With financial ties to nearly two dozen
drug and biotech companies, Dr. Charles B. Nemeroff may hold
some sort of record among academic clinicians for the most
conflicts of interest. A psychiatrist, a prominent researcher,
and chairman of the department of psychiatry and behavioral
science at Emory University in Atlanta, Nemeroff receives
funding for his academic research from Eli Lilly, AstraZeneca,
Pfizer, Wyeth-Ayerst -- indeed from virtually every
pharmaceutical house that manufactures a drug to treat mental
illness. He also serves as a consultant to drug and biotech
companies, owns their stocks, and is a member of several
speakers' bureaus, delivering talks--for a fee--to other
physicians on behalf of the companies' products.
But it was just three of Nemeroff's many financial
entanglements that caught the eye of Dr. Bernard J. Carroll
last spring while reading a paper by the Emory doctor in the
prominent scientific journal, Nature Neuroscience. In
that article, Nemeroff and a co-author reviewed roughly two
dozen experimental treatments for psychiatric disorders,
opining that some of the new treatments were disappointing,
while others showed great promise in relieving symptoms. What
struck Carroll, a psychiatrist in Carmel, Calif., was that
three of the experimental treatments praised in the article
were ones that Nemeroff stood to profit from--including a
transdermal patch for the drug lithium, for which Nemeroff
holds the patent.
Carroll and a colleague, Dr. Robert Rubin, wrote to the editor
of Nature Neuroscience, which is just one of a family
of journals owned by the British firm, Nature Publishing
Group, pointing out the journal's failure to disclose
Nemeroff's interests in the products he praised. They asked
the editor to publish their letter, so that readers could
decide for themselves whether or not the author's financial
relationships might have tainted his opinion. After waiting
five months for their letter to appear, the doctors went to
The New York Times with their story--a move that sparked a
furor in academic circles, and offered the public yet another
glimpse into conflict of interest, one of the most contentious
and bitter debates in medicine.
In his defense, Nemeroff told the Times he would have
been happy to list his (many) relationships with private
industry--if only the journal had asked. "If there is a fault
here," he said, "it is with the journal's policy," which did
not require authors of review articles to disclose their
conflicts of interest.
And that is pretty much where the debate over conflict of
interest in medical journals stands: Should research
scientists who have financial stakes in the products they are
writing about be forced to disclose those ties? To which the
average person might reasonably respond, of course they
should. But the more pertinent question is why scientists with
financial stakes in the outcome of scientific studies are
allowed anywhere near those studies, much less reviewing them
in elite journals.
The answer to that question is at once both predictable and
shocking: For the past two decades, medical research has been
quietly corrupted by cash from private industry. Most doctors
and academic researchers aren't corrupt in the sense of
intending to defraud the public or harm patients, but rather,
more insidiously, guilty of allowing the pharmaceutical and
biotech industries to manipulate medical science through
financial relationships, in effect tainting the system that is
supposed to further the understanding of disease and protect
patients from ineffective or dangerous drugs. More than 60
percent of clinical studies--those involving human
subjects--are now funded not by the federal government, but by
the pharmaceutical and biotech industries. That means that the
studies published in scientific journals like Nature
and The New England Journal of Medicine--those critical
reference points for thousands of clinicians deciding what
drugs to prescribe patients, as well as for individuals trying
to educate themselves about conditions and science reporters
from the popular media who will publicize the findings--are
increasingly likely to be designed, controlled, and sometimes
even ghost-written by marketing departments, rather than
academic scientists. Companies routinely delay or prevent the
publication of data that show their drugs are ineffective. The
majority of studies that found such popular antidepressants as
Prozac and Zoloft to be no better than placebos, for instance,
never saw print in medical journals, a fact that is coming to
light only now that the Food and Drug Administration has
launched a reexamination of those drugs.
Today, private industry has unprecedented leverage to dictate
what doctors and patients know--and don't know--about the $160
billion worth of pharmaceuticals Americans consume each year.
This is an unsettling charge that many (if not a majority) of
doctors and academic researchers don't want to acknowledge.
