WHIFF OF BIAS IN RESEARCH GROWS HARDER TO AVOID

The editor of the New England Journal of Medicine recently accused medical
professors of being open to the charge that their words are for sale-- to
the pharmaceutical industry.

"What is at issue is not whether researchers can be 'bought' in the sense of
a quid pro quo," writes Dr. Marcia Angell. "It is that close and
remunerative collaboration with a company naturally creates goodwill on the
part of researchers and the hope that the largesse will continue. This
attitude can subtly influence scientific judgment?"

Dr. Angell thinks many of the speaking and writing arrangements between
medical school faculty members and drug companies should be banned. And
she's not alone. In a few weeks, the U.S. Congress will hold hearings on the
ties between medical researchers and drug companies. Members of Congress are
worried because there's mounting evidence that in medicine, corporate
connections can translate into biased science.

And it's turned out that in some cases, the doctors making decisions for the
U.S. government about whether to approve a certain drug or vaccine, have
financial links to the makers of the same drug or vaccine. That means that
the decisions could be biased, or could appear to be biased, in favour of
the manufacturers.

Health Canada has similar concerns that doctor who serve as advisors to the
Health Protection Branch not have links to the makers of the very drugs they
were advising the government on. Health Canada's current conflict of
interest policy tries to protect against that possibility.

In a sample memo to would-be members of its advisory committees, it states:
"When acting for the government, it is not sufficient to avoid actual
conflicts of interest. One must also avoid any situation which might cause
the public to doubt the objectivity of government action. In other words,
the test in any given case is not simply whether there is an actual conflict
of interest but rather whether a well-informed member of the public might
have reasonable grounds for concern that the conduct of government is
influenced by illegitimate considerations."

And the memo goes further: "This is especially so in a sensitive area such
as health protection where the actions of government are subject to intense
scrutiny and where experience has shown that minor incidents may
occasionally be blown out of proportion and affect negatively the reputation
of the persons concerned."

The memo reads like an attempt to ensure that decisions about drugs at the
federal level are not biased in favour of the companies making the drugs.
It's a warning to medical experts with links to drug manufacturers to please
stay away, lest they and the government wind up regretting it later.

But the government may have trouble putting the policy into practice.

Consider the difficulties John Hoey faced at the Canadian Medical
Association Journal, when he tried to make sure that editorials in the
journal were not biased in favour of drug manufacturers.

Dr. Hoey is the journal's editor. A few years back, he made a rule that
authors of editorials could not have financial connections to manufacturers
of the products they discuss. In other words, doctors wouldn't be asked to
advise their fellow physicians to prescribe a given drug, if the doctors
giving out the advice could be linked to the drug's manufacturer.

The New England Journal of Medicine has had a similar policy in place for
the past decade. But at the Canadian Medical Association Journal, Dr. Hoey
had to abandon the policy early on. He says there simply weren't enough
doctors who had the requisite expertise to offer opinions on a given drug,
but didn't have ties to the makers of those drugs. Canada doesn't lack for
expert doctors. But, says Dr. Hoey, they almost all have ties to the drug
companies.

Even the austere New England Journal may no longer be perceived as
attempting to protect readers from biased viewpoints. Dr. Angell is soon to
be replaced, and the new editor, Dr. Jeffrey Drazen, has long-standing ties
to nine major drug companies. He's promised to stay out of decisions around
papers that concern products made by these firms.

But Dr. Drazen's appointment shows just how difficult it has become to avoid
the perception of bias in medical research today.

Dr. Shuchman is on assignment for the summer. Second Opinion will return in
the fall.