Pharmaceutical Companies and Their Influence on Scientific Research
Pharmaceutical companies find themselves at a crossroads, navigating between economic interests and the well-being of humanity. They elicit trust and skepticism, prompting us to question the validity of these preconceptions.
Today, I invite you to delve into pharmaceutical companies’ influence on research and how to interpret studies critically.
Understanding the Reach of Pharmaceutical Companies
The term ‘power’ frequently surfaces in discussions about pharmaceutical companies, and their influence is substantial. This influence extends beyond political connections and encompasses their sales prowess.
In 2019 alone, the global pharmaceutical market amassed approximately €1,007.44 billion, a 3.2% increase from the previous year. Europe, Japan, and North America collectively contribute nearly three-quarters of the total sales [1]. While the United States boasts the world’s largest pharmaceutical market, Germany holds the fourth position [1].
The Peter Gøtzsche Controversy
A provocative statement emerged from Danish physician Peter Gøtzsche in an interview: ‘Pharmaceutical companies are worse than the Mafia because they cause more deaths with their drugs’ [2].
Peter Gøtzsche is no newcomer to the pharmaceutical realm. He initially worked for drug manufacturers and was elected to the Cochrane Board in 2016. To provide context, the Cochrane Collaboration is an international research network that produces evidence-based healthcare reviews [3].
However, in 2018, the Cochrane Collaboration expelled him. Prof. Dr. rer. nat. Gerd Antes, the then co-director of Cochrane Germany, cited behavioral issues as the cause for this expulsion. Allegedly, Peter Gøtzsche exhibited improper conduct with colleagues and lacked diplomatic communication skills [4].
Yet, some suspect the medical researcher was ousted due to his critical stance. He consistently advocated for the full disclosure of clinical study data. For example, he and his colleagues uncovered instances where data regarding the efficacy assessment of HPV vaccination were omitted from publication [5].
Does this make Peter Gøtzsche a whistleblower? That may be a stretch. However, the physician has underscored the importance of scrutinizing research findings more closely.
Trust and Controversy: Ethical Dilemmas in Pharmaceutical Research
Pharmaceutical companies often find themselves at the center of a polarizing debate. While some individuals place unwavering trust in these entities, others harbor deep-seated resentment towards ‘big pharma.’
But what underlies this recurring struggle with the public perception that pharmaceutical companies face? The Institute for Medical Anthropology and Bioethics has investigated this matter and has pinpointed several ethical problem areas, including:
- Selective Data Publication: Research companies have been known to selectively filter the data they choose to publish [6]
- Profit-Centric Priorities: Research priorities within pharmaceutical companies often align with profit maximization possibilities [6]
- Differing Research Standards: The standards upheld by pharmaceutical companies in their research endeavors may vary [6]
Good to Know!
Numerous criticisms are intricately tied to the research itself. Therefore, thoroughly examining a study along with all its associated information is essential. In due course, we will provide insights into the significance of authorship details, conflicts of interest, and the study’s implementation.
Pharmaceutical Companies: A More Nuanced Perspective
How do you feel about pharmaceutical companies after reading the article up to this point? Are you convinced of their intentions, or do you doubt their motives? Let us explore the other side of the coin together. As is often the case, the reality is far from black and white regarding pharmaceutical companies. Despite receiving criticism, they play an indispensable role.
Indeed, ethical conflicts and shortcomings exist, but it would be unjust to condemn the entire industry for them. After all, pharmaceutical companies generally enjoy a better reputation compared to other sectors [7].
However, their market consists of products people sometimes require but prefer not to consume. Unlike a captivating book or a delicious pasta dish from your favorite restaurant, choosing a pharmaceutical product does not bring joy. This intrinsic nature is why pharmaceutical companies may never top popularity charts [7].
In the following sections, I aim to illustrate why the work of pharmaceutical companies holds particular significance, especially for those dealing with endometriosis.
Illustration: Dienogest and ‘The Pill’
According to the guideline program of the German Society of Gynecology and Obstetrics (DGGG), hormonal therapy serves as a crucial treatment option for endometriosis.
