Diabetes Self-Management Blog

Earlier this year, we wrote about how corporate funding of research is treated, asking if it deserves to be singled out in a way that other potential biases are not. A recent study may help provide an answer to that question.

Since it has been the subject of intense controversy, the Type 2 diabetes drug rosiglitazone (brand name Avandia) is a naturally fitting case to use when looking at the possibly biasing effects of corporate funding. Avandia’s status means that it has been the subject of numerous studies and opinion pieces, with varying views on its suitability as a drug. For this study, published online by the journal BMJ on March 18, researchers examined 202 published articles on the risk of heart attack associated with Avandia, including “guidelines, meta-analyses, reviews, clinical trials, letters, commentaries, and editorials.” They looked for potential conflicts of interest — that is, financial ties to Avandia’s manufacturer (GlaxoSmithKline), its chief competitors in this drug class (Takeda and Eli Lilly, manufacturers/marketers of Actos, a drug in the same class as Avandia), or another diabetes drug manufacturer — for each author within two years of the article’s publication, whether or not the conflict was stated in the article. They then had two independent analysts, unaware of any conflicts of interest, categorize each article as favorable, neutral, or unfavorable to Avandia.

The researchers found that authors with a favorable view of Avandia were more likely to have a financial link to a diabetes drug manufacturer, and even more likely to have a link to GlaxoSmithKline, than authors with an unfavorable view of Avandia. In addition, authors with an unfavorable view of Avandia tended to be “largely free of identifiable financial conflicts of interest.” This was true of articles published both before and after the US Food and Drug Administration (FDA) issued a special safety warning for Avandia and Actos in 2007. However, only half of the articles included in the study had a conflict of interest statement. The researchers found this rate “disappointing,” but noted that conflict disclosure rates seem to have improved over the last decade.

Given that ties to manufacturers of competing drugs were linked to more favorable views of Avandia, there appears to be more at work in this picture than a simple slant due to financial motivation. These results suggest, in fact, that links to drug companies might cause a more favorable view of drugs in general — or, conversely, that people with a favorable view toward drugs decide to work for drug companies. These scenarios cast doubt on the current system in which drug manufacturers hire researchers to carry out trials of their drugs. In a New York Times article on this study, the two scientists who analyzed articles for the study lamented that drug-company funding is currently the only way to advance research on new drugs, given the lack of funding available from federal agencies or other organizations with no direct financial ties.

What do you think — should medical publications tighten their rules for reporting of conflicts of interest? Or does this study show that the situation is more complicated than simple disclaimers would suggest? Is it possible that researchers with no ties to drug companies have their own special biases? Should funding for drug trials be transformed, possibly through expanded federal funding? Leave a comment below!

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Comments
  1. Let’s look at the situation in broad strokes. A significant part of the population has a bias against using drugs, with many folks swearing off even aspirin.
    Another significant group is of the opinion that some miracle chemical will cure everything and even stop the aging process, if only enough research is done.
    There is a good deal of controversy on either side of those two positions and the media contributes to the controversy as in the above article.
    A third significant group feels a sense of being trapped in that they have diabetes, high cholesterol, or high blood pressure, and must take many of these medications to stay alive.
    This third group obviously has the most to lose in the event of problems encountered after a particular drug has become part of the medical distribution channels.
    In any event, I find it highly unlikely that there are many left in a fourth group that have unbiased opinions on the matter.
    There has been enough information spread around on the many issues that one would have to be “in the woods” to not have an opinion. I’ll let you determine what “in the woods” means here.

    Posted by Eugene Gaudreau |
  2. I’ve just stopped taking actos because of the same reasons. I was able to beat the congestive part of the drug with 3000mg of fish oil for about two years. However, recently using motrin for diabetic nerve pain in my legs at night caused the congestive problems associated with the class of drugs.

    Posted by Harry......................... |
  3. Tighten the rules for reporting ALL conflicts of interest. Reserchers, regardless of where the money comes from, should have no ties what so ever
    with drug companies or the reporting medical publications.

    Jim Y.

    Posted by Jim Yeager |

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