Because those of us who are advocating serious reforms in the medicine-Pharma relationship are finally starting to be heard, we now threaten the industry sufficiently to make us worth powder and shot for a counter-attack.
The latest counter-attack seems to be to accuse those advocating reform of the dread "intellectual bias." This charge surfaced in a response to a letter to the editor in Critical Care Medicine.(1) The letter disagreed with recommendations in guidelines written by the Surviving Sepsis Campaign, and discussed commercial ties of the SSC to the pharmaceutical industry. Note that the authors of the letter, Eichacker, Natanson, and Danner, had previously criticized the SSC guidelines in the New England Journal of Medicine,(2), as discussed in this post.
Two members of SSC, Phillip Dellinger and Charles Durbin, then proceed to reply, mainly in the form of accusing the NIH scientists of having no real evidence to back up their claims and yet repeating their attacks on Xigris incessantly despite having no evidence. Here is the key paragraph:
'Drs. Eichacker, Natanson, and Danner accuse the SSC of being biased toward industry, yet fail to acknowledge their own intellectual (academic) bias. This form of bias can be defined as presenting personal, entrenched beliefs as scientific truth in an area where no clear-cut consensus exists. We believe this intellectual bias can be more insidious and damaging than the potential bias arising from affiliations with industry.'
Now, this is quite a piece of work. The NIH scientists believe that the preponderance of the scientific evidence supports their point of view. The SSC guys believe the same for their own point of view. That makes the NIH people guilty of 'intellectual bias' while the SSC remains innocent of that sin.
What is even more breathtaking is that intellectual bias (whatever that turns out to be) is actually much worse than commercial bias. As I have reviewed in HOOKED and on this blog, and as numerous meta-analyses and systematic reviews have shown, commercially sponsored studies are roughly 4 times more likely than neutral studies to favor the company's drug. So commercial bias has been shown to be real and substantial. Against that empirical proof, we are being invited to dismiss commercial bias as no big deal, but to quake in our boots at the possibility of 'intellectual bias.'
The implicit subtext, as best as I can read it, is that people ('academic intellectuals') who work at NIH, or at universities that believe in avoiding conflicts of interest with industry, are some sort of ivory-tower, goody-two-shoes weirdos. They think they are intellectually superior to the rest of us mere mortals, and the best thing to do with these insufferable twits is to ignore them. By contrast, scientists who jump into bed with industry at the first opportunity are regular people just like us, and are hard-headed, pragmatic realists. Their take on the world is much more reliable.
Dr Brody then warns,
I expect to see charges of 'intellectual bias' repeated regularly whenever Pharma feels that it is being placed on the defensive by demands for reform.
The good news here is that those within the cozy academic-medical-industrial complex, and particularly the academic leaders who work part time for health care corporations, and often seem to be promoting their products and services in the guise of disinterested academics, are no longer so comfortable in these roles. Rather than merely ignoring the few people who think that such conflicts of interest may be bad for academia, science, health care and the public, they feel the need to make ad hominem attacks, in this case, charging "intellectual bias. " Let's hope they will soon feel the need to be even more defensive.
1. Eichacker PQ, Natanson C, Danner RL. Separating practice guidelines from pharmaceutical marketing [special letter to the editor, with reply]. Crit Care Med 35:2877-80, 2007.
2. Eichacker PQ, Natanson C, Danner RL. Surviving sepsis - practice guidelines, marketing campaigns, and Eli Lilly. N Engl J Med 2006; 335: 1640-1642. (see link here.)