What's your price?

i attended several cme meetings sponsored by drug companies in the
last couple of months:

1. jnc 7 report: sponsored by chlorthalidone makers
message: chlorthalidone best diuretic. should be stated as initial drug to
all patients. forget other drugs which are trivialities.

2.simvastatin vs atorvastatin: sponsored by simvastain makers.
message: simvastain a miracle drug, quoted 4S extensively,atorvastatin an
upstart, probably bogus drug not fully studied, does not reduce mortality.

3:management of unstable angina: sponsored by makers of lmwh.
message: all patients need to be on lmwh. alot of emphasis on EARLY
invasive intervention as speaker was an interventionalist.

4.recent advances in coronary artery disease: sponsored by ? yes you are
right, makers of des.
message: coronary restenosis can only be met head on with drug eluting
stents(des). speaker an interventinalist did not elaborate on
massive/collosal advances in field of imaging, drugs and surgery in
management of cad.

in return there were sumptious dinners ,sweets and unlimited booze,
sufficient to enebriate a whole city!

Competing interests:  
None declared

Last night on Channel Five 'Law and Order' was about a murder
committed by a psychotic patient on an experimental drug, with more and
more irregularities coming to light as the story unfolds. The
overconfident researcher is shown to succomb to 'sponser pleasing' and the
inability to admit to mistakes to protect his good standing. His errors
include breaking protocol, changing findings and reports, cutting corners,
using excluded patients in his study, deceiving drug company
representatives, patient and parents. The conclusion made is that because
he did not do a PET scan on every patient he included in his study and
only requested it later, and then failed to reveal the result early
enough, he (the researcher) was guilty of the deaths of the victim and the
now inoperable patient.

Sometimes we are oblivious to the negative input patients get from
the media. I can only imagine what impression this must leave with
patients who might be recruited into studies in the near future. Its also
great for creating even more unrealistic expectations. Imagine every
patient you recruit for a study demand a PET scan first! It surely was a
bad PR night for research and medicine in general. I salute the BMJ for
talking openly about possible bias in research and giving a more balanced
view. By bringing such discussions into the open those doing an honest job
have a place to express and defend themselves, and patients have access to
balanced discussion. Hopefully they can take comfort in the fact that we
are seen to take a stand together against biased research.

Competing interests:  
None declared

We regularly accept money from private and public sector clients to
carry out a range of evaluation studies. For the pharmaceutical industry,
these are typically then submitted to scrutiny by NICE.

There are other
ways in which this could be done, e.g. with NICE commissioning an outline
model to which companies could submit data but the present system provides
for review and checking. Many of our studies are published in peer
reviewed journals. Of course there is a risk that we will be pressurised
into putting the best spin on things. We have two defences.

We point out
that our reputation depends on not being biased (though we are accused of
it from time to time) and in that lies our value to our clients.

Secondly, we point out that if we distort the position, this will only
serve to make the actual position look even worse when it comes out, as it
inevitably must. We would be more than happy to publish papers in the BMJ
with the kind of review that you have recently published on a range of
different articles, so that your readers could judge for themselves.

More
seriously, you appear to assume that only private companies exert pressure
to get the results they want. Where have you been while the spin machine
in politics has been demonstrating its latest gyrations? In my career in
consulting in health economics, I have come under more pressure to
generate good results from public bodies than private, though this may
just be a chance occurrence. If economic or other evaluations are to be
of value to their sponsors, they must make the case. If they are to be of
value to society, they must make the case honestly and transparently.

Transparency and peer review are the best defences against the agendas of
others.

Competing interests:  
YHEC Ltd is a contract research and consulting company owned by the University of York. Our clients include pharmaceutical companies, the NHS, the Department of Health and overseas agencies and governments.