Funding from the medical industries threatens the integrity of research.

Fortune 500 drug companies took 9 percent of their income as profits in 1970 and 18 percent in 2002. To ensure profits, the pharmaceutical industry has taken over many responsibilities for medical research once held by universities. That process threatens scientific integrity.

John Abramson, a family doctor writing in the Nieman Reports (Summer 2003), shows journalists how a scientific report in the New England Journal of Medicine of November 2002 takes on the characteristics of a sales pitch. He introduces us to the world of commercialized scientific research.

The authors of the journal article suggest that a test for inflammation, the C-reactive protein (CRP) test, can be used to identify people with potential heart disease. They found that women with the highest CRP levels are predisposed to heart disease.

According to Abramson, the media reported the study as a scientific breakthrough. U.S. physicians were going to find people with silent heart disease and treat them preventatively with cholesterol-lowering drugs, often referred to as statins.

Abramson believes that those reporting on the journal article should have clarified the distinction between absolute risk and relative risk. Had they referred to the absolute risk, their readers would have learned that the 20 percent of the women at highest risk suffered only 2.3 episodes of cardiovascular disease per 1,000 women, per year, compared to one episode per 1,000 among the 20 percent at lowest risk. Ignoring the absolute risk in favor of the relative risk, the article’s authors themselves pumped up their findings with the expression “2.3 times more likely.”

He asks reporters to search out undisclosed conflicts of interest. He notes that the lead author of the article holds patents on the use of inflammation tests for predicting heart problems. Two of the authors in the NEJM article turn out to have conducted research funded by a manufacturer of a statin drug. And four days after publication, the AstraZeneca Co. announced a research project to demonstrate that statin drugs might protect people with high CRP levels from heart disease. The director of the new study would be the lead author of the NEJM article.

Abramson is hinting at the potential for harmful, secretive collusion between money interests and medical research. The Bayh-Dole Law of 1980 set the stage for medical centers to farm out research to corporations by allowing university recipients of federal grants to secure patents for their discoveries and to market them.

Industry now pays for 70 percent of present-day clinical research. Its support for university research doubled between 1980 and 2001. Financially strapped university hospitals have received large grants from companies for which the companies gain exclusive access to scientific discoveries. Drug manufacturers have recently set up “contract research organizations” to carry out clinical trials, and most pharmaceutical research is now performed by company employees, among them university scientists.

Medical and scientific leaders, along with activists in the campaign for universal health care, have issued warnings. Research findings that do not serve company purposes are going unpublished, and the scientific community is losing access to data.

Companies hire prominent scientists to ghostwrite reports of research they had nothing to do with. Reports of possible harm from old and new drugs have been lost, reinterpreted or withheld from publication. The companies hire scientists to design research projects programmed to yield desired results. Conclusions reached by company researchers are four times more likely to favor industry products than are independent research findings.

Academic researchers and others who are in the pay of pharmaceutical companies take in generous retainer fees, receive stock options and sit on company boards. Many of them sit on prestigious review boards set up to recommend treatment strategies for physicians, and their inclination to favor their companies’ products has been well documented.

What about people’s health? What about science in the public interest? Medical scientists and practitioners – not just company executives – apparently abide by market rules; idealism goes onto the back burner. But this is the important question: When and how are the people themselves going to stand up for their own health and safety?

William T. (Tom) Whitney Jr. of South Paris has practiced or taught pediatrics for 35 years, and he is especially interested in public health and developmental pediatrics.