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much higher annual iatrogenic death rate than 783,936. Dr Leape, in 1994, said his figure of 180,000 medical mistakes annually was equivalent to three jumbo-jet crashes every two days.'* Our report shows that six jumbo jets are now falling out of the sky each and every day! much higher annual iatrogenic death rate than 783,936. Dr Leape, become as blurred as they are now, the business goals of industry in 1994, said his figure of 180,000 medical mistakes annually was influence the mission of medical schools in multiple ways". She equivalent to three jumbo-jet crashes every two days.'* Ourreport did not discount the benefits of research but said a Faustian bar- shows that six jumbo jets are now falling out of the sky each and gain now existed between medical schools and the pharmaceutical every day! industry. Angell left the NEJM in June 2000. Two years later, in June Correcting a Compromised System 2002, the NEJM announced that it will now accept contributions What we must deduce from this report is that medicine is in from biased journalists (those who accept money from drug com- need of complete and total reform—from deciding the curriculum —_ panies) because it is too difficult to find ones that have no ties. in medical schools to protecting patients from excessive medical Another former editor of the journal, Dr Jerome Kassirer, told intervention. It is quite obvious that we can't change anything if | ABC News [June 12, 2002] that was just not the case, that there we are not honest about what needs to be changed. This report are plenty of researchers who don't work for drug companies.” simply shows the degree to which change is required. We are The report said that one measurable tie between pharmaceutical fully aware that standing in the way of change are powerful phar- companies and doctors amounts to over $2 billion a year spent for maceutical companies, medical technology over 314,000 events that doctors attend. The companies and special-interest groups with ABC report also noted that a survey of clini- enormous vested interests in the business of cal trials revealed that when a drug company medicine. They fund medical research, sup- funds a study, there is a 90% chance that the port medical schools and hospitals and drug will be perceived as effective—where- advertise in medical journals. With deep as a non-drug-company-funded study will pockets they entice scientists and academics show favourable results 50% of the time. It to support their efforts. appears that money can't buy you love, but it Such funding can sway the balance of Our report can buy you any "scientific" result you want. opinion from professional caution to uncriti- The only safeguard to reporting these studies cal acceptance of a new therapy or drug. shows that was if the journal writers remained unbiased. You only have to look at the number of vest- ivi 1 That is no longer the case. ed people on hospital, medical and govern. SIX sumo rt 5 Cynthia Crossen, a writer onthe wal ment health advisory boards to see conflict o are now ‘a in treet Journal, is the author of Tainte: interest. The public is mostly unaware of these interlocking interests. For example, a 2003 study found that nearly half of medical school faculty who serve on Institutional Review Boards (IRB) to advise on clinical trial research also serve as consultants to the pharmaceutical industry.'’ The authors were concerned that such representation could cause potential conflicts of inter- est. A news release by Dr Erik Campbell, the lead author, said: "Our previous research with faculty has shown us that ties to industry can affect scientific behavior, leading to such The First latrogenics Study things as trade secrecy and delays in Dr Lucien L. Leape opened medi- publishing research. It's possible that similar relationships with cine's Pandora's box with his 1994 JAMA paper, "Error in companies could affect IRB members' activities and attitudes." Medicine" [Dec 21].'° He began the paper by reminiscing about Florence Nightingale's maxim, "First do no harm". But he found Medical Ethics and Conflict of Interest in Scientific evidence of the opposite happening in medicine. He found that Medicine Schimmel (1964) reported that 20% of hospital patients suffered Jonathan Quick, Director of Essential Drugs and Medicines iatrogenic injury, with a 20% fatality rate. Steel (1981) reported Policy for the World Health Organization, wrote in a recent WHO that 36% of hospitalised patients experienced iatrogenesis, with a Bulletin [Dec 17, 2001] that "If clinical trials become a commercial 25% fatality rate, and adverse drug reactions were involved in venture in which self interest overrules public interest and desire 50% of the injuries. Bedell (1991) reported that 64% of acute overrules science, then the social contract which allows research heart attacks in one hospital were preventable and were mostly on human subjects in return for medical advances is broken".” due to adverse drug reactions. However, Leape focused on his The former editor of the New England Journal of Medicine and Brennan's "Harvard Medical Practice Study", published in (NEJM), Dr Marcia Angell, struggled to bring the world's atten- 1991.'* They found that in New York State in 1984 there was a tion to the problem of commercialising scientific research in her 4% iatrogenic injury rate for patients, with a 14% fatality rate. outgoing editorial, "Is Academic Medicine for Sale?"” Angell From the 98,609 patients injured and the 14% fatality rate, Leape called for stronger restrictions on pharmaceutical stock ownership __ estimated that in the whole of the United States, 180,000 people and other financial incentives for researchers. She said that grow- die each year partly as a result of iatrogenic injury. ing conflicts of interest are tainting science. She warned that Why Leape chose to use the much lower figure of 4% injury for "When the boundaries between industry and academic medicine his analysis remains in question. Perhaps he wanted to tread Truth: The Manipulation of Fact in America (1996), a book about the widespread practice of lying with statist > Commenting on the state of scientific research, she said that "The road to hell was paved with the flood of corporate research dollars that eagerly filled gaps left by slashed government research funding". Her data on financial involvement showed that in 1981 the drug industry "gave" $292 million to colleges and universities for research; in 1991 it "gave" $2.1 billion. out of the sky each and every day! Our report shows that six jumbo jets are now falling out of the sky. each and every day! Medical Ethics and Conflict of Interest in Scientific Medicine Jonathan Quick, Director of Essential Drugs and Medicines Policy for the World Health Organization, wrote in a recent WHO Bulletin [Dec 17, 2001] that "If clinical trials become a commercial venture in which self interest overrules public interest and desire overrules science, then the social contract which allows research on human subjects in return for medical advances is broken".” The former editor of the New England Journal of Medicine (NEJM), Dr Marcia Angell, struggled to bring the world's atten- tion to the problem of commercialising scientific research in her outgoing editorial, "Is Academic Medicine for Sale?"” Angell called for stronger restrictions on pharmaceutical stock ownership and other financial incentives for researchers. She said that grow- ing conflicts of interest are tainting science. She warned that "When the boundaries between industry and academic medicine NEXUS + 19 AUGUST - SEPTEMBER 2004 www.nexusmagazine.com