Once grasped, however, the full scope and consequences of
medical conflict of interest beget grave doubts about the
veracity of wide swaths of medical science. As Dr. Drummond
Rennie, deputy editor of The Journal of the American
Medical Association (JAMA), puts it, "This is all about
bypassing science. Medicine is becoming a sort of Cloud Cuckoo
Land, where doctors don't know what papers they can trust in
the journals, and the public doesn't know what to believe."
Clinical trial and error
How did we get to this point? What effect is industry
influence having on the treatment of patients? And why are the
medical journals not more vigilant to weed out papers that
have been distorted by conflict of interest? The answers to
these questions begin, oddly enough, with an amendment to U.S.
patent law called the Bayh-Dole Act. Passed in 1980, Bayh-Dole
for the first time permitted universities to commercialize
products and inventions without losing their federal research
funding, the seed money for innovative research. The
brainchild of George Keyworth II, President Reagan's science
advisor, who was watching the United States get beaten in
world markets by the Japanese, Bayh-Dole was intended to
stimulate advanced technological invention and speed its
transfer from university labs into private industry, where it
could be put to work spurring U.S. productivity.
It seemed like a win-win proposition. Indeed, Bayh-Dole has
helped launch the biotech industry and has propelled several
life-saving products to market. The basic research behind
Gleevec, for instance, an incredibly effective new anti-cancer
drug, was done by a university scientist. The drug's
manufacturer, Novartis, stepped in and provided additional
funding for development. In 1984, private companies
contributed a mere $26 million to university research budgets.
By 2000, they were ponying up $2.3 billion, an increase of
9,000 percent that provided much needed funds to universities
at a time when the cost of doing medical research was
skyrocketing.
That's the upside. The downside is that Bayh-Dole has also
fostered increasingly cozy relationships between the academics
upon whom the nation depends for unbiased medical information
and Big Pharma, private companies whose main goal, let's face
it, is making a profit. And we're talking serious money here.
In addition to the salaries built into company-sponsored
research grants, academic clinicians at medical schools can
pad their already decent incomes with $1,000-a-day consulting
contracts with pharmaceutical companies, patent royalties,
licensing fees, and big-payoff stock options. Nemeroff stood
to reap as much as $1 million in stock from a company that
manufactured one of the products in his Nature Neuroscience
paper. At many of the top research universities and medical
schools around the country, a substantial percentage of the
faculty enjoys the perks of industry relationships. At MIT, 31
percent of the science and engineering faculty has outside
income; at Stanford Medical School, it's 20 percent.
What's in it for the pharmaceutical companies? Simple
economics. It's Marketing 101. By penetrating the wall that
once existed around academic researchers, drug companies have
gained access to the "thought leaders" in medicine, the big
names whose good opinion of an idea or a product carries
enormous weight with other physicians. Companies target
academic KOLs, or Key Opinion Leaders, in the lexicon of
marketing, and woo them with invitations to sit on scientific
advisory committees, or to serve as members of speakers'
bureaus, which offer hefty fees for lending their prestige to
a company and touting its products at scientific meetings and
continuing medical education conferences. Of course, KOLs must
be convinced of their own impartiality, says Carl Elliott, a
moral philosopher at the University of Minnesota and author of
Better Than Well: American Medicine Meets the American
Dream. "If they understood that they were being used as
industry mouthpieces, they would probably pull the plug on the
whole enterprise." Drug companies encourage their KOLs to
consult for multiple companies so the appearance of
objectivity can be maintained. But the drug industry's most
powerful means of boosting the bottom line is funding
research, which allows companies to control, or at least
influence, a great deal of what gets published in the medical
journals, effectively turning supposedly objective science
into a marketing tool.
"These are not benign people who are interested in helping
people with their new wonder drugs," says Drummond Rennie.
"The drug companies are run by hard-nosed marketers, not by
the physicians and the scientists. They use what works, and
money works." Rennie, who has a thatch of unkempt white hair
and remnants of the accent of his native Leeds, England, got a
clear picture of the extent to which drug companies will go to
control the results of studies they fund in 1993, when a
colleague at University of California San Francisco tried to
publish a paper in JAMA in 1993 on the metabolic
activity of four different forms of thyroid hormone. Betty J.
