Over the past few years, the doctor, journalist and evidence freak Ben Goldacre has been crusading to tackle drug company distortion of medical evidence, the extent of which, according to Ben’s writing, has been truly staggering.
Multiple studies have shown that if you look at published drug trials, those that were funded by a drug company will have positive findings a lot more often than those that are government-funded.
It might be tempting to look for some subtle manipulation of the data to explain this, but there is a much simpler explanation for most of it, which is that drug companies have just shoved results they don’t like in a drawer.
Not only have half of the trials that have been conducted never been published, but positive trials are twice as likely to have been published as negative ones.
The amazing thing is that this has been allowed to go on to such an extent. While there are token rules on publishing trial data, they are not enforced, and flaunting them is endemic.
Goldacre thus started a campaign in 2013 called ‘All Trials’ which calls for all past and present clinical trials to be registered and their results reported. It has been having some success, although its recent research shows there is still a long way to go: in 2018 it found that 46% of EU trials have not reported results according to the EU’s rules.
Companies have not responded equally to these demands for transparency.
GlaxoSmithKline quickly agreed to share clinical study reports for all trials back to 2000 and set up a unit within the company to process them.
AbbVie and InterMune instead sued the European Medicines Agency to try to prevent equivalent documents being released. ‘All Trials’ therefore does a ‘transparency index’ of all pharmaceutical companies, rating them on their commitment to trials transparency.
Those companies that are on the table have the following rankings:
Trials transparency rating
||Johnson & Johnson
||ViiV healthcare (GlaxoSmithKline)
Warping the medical literature is not the only place that Goldacre describes pharmaceutical companies introducing huge biases into a system that really needs to be cold, clinical and objective. Over half of the industry’s – huge – marketing budget goes on ‘drug reps’.
There is now one drug rep for about every three to six doctors. In theory, drug reps just inform doctors about medicines. But of course, it helps things along if they are nice and charming, and give doctors little gifts, and keep notes on their personal lives so as to be able to bond with them better.
Rather ridiculously, the doctors who engage with this mostly deny that it influences them while agreeing that it probably does influence other doctors. It has been shown that doctors who spend more time with reps are less likely to prescribe rationally, instead being more likely to prescribe the products from the reps’ companies.
Drug companies also pay for tutorials, teaching and conferences, staffed with experts who like their drugs. And obviously, they don’t do this out of the kindness of their hearts.
One leaked calculation, done by Merck, of its ‘return on investment’ from running discussion groups for doctors, was that a dollar spent on teaching brought in two dollars in revenue from an increased prescription of its drugs.
None of this is inevitable. In Norway, the industry is banned from funding any continuing medical education for doctors. In the UK, they are allowed to fund all of it.
As Ben Goldacre says in his book:
“The Department of Health spends a few million pounds a year providing independent medicines information to doctors. The industry spends tens of billions on providing biased information.
This presents a bizarre situation: doctors’ continuing education is paid for, almost exclusively, by the industry whose products they buy with public money, and by the industry that has been shown routinely to mislead them.”
This is a symptom of the culture that has led academics to be repeatedly encouraged by neoliberal UK governments to engage more with industry, with little
concern for the conflicts of interest generated. Obviously, all of this has effects on health. But it also has effects on money.
A 2010 study calculated that at least £1 billion is wasted every year from doctors using branded drugs when there is an identical generic drug available.6
Patient support groups
Another area where pharmaceutical companies exert covert influence is through patient support groups, who often receive substantial funding from them – hundreds of thousands of pounds per group – without properly declaring it.
From 2012 to 2016, the drug industry donated over £57 million to UK patient organisations.
The amount is rising fast, and the annual amount more than doubled over the period. Pfizer was the biggest donator and, in 2016, it gave over £5 million to Cancer Research UK and Breast Cancer Now. Pfizer has just launched a very expensive new breast cancer drug called Palbociclib.
This is important in the UK, as representatives of patient groups often sit on NICE advisory panels which feed into the decisions about which drugs the NHS should use.
There is plenty of evidence that the money has an effect. One study looked at patient groups lobbying the European Commission. Those that were funded by pharmaceutical companies were substantially more likely to support “an expanded role of the pharmaceutical industry as an information provider” on drugs.
For more information see All Trials or Ben Goldacre’s book, Bad Pharma.