Study Sees a Slant in Articles on DrugBy Nicholas Bakalar
A new analysis of reviews and articles about the controversial diabetes drug Avandia has
found that experts who were paid by its manufacturer have been significantly more likelythan others to draw positive conclusions about the drug’s safety and efficacy.
Since 2007, scientists have published hundreds of studies, reviews and opinion articles
about Avandia in scientific journals and elsewhere, arriving at a range of conclusions, somesharply opposed to one another.
Avandia, or rosiglitazone, is prescribed, along with diet and exercise, to help control
blood glucose levels in people with Type 2 diabetes. In 2007, The New England Journalof Medicine published a review of studies and concluded that its use was associated with asignificant increase in the risk for heart attack.
After a Congressional investigation, the Food and Drug Administration imposed a “black
box” safety warning on the medicine. In February, The New York Times described confi-dential F.D.A. reports recommending that Avandia be removed from the market.
To explore possible links between authors’ financial interests and opinions, researchers
reviewed 202 articles by 180 authors who wrote about Avandia and the risk of heart attack. Then they had independent reviewers with no conflicts of interest grade each article asfavorable, neutral or unfavorable, based on the authors’ positions on an association betweenAvandia and heart attacks and on their recommendations for continuing or ending its use. The study was published online on March 18 in the journal BMJ.
Often, authors with favorable opinions of the drug were paid both by Avandia’s maker,
GlaxoSmithKline, and by its competitors. Of those who offered favorable views, 87 percenthad potential conflicts with Glaxo. Among authors who had unfavorable opinions, only 20percent had received money from Glaxo.
Mary Anne Rhyne, a spokeswoman for Glaxo, said in an e-mail message: “Of the 202
articles, only 10 were original scientific research. Many of the articles reviewed were opinionpieces — editorials, commentaries or letters.
It is important to note that the authors’
conclusions do not impugn the validity of the scientific data.”
interviews last week, Dr. Rudy Bilous and Dr. Mark W. Stolar, two of the scientists
who reported favorable findings on Avandia, said drug company financing could create anappearance of bias.
“We can’t have it both ways,” said Dr. Bilous, an endocrinologist at James Cook Uni-
versity Hospital in Middlesbrough, England. “If people want drugs, the only people inthe current environment doing the work and funding the research are the pharmaceuticalindustry, and their concern is for licensing, not necessarily the science.”
Dr. Stolar, a professor of clinical medicine at Northwestern, had a similar view. “There
is no broad enough funding on the national level for significant research,” he said. “Theproblem is that the interpretation of the findings gets skewed because of that. There arevery few people in whom I don’t detect bias based on where their conflicts lie.”
The BMJ review found that 90 of the 202 articles were by people with potential conflicts,
but only 69 of them had a statement disclosing the fact. They uncovered the 21 remainingconflicts by searching the Internet and other publications by the same authors.
The study’s authors acknowledged that their work was observational and that they were
unable to assign a monetary value to any of the relationships they found.
Dr. Amy T. Wang, the lead author and a resident in internal medicine at the Mayo Clinic,
emphasized that the study drew no conclusions about the safety or efficacy of Avandia.
Ms. Rhyne said GlaxoSmithKline “will disclose research payments made to health care
professionals and their institutions” beginning in 2011, with the disclosures covering researchstudies that began on or after Jan. 1, 2010.
An article on Tuesday about financing of research into the diabetes drug Avandia misstated a researcher’s
relationship with the drug industry. The scientist, Dr. Mark W. Stolar, an associate professor of medicine
at Northwestern, who reported findings favorable to Avandia, has received payments from Takeda Pharma-
ceuticals, which makes diabetes drugs, but not from GlaxoSmithKline, which makes Avandia.
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