals publish a far higher proportion of trials funded by the pharmaceutical industry than the BMJ.
Competing interests were a major debating point in the court case that concluded this week in which more than 100 women sued the manufacturers of third generation contraceptive pills because they failed to warn of the increased risk of thromboembolic disease (p 237). The judge ruled that there was no increased risk, which conflicts with the conclusion of a systematic review published in the BMJ.
It seems unlikely that this judgment will end the controversy, and we hope to publish an editorial next week.
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