Publication Bias: Calling Academic Physicians to Account

To the Editor: The field of medicine is being called to account for its practices and involvement with the pharmaceutical industry. It is striking how few academic physicians have come forward to take responsibility for the roles they have played in inflating the benefits of many of the drugs prescribed today. Such practices have been described in detail in a number of recent books (1, 2) . Neither faculty nor academic institutions have responded adequately to those serious and substantive challenges to their integrity.

In their recent commentary, published in the February 2009 issue of the Journal, Sanjay J. Mathew, M.D., and Dennis S. Charney, M.D. (3), recommended several changes in the methods employed to evaluate the efficacy of new drugs. They suggested the development of “academic disease-focused clinical research centers.” Therein lies the problem: Academic departments that have long-standing financial ties to the pharmaceutical industry should not be given the charge to change the system.

I am a practicing clinician at a community mental health center. It was obvious to me 1 year after its release that olanzapine caused significant weight gain. During this time, many academic psychiatrists collaborated with Eli Lilly and other drug companies to develop studies, promote lectures, and write articles whose aim was to mask rather than to understand and illuminate the problem. If this was obvious to a practicing clinician who was merely paying attention to the fact that many patients were gaining weight while taking olanzapine, should it not have raised some suspicions with the researchers who had been using this drug for years in the pre-approval trials?