Did Tamiflu reviewers have a bad case of the financial conflict bug?

Tamiflu influenza neuraminidase inhibitors conflicts of interest
(stanrandom/Flickr)

This winter, if your doctor suggests that you take Tamiflu, you might want to ask for a conflict of interest statement: a new study suggests that doctors who received payments from the makers of flu-fighting neuraminidase inhibitors—drugs like Tamiflu® and Relenza®—were more likely to view the drugs’ prowess in a favorable light.

In the study, published last week in the Annals of Internal Medicine, a team led by Boston Children’s Hospital’s Florence Bourgeois, MD, MPH, tallied up the financial connections of doctors who participated in 37 reviews of neuraminidase inhibitors.

While it’s been unclear for years whether these drugs really are effective against influenza, it was crystal clear that financial relationships are associated with positive reviews. Of the eight studies where Bourgeois’s team found evidence of a conflict of interest, seven came out in favor of the drugs for either treatment or prevention of the flu.

Contrast that with the 29 reviews where there weren’t conflicts of interest. In that group, only five conclusions were positive.

That shaky evidence has cost a lot of money. Bourgeois’s team notes that in 2009:

“…governments around the world spent $6.9 billion building stockpiles of oseltamivir [Tamiflu], an investment that remains poorly supported by available clinical evidence.”

Ask your doctor if transparency is right for you

Of course, conflicts of interest in medicine and the pharmaceutical industry aren’t new news. It’s been standard practice for years among pharma and device manufacturers to pay doctors and researchers for their services in a scientific or advisory capacity. Those payments, in turn, can influence how a doctor or scientist views a company’s research, or how they design or interpret clinical trials of a company’s products.

Right now, transparency seems to be the best medicine available for controlling the influence of this practice. Journals often require doctors and scientists who study or review specific drugs or devices disclose financial conflicts of interest when they publish their results.

Florence Bourgeois Tamiflu influenza neuraminidase inhibitors conflicts of interest
Florence Bourgeois, MD, MPH
The Affordable Care Act’s “Sunshine Act” goes further, requiring companies involved in federally funded health care programs to disclose certain payments or gifts of value given to doctors and teaching hospitals.

The first numbers released through the Act provide a snapshot of how pervasive the practice is. Just in the second half of 2013, companies handed $3.5 billion over to U.S. doctors and teaching hospitals. And that’s just what was revealed in a partial dataset.

Bourgeois, an emergency medicine physician who studies the drug development and approval process, thinks that more needs to be done.

“The simple disclosure of these conflicts may not be sufficient,” she told U.S. News & World Report. “What we need is a better method for managing these conflicts of interest so that we make sure that we have productive collaboration and relationships with industry, but also that the scientific evidence remains robust, valid and unbiased.”

Read more coverage of Bourgeois’s study on The Wall Street Journal’s Pharmalot blog, The Guardian, and Bloomberg News.

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