February 23, 2008

Subverting the Review Process

Posted by Eric at 6:08 pm | Category: News, Pharmaceuticals, Politics, Science

Via Pharmalot, apparently Pfizer is going to court to try to force the NEJM to release its confidential reviews of articles on Celebrex and Bextra, two of Pfizer’s products that have been targeted for lawsuits on their side effects.

Now, I’m not saying either way whether Pfizer is guilty of misinformation and such on Celebrex and Bextra, but this subpoena is just wrong. The scientific peer-review process has traditionally depended on confidentially to ensure candid and honest statements about the quality of research without fear of repercussions or retribution. It’s not perfect, but it’s sure a hell of a lot better than going without a peer-review system, and trying to break the confidential review system is like trying to force journalists to open up their sources. It stops the flow of good journalism, and it stops the flow of proper science.

Pfizer isn’t doing itself or the rest of the drug industry any favors, either. For whatever reason, people hate drug companies even more than they hate other companies (except maybe Big Tobacco), perhaps because they think that drug companies are evil machines sucking money out of sick and desperate people. That’s not true, and there are many noble people, including doctors and scientists, working hard out there in the drug industry to find the latest drugs to help people, but these kinds of antics from the top are just awful. I don’t envy the researchers at Pfizer, as they don’t deserve society’s scorn for all of this.

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3 Responses to “Subverting the Review Process”

  1. Apollo Says:
    February 24th, 2008 at 11:28 am

    This is a pretty low move, but I suspect this sort of action is precisely why many people don’t like pharmaceutical companies as compared to companies in other industries. It’s the same reason why many people don’t like some doctors: they don’t follow the rules, and they think they can do whatever they want (for whatever reason). What adds insult to injury is the notion that there are many good people in both drug research and medicine and that these fields carry a strong humanitarian mission (one, to develop drugs to improve and save lives, and the other, to diagnose disease and use those therapeutics and others to the same end). Physicians, however, now usually have a lot of oversight that prevents them from deviating too far from standard conduct in everyday operations. The most egregious cases (usually) become malpractice suits. Similarly, it seems that “egregious” errors by pharmaceutical companies are punished by the removal of drugs from the market. Is there much oversight over the day-to-day operations of these companies, though, to keep them honest before it gets to the point of catastrophe/egregious error? While it isn’t hard to keep individual physicians in line, I think it would be much harder to keep a massive company in check (and I think most people associate the ills of pharmaceutical companies with the huge companies).

  2. Eric Says:
    February 24th, 2008 at 1:10 pm

    I think the dislike of pharma companies, at least in part, comes long before they started doing stuff like this. I think some of it has to do with increased oversight from the FDA. Safety restrictions are much harder to hurdle these days, and more and more things seem to fail for strange reasons (especially as these days, treatments are moving towards more and more complex diseases). Every drug retraction is now associated with a news sensation and massive lawsuits. Drug companies, because they’re larger and more beholden to the fickle (and oftentimes ignorant) shareholders, are getting more desperate, and so resort to more and more shameful tactics to stretch out their increasingly slow-moving pipeline. They’re also less likely to devote time to pro bono drug development or basic science research.

    In addition, pharma companies haven’t been doing very good PR management. Mostly, their public face these days is direct-to-consumer ads, which isn’t the most positive image, as they come off as shameless hucksters to a lot of people, including doctors. In addition, the whole complementary and alternative medicine movement these days has essentially built itself on railing against established medicine, of which a large part is big pharma (but it also includes “normal” doctors). Pharma, being made up of “big evil corporations”, takes the biggest hit, I think, just because they’re easy targets. People think that drugs are too expensive. People don’t understand trade barriers created by stupid governments establishing price controls, and they become easily seduced by the “natural remedies doctors and drug companies don’t want you to know about” tagline. Some people really do believe that drug companies are sitting on a secret “cure for cancer” that they don’t want to sell, in favor of money-making “life extending” drugs, which is an absolutely ridiculous notion.

    The problem is that the day-to-day operations of these companies is huge and sprawling, and these companies are so large that even occasional lapses in judgement would become common. A drug rep pushes a little to hard. A sales person slips and makes a little white lie. A manager doesn’t notice the chronic lier in the marketing department. Little stuff, but they get blown up, I think. So for the most part, people in drug companies are honest. Occasionally, the bad apple comes in, and that ruins it all for the whole of them.

    I think drug companies just have to start using some sort of zero-tolerance type of PR management in order to improve their image and get customers to start liking them again. In other industries, a computer fails here and there, a product has a slight defect, usually no big deal. In pharmaceuticals, people have no tolerance for errors of judgment, and rightly so. Lives are at risk, and I think the managers need to start looking longer term than trying to pump sales for the next quarter.

  3. Review confidentiality and related issues « Suicyte Notes Says:
    February 28th, 2008 at 5:02 pm

    [...] can find extensive coverage of this incident in a number of blogs, including Pharmalot and The Futile Cycle. As can be expected, bloggers and most scientists I spoke to take side with the NEJM. As a [...]

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