Dong, a pharmacologist, had been contracted in 1987 by Flint
Laboratories to run a clinical trial comparing Synthroid,
Flint's synthetic version of thyroid hormone, to that of three
competing formulations. At the time, Synthroid was the market
leader and the most expensive drug in its class. Dong and
Flint signed a lengthy agreement detailing the design of the
study, and both sides fully expected the results would show
that Synthroid was superior.
But all four drugs turned out to be essentially equivalent. In
1990, as Dong prepared a paper for JAMA, the company
that was at first so eager to solicit her help, launched a
vigorous campaign to discredit the study. Flint then rushed
its own paper into press at a less prestigious journal,
concluding--surprise!--that Synthroid was superior. After
numerous attempts to address the company's criticisms, Dong
finally submitted her paper to JAMA, only to withdraw
it three months later when the firm threatened to sue for
breach of contract. It took the FDA and U.S. Department of
Health and Human Services to get the company to back down.
Dong's paper did not see print in JAMA until 1997.
In this case, it might seem as if the only real harm to the
public during the seven years that elapsed from the time Dong
completed her study to its publication was higher prices to
patients and insurers. To Rennie's way of thinking, the Dong
imbroglio and others like it have a more insidious effect by
sending a chilling message to scientists, namely, don't bite
the hand that feeds you. In a recent survey of clinical
researchers, nearly 20 percent of respondents admitted to
delaying publication of their results by more than six months
at least once in the last three years to allow for patent
application, protect their scientific lead, or to slow the
dissemination of results that would hurt sales of their
sponsor's product--often without overt pressure from the
company. "If you're getting a lot of money from a corporate
sponsor, it's easy to get the impression that you'll get even
more for future research if you don't write up the negative
results," says Rennie--and that your funds will dry up if you
do.
The bottom line is that articles appearing in medical journals
contain a lot of happy talk about medical products. At least
eight studies have shown that industry-sponsored research that
gets published tends to produce pro-industry conclusions,
according to a review by Yale University researchers that
appeared last year in JAMA. By reanalyzing data from
eight separate studies of the effect of conflict of interest
on 1,140 published scientific papers, the researchers found
that papers based on industry-sponsored research are
significantly more likely to reflect favorably on a sponsoring
company's drug or device than research that is supported by a
non-profit entity or the federal government.
How can this be? Isn't science, well, scientific, an objective
search for the truth? That's what many academic clinicians,
especially those who are mixed up with corporate sponsors,
would have the public believe. A typical comment comes from
Niels Reimers, an early promoter of industry-university ties,
who told the Hartford Courant, "You may think I'm a Pollyanna
or something, but most people are honest. It's sort of the
ethos of academic research." Here's Dr. Irwin Goldstein, a
Boston University urologist who has consulted for at least
seven companies developing impotence therapies: "Science is
science. It comes down to the bottom line. What the data
shows, the data shows."
Such statements reflect the ideal of science, not the reality,
says Dr. Marcia Angell, former editor in chief of The New
England Journal of Medicine. Public protestations aside,
she says, "Clinicians know privately that results can be
jiggered. You can design studies to come out the way you want
them to. You can control what data you look at, control the
analysis, and then shade your interpretation of the results."
Even the most careful research can be fraught with murky
results that require sifting and weighing, a measure of
judgment that the researcher hopes will bring him closer to
the truth. Was this patient's headache caused by the
antibiotic you gave her, or does she have a history of
migraines? Is that patient's depression lifting because of the
drug you are testing, or because a kindly doctor is actually
listening to him?
Sometimes there isn't much that journal editors can do to
separate good science from that which has been weighed,
sifted, and jiggered according to a corporate sponsor's needs.
Increasing numbers of studies that get published are actually
written by PR firms, "medical communications" specialists, who
then go out and recruit an academic willing to put his name on
the paper, for a fee. Other studies simply omit data that
detract from the sponsor's message. In September 2000, for
example, JAMA published a paper comparing the
prescription painkiller Celebrex to over-the-counter
ibuprofen. The manufacturer of the prescription drug, known as
a selective Cox-2 inhibitor, launched the study in order to
show that Cox-2 inhibitors, a class that also includes the
prescription drug Vioxx and was already worth $3.5 billion a
year, cause fewer instances of bleeding in the stomach and
intestine than either aspirin or ibuprofen. The huge study,
which looked at six months of data from more than 8,000
patients, produced unambiguous results: There were fewer side
effects among patients on the Cox-2 drug.