In line with expert consensus, symptomatic drug treatment involves prescribing a suitable progestogen, such as Dienogest, as a first-line treatment [8].
Physicians may also employ combined oral contraceptives in second-line therapy, commonly known as ‘the pill’ or GnRH (gonadotropin-releasing hormone) treatments [8].
Hormonal therapy aims to alleviate bleeding, reduce lesion size, and alleviate pain [9].
The availability of these medications is made possible by the pharmaceutical industry.
Research on Endometriosis
In recent decades, scientists have made significant strides in understanding endometriosis. Yet, many questions remain unanswered. What precisely causes this condition, and how can it be effectively treated?
Since there is no cure for endometriosis, extensive research is still imperative. A PubMed search for ‘endometriosis’ yields a staggering 30,649 results. Pharmaceutical company employees contribute to many of these articles [10].
One notable figure is Dr. Andrea Wagenfeld, a researcher at Bayer, Germany’s largest pharmaceutical manufacturer, specializing in women’s health [11].
Her work is dedicated to polycystic ovary syndrome and endometriosis. Dr. Andrea Wagenfeld specifically investigates biomarkers and measurable parameters that provide insights into the effectiveness of treatments for gynecological conditions [11].
A modulator that binds to the progesterone receptor is of particular interest to endometriosis patients. This is relevant because progesterone can inhibit endometrial (uterine lining) growth [12].
Research by pharmaceutical companies thus contributes significantly to foundational research and the development of therapies.
Pharmaceutical companies undoubtedly make a substantial contribution. Nevertheless, like individuals and any other entity, they have conflicts of interest that cannot be summarily dismissed. They should neither be vilified nor trusted unquestioningly. It is essential to always consider the valuable work of pharmaceutical companies within the context of their interests. Keep your eyes open when working with sources.
Interpreting Research Correctly: Three Essential Steps
Interpreting studies correctly entails examining the research content and peripheral information about the author and potential conflicts of interest. Let us explore together how to assess studies comprehensively.
1. Shed Light on the Authors
Before delving into the study itself, critically examine the authors involved. What qualifications do they possess to conduct this research? In some cases, links to their curriculum vitae are provided alongside their names. Alternatively, you can use a search engine to learn more about the individuals. It is also informative to determine if the author has conducted previous studies and the topics they have covered. This effort can be rewarding, especially when multiple individuals collaborate on a survey, as it provides deeper insights into the background.
2. Scrutinize Conflicts of Interest
Conflicts of interest disclosures are particularly intriguing as they unveil significant connections. But what exactly constitutes a conflict of interest? Back in 1994, Dennis F. Thompson defined the term in the New England Journal of Medicine, stating:
‘A conflict of interest is a particular situation in which a professional’s judgment about a primary interest (such as a patient’s welfare or the validity of research) may be unduly influenced by a secondary interest (such as financial gain).’ [13]
Examples of Financial Conflicts of Interest:
- Employment relationship, such as in a pharmaceutical company [14].
- Research funding [14].
- Speaker fees [14].
- Paid consultancy roles [14].
- Ownership of related shares.
Examples of Non-Financial Conflicts of Interest:
Good to Know!
Conflicts of interest can potentially influence the outcomes or interpretation of study results. Nonetheless, it is essential to recognize that this influence is not inevitable. Therefore, a thorough examination of conflicts of interest is a valuable endeavor. It is worth noting that being a ‘paid consultant’ may carry more potential for bias compared to involvement in a scientific society.
3. It is important to note that a conflict of interest does not necessarily render a study worthless or incorrect. However, it does underscore the need for a more critical approach when evaluating such findings.
Consider whether the results align with existing research literature. Assess the methodology for its rigor. Explore whether there might be alternative explanations for the results, such as biases. Investigate if independent studies on the same topic or drug are available.
Reviewing the Study Design
Research studies can vary significantly in their structure. Determining the chosen study design is crucial, as this greatly influences the study’s quality and credibility. The study type should be defined as a fundamental aspect of the invention even before research commences.
