Sam Uretsky

Profits in Misinformation

You don’t need to drink eight glasses of water every day. Source: BMJ (it used to be called the British Medical Journal until the publishers and editors got the idea from auto makers that people don’t want names, they want letters that have no clear meaning whatever). Dec. 22, 2007, pages 1288-1289. The report was titled “Medical Myths” and made the point that having a degree in medicine is no assurance of infallibility (although more than a few people would be prepared to dispute that idea — most of them people with MD degrees.)

Unfortunately, most of the myths that the authors exploded have no practical application. It may be interesting to know that the idea that hair and nails continue to grow after death is false — some of us would rather know how to get our hair to grow while we’re still alive — but that doesn’t matter when it comes to patient care. Similarly, it’s not true that we use only 10% of our brains — some of us apparently use far less and still manage to have popular radio shows and write best sellers. The lesson to be learned from the article is that physicians and surgeons may be ill-informed, and misinformed. What the authors didn’t say is that misinformation may be part of business as usual in the health care industry.

On Dec. 21, 2007, the New York Times reported that the drug manufacturers Merck and Schering-Plough conducted studies of their cholesterol-lowering drug ezetimibe, marketed as Zetia and as part of the combination drug Vytorin, without publishing the results of these studies. The information, which appears on the Food and Drug Administration web site, may or may not indicate that ezetimibe may cause liver damage over long-term use. While ezetimibe has been widely used and seems to have a high level of safety, all the risks won’t be known until the results of these studies have been fully analyzed, and the results made generally available. In the meantime, prescribers may be under the impression that ezetimibe is safer than it really is. In 2004, the Public Citizen Health Research Group published a warning that ezetimibe might be more hazardous than generally believed, and recommended that the drug not be used until more was known about its risks.

While the unpublished study doesn’t seem to be a smoking gun, and the Times acknowledges that even physicians who have been critical of ezetimibe concede that it’s generally safe, the failure to make the information available promptly is disheartening. In the past, both researchers and drug manufacturers have suppressed studies that failed to show the sort of results they were after. In the past, study sponsors were reported to have suppressed studies that didn’t give the desired results. In addition, researchers were disinclined to submit reports of studies that didn’t have a statistically significant outcome, even when the results of those studies might be important in patient care just by showing that two procedures, or two drugs, were essentially equal. There’s some disagreement over whether editors showed a preference for studies with a statistically significant outcome, but they would be only human if they did.

In 2004, New York State’s then-Attorney General (now Governor) Eliot Spitzer announced a settlement with Glaxo-SmithKline in which GSK became the first pharmaceutical manufacturer to promise release of all study results of its products. In September 2007, President Bush signed a bill that requires drug manufacturers to release all study data, including results which are unfavorable to their products — but this is a prospective requirement and didn’t apply to the ezetimibe studies which were completed before the law was signed. Even with the law in place, don’t count on any major changes in the way things work — the requirement that a study result be published doesn’t mean that it has to be in a journal that’s read by anybody who isn’t on the editorial board.

We rely on physicians knowing what they’re prescribing — in terms of both safety and price — but the system is still skewed to be sure that prescribers get only the information the companies want them to have.

The BMJ exposed a few medical myths, but as Donald Rumsfeld said “As we know, there are known knowns. There are things we know we know. We also know there are known unknowns. That is to say we know there are some things we do not know. But there are also unknown unknowns, The ones we don’t know we don’t know.” And there’s a lot of money riding on keeping things that way.

Sam Uretsky is a writer and pharmacist living on Long Island, N.Y.

From The Progressive Populist, February 1, 2008

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