Doctors without borders: why you can't trust medical journals anymore

Washington Monthly, April, 2004 by Shannon Brownlee

By the fall of 1997, however, the FDA had already begun to receive reports of patients on Rezulin suffering liver failure, a side-effect that the agency's advisory panel glossed over during its deliberations. A paper published in the New England Journal also made scant reference to liver toxicity, saying the drug was "well tolerated, and most adverse events were considered to be related to the underlying diabetes." Several clinicians with ties to the company subsequently urged the FDA not to withdraw the drug, even as the body count was rising. According to a Los Angeles Times investigation, at least 12 of 22 scientists who played a central role in the federally-funded study of Rezulin received research funding or other compensation from Warner Lambert, while four of the 12 voting members of the FDA advisory panel that approved Rezulin, and kept it on the market an extra 30 months, had financial ties to the company.

When industry has penetrated every level of medicine from the lab bench to the FDA advisory panels, from the pages of the medical journals to your doctor's prescription pad, how are physicians to make decisions about treating their patients? How are they to know whether or not expensive calcium channel blockers are really better than over-the-counter diuretics for high blood pressure? (They're not.) Should you take a mildly depressed teenager to a psychotherapist, or put him on an antidepressant and risk sending him into a suicidal tailspin? Maybe a cholesterol-lowering statin drug will prevent this patient from suffering a heart attack, as the studies claim. Then again, maybe it will simply cause her muscles to break down and destroy her kidneys, one of the drug's side effects.

And what about us patients? What are we to do with the knowledge that much of what passes as science in medicine is little more than gussied-up marketing? There isn't much we can do. And so, I say if you're ill, if you are ailing, or just sick at heart, go find a doctor who listens, who holds your hand. Just make sure you find a doctor who looks at evidence, not opinion, and when she pulls out the prescription pad, start asking a lot of questions.

Shannon Brownlee is a fellow at the New America Foundation.