A year later, news surfaced that patients had actually been
followed for 12-15 months at the time the JAMA paper came out,
not six, and that during the second half of the study, the
group taking the Cox-2 drug suffered higher rates of
gastrointestinal side-effects than patients on the
over-the-counter painkiller. To make matters worse, patients
on the Cox-2 developed serious heart problems three times more
often than those on ibuprofen. The authors of the paper--all
of them either consultants to the manufacturer or employees,
defended their decision to report only the first, positive,
half of their study, saying several patients who weren't
taking the Cox-2 drugs dropped out after six months, making
the statistics more difficult to analyze. But Dr. Catherine D.
DeAngelis, JAMA's editor in chief, told The
Washington Post: "I am disheartened. We are functioning on
a level of trust that was, perhaps, broken."
Disheartened? Not furious? No, because DeAngelis could not
know for certain whether or not the authors held back half the
data in order to make their sponsor's drug look better, no
matter how likely that explanation may seem. When researchers
submit papers to a journal, the editor has little choice but
to trust the authors have employed a ruthless skepticism when
viewing their own results, that they have bent over backwards
to minimize self-delusion. Editors and peer reviewers can
ferret out sloppy reasoning, look at how an author has
designed and executed a study, and correct faulty statistics,
but as Angell remarked, "We don't put bamboo slivers under
their nails. If they wanted to lie, they could lie."
Articles of faith
Dr. Arnold Relman began worrying about this problem way back
in 1977, when he became editor-in-chief of The New England
Journal. That year, Relman got a call from a reporter
about a paper that was due to appear in the next issue,
discussing serious side effects--including lowering a man's
testosterone and sperm counts--of a popular antacid. The
reporter wanted to know what Relman intended to do about the
fact that Wall Street analysts had acquired early copies of
the paper and now the stock of the company that made the drug
was falling.
Relman, who began practicing medicine in the 1950s and calls
himself a "relic," says before that reporter's call, it had
never occurred to him that medical research could have
financial consequences for industry. But the more he thought
about it, he told me recently, "The more I became convinced
that the commercialization of medical practice and medical
research, and the use of the information for commercial
purposes, was a major threat to the integrity of the whole
system." He recognized that medical researchers, being only
human, would have trouble applying that ruthless skepticism
that was so necessary to good science when there was money at
stake.
The obvious solution to Relman and Angell, who was by then a
deputy editor at The New England Journal of Medicine,
was disclosure. Forcing authors to tell the world they were
taking industry money, the editors reasoned, would prompt a
little soul-searching among researchers who might otherwise be
inclined to turn a blind eye to negative results or shade
conclusions in favor of a corporate sponsor. It would put them
on notice that readers would be watching. The editors also
figured that disclosure would help readers judge the validity
of an author's conclusions. "They could evaluate the data for
themselves," Relman told me recently. "But the discussion, the
interpretation by the author can be slanted . . . it was still
important for readers to know when articles were sponsored by
industry." JAMA, largely at Rennie's urging, followed
suit soon after.
Six years later, Relman upped the ante by barring researchers
with conflicts of interest from writing editorials or review
articles--like the one penned in Nature Neuroscience by
Charles Nemeroff "because they carry great weight with doctors
in private practice." Angell explains their decision like
this:
"Imagine a judge who has before him a case involving two
companies suing each other--and he owns one of the companies.
And he says, 'Not to worry. I'm a judge and I learned how to
evaluate things in a dispassionate way.' He'd be laughed out
of court." She and Relman argued that just as judges must
recuse themselves from cases in which they have financial ties
to a litigant, editorialists and review authors with conflicts
of interest should refrain from offering medical opinions.
