Beyond conflict of interest: maybe wrong questions are being asked

Editor—Lenzer reports that scandals have eroded the US public's confidence in the drug industry.¹ Although we should be shocked over the tangled fiduciary relations between the cholesterol guideline authors and Big Pharma, we should also examine how the underlying research was funded. Beyond the overt conflicts of interest among eight of nine authors of the guidelines, what of the funding sources for the studies upon which they were based? We need to ask if drug companies are driving not merely the conclusions but the questions to be researched.

The ATP III update recommendations were based on five major studies on the effects of three statins in lowering cholesterol concentrations. In all cases a majority of principal investigators had received money from pharmaceutical manufacturers through consultancies, lecture fees, or outright employment.

More importantly, all five studies were directly funded by the statin manufacturer(s). So before the conclusions were reached and the guidelines issued, the matter of what to investigate had apparently been determined by the funders.

There's little question that statins reduce cholesterol; tougher questions addressing causes of high cholesterol go unfunded. How many other good research questions will never be addressed because they are not expected to rapidly yield a profitable drug?

As we come to expect some fiduciary relations between clinical researchers and drug manufacturers, our healthy sense of outrage becomes numbed. Let's remember to direct what remains less toward the pipers and more toward those who call the tune.