Respectful Insolence

The Big Pharma conspiracy is not doing its job

If you listen to what advocates of homeopathy, acupuncture, or whatever form of so-called “alternative” medicine you can think of (in reality, non-evidence-based medicine for the most part), you’d think that physicians are in the pockets of Big Pharma, hopeless slaves to its propaganda, addicted to its tchotchkes and swag. Sadly for Big Pharma, they may not be having quite the effect it had hoped, if this roundtable discussion of primary care doctors about a study on NSAIDS and pain is any indication:

Should we believe this study?

Bob: When I decide to read an article, I first look at the title. Then I go to the last page to see if the study was sponsored by one of the makers of the product being studied. If so, my degree of skepticism heightens exponentially. This particular study happens to be sponsored by McNeil Pharmaceutical (the maker of extended-release acetaminophen).

Andrea: Same here. When pharmaceutical companies are involved in a study, there is a fourfold greater chance that the study will have a positive outcome than if the study was not funded by the industry.1 Somehow, the conclusions almost always come out in favor of the sponsor’s product.

Mark: My favorite example is when a review of 56 industry-sponsored trials of NSAIDs for osteoarthritis was performed, all 56 trials found NSAIDs to be beneficial. Not one trial had an unfavorable outcome.

Oh, no! Bob, Andrea, and Mark clearly haven’t gotten the memo. Of course, ultimately they agreed with the outcome of the study, even though it was sponsored by a pharmaceutical company, but they only did so because the study was well-designed and its results were in line with other studies. However, they concluded that for ankle sprains, good old-fashioned acetaminophen is just as good as the more expensive NSAIDS for analgesia.

Clearly more drug company dinners, pens, and freebies are required.

Comments

  1. #1 KC
    December 18, 2007

    And Mugs. You know, the sort they give you, and you hang on to for years, and then one day while you’re drinking, you wonder what the heck Aerotech Scientific Staffing was trying to sell you to begin with.

    They’re so crafty, I be there’s mind control drugs in the ceramics to keep people in on their conspiracy.

  2. #2 Dave Briggs
    December 18, 2007

    They’re so crafty, I bet there’s mind control drugs in the ceramics to keep people in on their conspiracy.

    Posted by: KC | December 18, 2007 5:06 PM

    Yep,
    Plus the new micro chip that resonates at the same frequency as the agreement center of the brain! LOL!
    Dave Briggs :~)

  3. #3 Magister Ludi
    December 18, 2007

    Adding fuel to the fire, I’ll bet you’ll find this worthy of comment: http://www.alternet.org/module/printversion/68065

  4. #4 Orac
    December 18, 2007

    You haven’t been reading every day, have you? I just took that one on last week.

  5. #5 PalMD
    December 18, 2007

    Well, my reps all ran out of money for the year. No lunches, no mugs, bubkes! I guess no more Lexapro, Celebrex, or Micardis for my patients!

  6. #6 MarkH
    December 18, 2007

    I don’t think this is a great argument Orac.

    On the one hand, yes, this is inconsistent with the idea that small gifts have a significant impact on how physicians approach the medical literature. However, some problems:

    1. Many doctors do not go straight to the literature and rely on reps for information.
    2. The effect of the gifts is subtle, and an overt test like this does not show much. It’s just like any advertisement. We know it works, but its very difficult to identify the exact moment that someone is molded by the message. If we want things to be based on evidence we should kill all forms of cheesy marketing in favor of legit info.

    Yes the cranks are totally over the top, but don’t make the mistake of appearing to be in favor of drug marketing, which almost by definition exists to encourage irrational prescribing decisions both through the consumer and provider.

  7. #7 Orac
    December 18, 2007

    Lighten up, dude. It’s nothing more than a little humor and sarcasm.

  8. #8 HCN
    December 18, 2007

    Are you saying that Mark is in humor denial?

    (sorry, I could not resist)

  9. #9 Shay
    December 18, 2007

    I learned a new word for alternative medicine today; “inclusive.”

    Isn’t that nicely, unobtrusively, ambiguous?

  10. #10 Schwartz
    December 19, 2007

    OMG, it sounds like anecdote… :)

  11. #11 petri
    December 19, 2007

    I guess my biggest qualm with their argument for some academic conspiracy is that it implies any researcher with a pharm grant is ethically ambiguous and willing to sell their reputation. This seems unlikely. Perhaps they should consider whether pharmaceutical companies tend to sponsor projects that have a high chance of coming out in their favor?

  12. #12 Dr. S.E.B.
    December 19, 2007

    Orac, are you now using anecdotal ‘evidence’ to support your claims? Hmmmm

  13. #13 Orac
    December 19, 2007

    See my response to Mark Hoofnagle (MarkH). It applies to you as well. Schwartz understood my intent well enough.

  14. #14 N.B.
    December 19, 2007

    Nice take on an issue I’ve approached before regarding NSAIDs and APAP–it’s good to get the “socio-political” angle and see that there are plenty of MDs out there using their heads.

  15. #15 DLC
    December 19, 2007

    I keep trying to get a job as a shill for Big Pharma, but I guess they already have enough. Perhaps if I had my own science blog. . .

  16. #16 Skeptic's skeptic
    December 21, 2007

    Well, the bottom line here is that the doctors DID end up agreeing with the results of the study, and whether it’s because it was a well-designed study or because they had all become mind-control slaves of big-pharma schwag, we’ll never know.

    The more troubling point is not whether or not doctors are able to critically examine the available evidence, but what is available as evidence. If all 56 industry-sponsored studies on NSAIDs favor the industry NSAIDs, and there are no studies funded by the generic aspirin makers that say the opposite, then even a reasonably nonbiased doctor will have no choice but to favor the industry NSAIDs given the evidence available. We see this particularly in marijuana research, where hundreds of millions of dollars are available to anyone who proposes to demonstrate that marijuana is bad in some way, whereas those who would like to demonstrate therapeutic benefit have to go cap-in-hand to private donors. The same can be said for psychotherapy, which evidence suggests is equally efficacious as antidepressants, but for which clinical trials are few and far between, leaving little to guide the treating clinician.

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