Stelfox H T, Chua G, O'Rourke K, Detsky A S
Department of Medicine, University of Toronto, ON, Canada.
N Engl J Med. 1998 Jan 8;338(2):101-6. doi: 10.1056/NEJM199801083380206.
Physicians' financial relationships with the pharmaceutical industry are controversial because such relationships may pose a conflict of interest. It is unknown to what extent industry support of medical education and research influences the opinions and behavior of clinicians and researchers. The recent debate over the safety of calcium-channel antagonists provided an opportunity to examine the effect of financial conflicts of interest.
We searched the English-language medical literature published from March 1995 through September 1996 for articles examining the controversy about the safety of calcium-channel antagonists. Articles were reviewed and classified as being supportive, neutral, or critical with respect to the use of calcium-channel antagonists. The authors of the articles were asked about their financial relationships with both manufacturers of calcium-channel antagonists and manufacturers of competing products (i.e., beta-blockers, angiotensin-converting-enzyme inhibitors, diuretics, and nitrates). We examined the authors' published positions on the safety of calcium-channel antagonists according to their financial relationships with pharmaceutical companies.
Authors who supported the use of calcium-channel antagonists were significantly more likely than neutral or critical authors to have financial relationships with manufacturers of calcium-channel antagonists (96 percent, vs. 60 percent and 37 percent, respectively; P<0.001). Supportive authors were also more likely than neutral or critical authors to have financial relationships with any pharmaceutical manufacturer, irrespective of the product (100 percent, vs. 67 percent and 43 percent, respectively; P< 0.001).
Our results demonstrate a strong association between authors' published positions on the safety of calcium-channel antagonists and their financial relationships with pharmaceutical manufacturers. The medical profession needs to develop a more effective policy on conflict of interest. We support complete disclosure of relationships with pharmaceutical manufacturers for clinicians and researchers who write articles examining pharmaceutical products.
医生与制药行业的经济关系存在争议，因为这种关系可能会引发利益冲突。目前尚不清楚制药行业对医学教育和研究的支持在多大程度上会影响临床医生和研究人员的观点及行为。近期关于钙通道拮抗剂安全性的争论为研究利益冲突的影响提供了契机。
我们检索了1995年3月至1996年9月间发表的英文医学文献，以查找有关钙通道拮抗剂安全性争议的文章。对这些文章进行了审查，并根据其对钙通道拮抗剂使用的态度分为支持、中立或批评三类。我们询问了文章作者与钙通道拮抗剂制造商以及竞争产品（即β受体阻滞剂、血管紧张素转换酶抑制剂、利尿剂和硝酸盐）制造商之间的经济关系。我们根据作者与制药公司的经济关系，研究了他们在钙通道拮抗剂安全性方面已发表的立场。
支持使用钙通道拮抗剂的作者与钙通道拮抗剂制造商存在经济关系的可能性显著高于中立或持批评态度的作者（分别为96%、60%和37%；P<0.001）。无论产品如何，支持性作者与任何制药商存在经济关系的可能性也高于中立或持批评态度的作者（分别为100%、67%和43%；P<0.001）。
我们的结果表明，作者在钙通道拮抗剂安全性方面已发表的立场与其与制药商的经济关系之间存在密切关联。医学界需要制定一项更有效的利益冲突政策。我们支持要求撰写有关药品文章的临床医生和研究人员全面披露与制药商的关系。