In medical research, scientists typically categorize research into primary and secondary. Primary research involves conducting the actual study, while secondary research involves experts analyzing existing study results and synthesizing them through meta-analyses or reviews.
Regardless of whether primary research encompasses basic, clinical, or epidemiological studies, selecting the study group is paramount.
The following questions can aid in evaluating the credibility of studies:
- Who funded or commissioned the study?
- Was the experimental design meticulously planned and executed?
- Were efforts made to minimize confounding variables, such as scientists standardizing observation times?
- Was there a control group for result comparison?
- How was the study group chosen? A random selection is generally preferable.
- Was a blinded approach employed to mitigate bias?
- Are the study results fully disclosed, including comprehensive statistical data presentation?
Good to Know!
Experts differentiate between single and double blinding. In single blinding, the patient remains unaware of the therapy being administered. In double blinding, the patient and the investigator are kept in the dark regarding the allocated treatment. Opting for the highest level of blinding possible is advisable to minimize bias.
In a Nutshell
Pharmaceutical companies naturally hold an economic stake in ensuring the consumption of their products, which motivates them to invest billions in the research and development of new drugs and therapeutic approaches. Given their substantial budgets and political connections, they wield significant influence in research.
Criticism is standard, with accusations of ethical breaches and statistical embellishments occasionally directed at them. However, it is essential to recognize that such criticism does not apply universally to the entire pharmaceutical industry. These substantial investments also contribute to advancing research.
Nonetheless, a critical examination of studies is essential. I recommend delving into the study’s methodology, potential conflicts of interest, and the authors’ backgrounds. By doing so, you can effectively discern valuable research from potentially biased study results.
References
- Bundesverband der pharmazeutischen Industrie: Pharma-Daten 2020
- Kritik an Arzneimittelherstellern – “Die Pharmaindustrie ist schlimmer als die Mafia” – Gesundheit – SZ.de (sueddeutsche.de)
- Willkommen auf unseren Webseiten | Cochrane Deutschland
- Cochrane in den Medien: Erläuterung der Widersprüche und Konflikte | Cochrane Deutschland
- Jørgensen L, Gøtzsche PC, Jefferson T. The Cochrane HPV vaccine review was incomplete and ignored important evidence of bias. BMJ Evid Based Med. 2018 Oct;23(5):165-168. doi: 10.1136/bmjebm-2018-111012. Epub 2018 Jul 27. Erratum in: BMJ Evid Based Med. 2020 Jun;25(3):e3. PMID: 30054374.
- IMABE: Der ethische Ruf der Pharmaindustrie
- Prat E. H., Ist die Pharmaindustrie wirklich so schlecht wie ihr Ruf? Wien Med Wschr (2005); 155: 502-521
- Deutsche Gesellschaft für Gynäkologie und Geburtshilfe: Leitlinienprogramm. Diagnostik und Therapie der Endometriose. August 2020
- Nagandla K, Idris N, Nalliah S, Sreeramareddy CT, George SRK, Kanagasabai S. Hormonal treatment for uterine adenomyosis. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD011372. DOI: 10.1002/14651858.CD011372. Accessed 10 December 2021.
- endometriosis – Search Results – PubMed (nih.gov)
- Andrea Wagenfeld im Porträt (bayer.com)
- Wagenfeld A, Saunders PT, Whitaker L, Critchley HO. Selective progesterone receptor modulators (SPRMs): progesterone receptor action, mode of action on the endometrium and treatment options in gynecological therapies. Expert Opin Ther Targets. 2016 Sep;20(9):1045-54. doi: 10.1080/14728222.2016.1180368. Epub 2016 May 14. PMID: 27138351; PMCID: PMC4989858.
- Thompson DF (1994) Conflicts of interest. N Engl J Med 330:503–503.
- Lieb K, Klemperer D, Koch K et al (2011) Mit Transparenz Vertrauen stärken. Ein Vorschlag zur Deklaration von Interessenkonflikten. Dtsch. Ärztebl. 108(6):A 256–A 260
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