Angell was still defending that decision a decade later, as
editor in chief at the Journal, when she wrote in 2000
that disclosure was not sufficient to preserve the integrity
of the science that appeared in her journal's pages: "We
believe that a policy of caveat emptor is not enough for
readers who depend on the opinion of editorialists." Why was
it necessary to defend the Journal's policies? Partly
because authors were ignoring them. In 1997, when Sheldon
Krimsky, a professor of public policy at Tufts University,
surveyed 61,134 articles in some 181 journals, he found that
only 0.5 percent disclosed a conflict of interest related to
the topic of the article, an impossibly low number given the
fact that a quarter of biomedical researchers at the time were
receiving funding from industry. The reason for this low rate
of disclosure, as Krimsky notes dryly in his book, Science in
the Private Interest, is that "author compliance is not
especially high."
"Lots of eminent people took great offense at being accused of
being influenced," Relman told me recently. "'What an
insulting thing to say. I value my reputation; doctors and
scientists know best. Trust us.' I spent the first 25 years of
my career doing clinical research and being one of them, and I
know the feeling." As Harvey Lodish, professor of biology at
MIT, huffed to Technology Review in 1984, when Relman
first required disclosure at the Journal, "Scientists
have all kinds of private consulting arrangements with
biotechnology companies and many own stock in these companies,
but that's nobody's business. It has nothing to do with the
quality of their research."
"They actually believe that they aren't influenced," says
Angell. Aside from the fact that it's not in physicians'
self-interest to acknowledge the effects of corporate money,
they may have a hard time seeing the problem for the same
reason fish don't know they're swimming in water: Doctors are
surrounded by conflicts of interest almost from the moment
they arrive at medical school. Pharmaceutical companies begin
wooing young doctors with small tokens at first, pens and
coffee mugs emblazoned with drug logos, then escalating to
pizza night for medical residents, dinners at expensive
restaurants and tickets to sporting events. Most schools offer
a class in medical ethics, but there's no requirement that
they discuss conflict of interest. Besides, a few lectures
can't outweigh the message young doctors absorb every day, as
they watch the icons in their profession--their professors,
visiting lecturers, heads of departments--taking gifts,
speaking on behalf of companies, flying first-class to medical
meetings in Paris and Honolulu. By the time medical residents
enter private practice or the lab, the gifts from industry no
longer seem like gifts, but entitlements, just another way to
be compensated for all those brutal, slogging years of lousy
pay and long nights.
A journalist friend of mine recently told me about the day his
then-girlfriend, who was a neurosurgeon, received a check for
several hundred dollars in the mail, along with a note from a
drug company representative. It seemed his girlfriend had made
favorable mention of a particular drug during a lecture she
delivered a few days earlier, and the money was just a little
thank you from the manufacturer. When my friend told her she
could not in good conscience cash the check--that it was a
conflict of interest--she looked at him, he said, as if he
were speaking in some unintelligible language.
This deafness to the power of money to corrupt medical science
leads physicians and scientists to display an arrogance and a
remarkable naïvete, both of which were very much in evidence
in a snippy editorial entitled, "Avoid Financial
'Correctness,'" written in 1997 by the editors at Nature.
They derided disclosure as a waste of time, writing, "This
journal will persist in its stubborn belief that the research
as we publish it is indeed research, not business." The
Nemeroff case has not changed the editors' view substantially,
although they did alter their policy after it broke. Nature
Publishing now requires editorial and review writers, along
with the authors of original research papers, to inform
readers whether or not they have conflicts of interest, or to
say they decline to declare. Charles Jennings, executive
editor of Nature, says they have no intention of
following the New England Journal in barring
editorialists who have conflicts. "I flatly disagree with that
policy," he told me. "That would exclude many of the leading
experts. You don't want a policy that prevents Thomas Edison
from writing about the future of electricity. Our position is
for readers to decide for themselves about whether an author
is biased."
Of course, most readers, especially practicing physicians,
don't have the expertise or the resources to decide for
themselves--to know how the studies might have been
constructed differently, whether the conclusions have been
shaded to favor the author's sponsor, or which data the author
decided conveniently to leave out of the article. Knowing that
an author might be biased doesn't aid in determining the
extent and nature of the bias. It's not as though there will
be two articles, one by a biased writer and one by an unbiased
writer, published side by side to allow readers to identify
the differences. Besides, conflicts of interest are now so
pervasive, says Rennie, many readers scarcely take note, even
when they're disclosed.
