If I really wanted to show the pharma giants as evil, I'd have done a lot more than just write about lack of placebo standards. I'd have started by pointing to the disturbing pattern of research-hiding that characterizes drug-company research (the subject of today's post). Then I'd follow up with posts on defective protocol designs (this is practically a book), such as allowing test subjects to continue to take anxiolytics and other psychoactive drugs, on the side, while participating in SSRI efficacy research. (Or testing individuals for placebo-sensitivity and then removing sensitive individuals from studies before they begin.) Then I might talk about the completely bizarre practice of pooling results from different studies (studies that differ in the number of subjects, subject demographics, length of study, and other parameters), something FDA actually allows companies to do. I'd look at how GlaxoSmithKline suppressed suicide data on Paxil. Then I'd talk about illegal marketing of mood stabilizers and antipsychotics by Abbott and Johnson & Johnson, respectively. I'd talk about recent meta-studies that have shown that SSRIs like Prozac have no more efficacy than placebo, and less efficacy than certain older drugs, despite years of blatantly misleading propaganda to the contrary by Eli Lilly and others. (There's also the fact that SSRI studies have notoriously high drop-out rates, and most of the people who drop out do so either because the drugs didn't do anything or caused them to get worse. The drop-outs represent data that doesn't get reported.) And on and on.
But let's limit the discussion, today, to selective publication of research.
There is no doubt whatsoever that the major drug companies have engaged in a systematic practice of "hiding bad results." There is also a tendency of companies to spin-doctor research to show poor results in a favorable light.
In a 2010 study by researchers from the American University in Washington, D.C., the authors found:
Meta-analyses of FDA trials suggest that antidepressants are only marginally efficacious compared to placebos and document profound publication bias that inflates their apparent efficacy. These meta-analyses also document a second form of bias in which researchers fail to report the negative results for the prespecified primary outcome measure submitted to the FDA, while highlighting in published studies positive results from a secondary or even a new measure as though it was their primary measure of interest.See "Efficacy and Effectiveness of Antidepressants: Current Status of Research," Psychotherapy and Psychosomatics 2010;79:267–279, full PDF here.
A German study (published in 2010) found that company-funded trials are four times more likely to find evidence in favor of the trial drug than studies funded by other sponsors.
Another study, published in 2003, found: "Studies sponsored by pharmaceutical companies were more likely to have outcomes favouring the sponsor than were studies with other sponsors (odds ratio 4.05; 95% confidence interval 2.98 to 5.51; 18 comparisons)."
In 2008, Erick Turner, M.D. and colleagues looked at 74 studies on antidepressants submitted to the FDA. They found that only half the studies were positive (showing good efficacy results). The unfavorable studies either weren't published (22 studies) or were spin-doctored to portray the results positively (11 studies) even though the results were actually poor. See "Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy" (New England Journal of Medicine 2008; 358:252-260).
The Turner study found that if you looked only at published literature, you'd get the impression that 94% of trials conducted were positive. But if you take into account unpublished as well as published studies, only 51% of all studies are positive (for the 74 studies they looked at, on a variety of antidepressant drugs).
In 2004, then-NY-Attorney-General Eliot Spitzer filed suit against GlaxoSmithKline, saying the firm committed fraud by withholding negative information and misrepresenting data on its antidepressant Paxil. Last July, the suit was settled for $3 billion, the largest drug-company settlement in history. It's important to note that GlaxoSmithKline didn't just cut a settlement deal. They actually pled guilty to the charges.
In 2007, FDA visited GlaxoSmithKline's Research Triangle Park (North Carolina) offices after reports in the New England Journal of Medicine showed that Avandia, GSK’s popular diabetes drug, increased patients' rate of heart attack by 43 percent. FDA found that GSK failed to report information on nine studies related to Avandia. FDA subsequently forced the company to respond with a plan to ensure that all relevant studies are reported to the government in the future. (See news account here.)
Meanwhile the Ottawa Hospital Research Institute, in conjunction with researchers from Canada, France and England, found that major drug companies routinely hid negative clinical trial information about 50 percent of the time.
Is there a pattern here? I think so.
It's clear that FDA needs to make available all drug company studies (after they've been submitted to FDA) online, on its web site, as a public service. This would effectively cause all studies, good and bad, to be published (to the Web). We shouldn't have to rely on a subculture of drug injury lawyers to dig up, and air out, pharma research through expensive deposition and discovery processes. Nor should it be necessary for anyone to file a Freedom of Information Act request to get drug-company-submitted research out of the Food and Drug Administration. This is information that needs to be exposed, not hidden.
It's very simple. What the drug companies need to do is report their findings -- 100 percent of the findings 100 percent of the time. If they won't do it, FDA should do it for them. Otherwise consumers and legitimate scientists alike are being misled. Bamboozled. Not by accident but deliberately. That's what the data show.