Race for the cure?
It's tempting to wonder what medical research would look like
if universities and medical associations and editors of
journals stopped talking about how to manage conflict of
interest and started thinking about how to expunge it. Just
say no. Proponents of Bayh-Dole will object, claiming the pace
of medical advances will slow to a crawl, but bear with me for
a moment and just imagine a different universe. Let's start
with the medical schools, those temples of higher learning.
They would be the first to cast out the drug merchants.
Hospitals would pay their medical residents a decent wage so
they can afford to buy their own beer and pizza. FDA advisory
panelists who have a financial stake in the drug being
considered would not be allowed to vote. And if the journals
stopped publishing papers and editorials penned by academic
clinicians with conflicts of interest, authors would be forced
to choose between taking scientific credit and taking the
money.
Of course, that's not going to happen unless academic
clinicians somehow decide there's something wrong with the
status quo. In Sheldon Krimsky's view, the only way to deter
conflict of interest is for academics to feel shame. Maybe so,
but as a journalist who has spent a decade and a half peering
at medicine from the outside, nose pressed to the glass, I'm
struck more than anything by the apparent lack of shame among
clinicians when it comes to this issue.
Here's a little thought experiment. Imagine that a medical
journalist, me, for instance, makes a tidy sum writing press
releases for, say Pfizer, the manufacturer of Viagra. I don't
make a fortune, maybe just enough to cover a year's tuition
for my son's private high school. And let's say for the sake
of argument I also buy a few dozen Pfizer shares. Then I turn
around and write a story for The New York Times about
several new drugs for treating erectile dysfunction.
What would you think, dear reader, should my financial
relationship with the pharmaceutical company that makes one of
the drugs featured in my story come to light? Would you have
reason to doubt its objectivity and accuracy? Of course you
would. Not only that, I would be ashamed to show my face in
any newsroom, and I would not be writing for the Times
again. I'm not trying to claim that journalists are paragons
of virtue, but we have no illusions about our ability to
withstand temptation and avoid shading what we say when faced
with a wad of cash.
Not so in medical research. In that world, the author of a
review article can have direct financial relationships with
the manufacturers of drugs he is critiquing and still argue he
has done nothing unsavory. What that suggests is a sense of
fiduciary responsibility is not built into the professional
code of medicine, a doctor's internal compass of right and
wrong.
And of course there are also pecuniary reasons not to
acknowledge the power of money. The fact is, universities and
doctors have become so dependent on industry largesse they
can't even imagine disentangling themselves. Repeal the Bayh-Dole
Act? Not on your life. Kick the drug representatives who wheel
their little carts filled with sample packets of drugs out of
your office? Who would pay for all those trips to medical
meetings in exotic locales?
Company line
And so they try to manage it. About half of universities
require that faculty disclose their conflicts of interest. A
scant 19 percent set limits on the outside financial interests
faculty may hold. Harvard University, long considered a
paragon of scientific virtue, is now considering relaxing its
rules governing industry collaborations. Now that Angell is
gone, even the once-starchy New England Journal has
loosened its restrictions on editorialists and review writers,
who are now free to enjoy some corporate largesse, just not
too much. "They think it's possible to be virtuous and rich at
the same time, to take money from companies and then manage
it," says Angell. "They come up with rules that are so
complicated in order to give the appearance of worrying about
this, when what they are really worried about is the money
might go away."
All their managing doesn't seem to be working, and we are the
ones who will suffer the consequences. In March 2000, the FDA
yanked a diabetes drug called Rezulin off the market after it
had been linked to at least 90 cases of liver failure and 63
deaths. The withdrawal came three years after the agency had
approved the drug to great fanfare. Articles in the popular
media quoted diabetes experts who praised Rezulin, calling it
"a truly novel approach," and the manufacturer,
Warner-Lambert, enjoyed a spectacular 144 percent rise in its
stock price.
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.
