JRSM >
Volume 99, Number 4 >
Pp. 163
JRSM
[kamran.abbasi{at}rsm.ac.uk]
Pfizer's response to last month's research paper investigating the risk of myocardial infarction with celecoxib therapy was depressingly predictable. This systematic review from the New Zealand Medical Research Institute alerted us to a potential doubling of that risk when compared with placebo and other analgesics, including traditional non-steroidal anti-inflammatory drugs.
A responsible reaction to this finding, particularly with Vioxx still featuring prominently in American courtrooms, would have been a promise to give this latest research serious consideration. Instead of a display of corporate conscience, Pfizer adopted a strategy that indicated that the drug controversies of recent years—with a demand for greater honesty and transparency from companies—had been inconsequential.
Mark Crotty, Pfizer New Zealand's General Manager, described the findings of the JRSM paper as `... extremely misleading... very much an incomplete review of the data—selecting six studies out of 48 available'. He sought to reassure people taking Pfizer's blockbuster, $2 billion a year drug. Unfortunately, this statement was more pleasing to Pfizer's shareholders than patients, and played on the public's understandable ignorance of the finer points of research methodology.
A good systematic review and meta-analysis does not include all the available research in the final analysis. This happens for very good reasons, namely that by excluding weak studies—and those that are not designed to answer the research question—we are much more likely to get close to the `truth'. Forty-eight might not beat six in the world of share prices and balance sheets, but in the world of good science, Mr Crotty, it can do.
`We dedicate ourselves to humanity's quest for longer, healthier, happier lives,' say Pfizer. They should also dedicate themselves to reading their own drug safety information, which states—in bold type—that celecoxib `may increase the chance of a heart attack or stroke that can lead to death'. Any company's desire to protect its reputation is perfectly understandable, but when that defence involves potentially misleading patients it becomes unnecessarily dangerous.
Now whether or not Mr Crotty has medical training is unclear to me. He could, of course, be a surgeon. Even if he were `Dr' Crotty, his understanding of research methodology suggests that his doctorate would have been neither medical nor scientific. What does a title matter anyway? Surely we should be judged by the quality of our work and the wisdom of our utterances? Should we be Miss, Mister, Doctor or MD? Nick Ibery and colleagues ask surgeons whether or not they wish to become doctors (p. 197), while Tom Treasure and Carol Tan try to make sense of these findings and reflect on a history of professional pomp and self-importance (p. 164).
How, for example, should we address doctors who are also linguists and archaeologists, which is the case for both Matthew Maslen and Piers Mitchell (p. 185)? At least their triple qualifications allow them unique insight to review the medical theories on the cause of death in crucifixion, and reach the conclusion that `... there is insufficient evidence to safely state exactly how people did die from crucifixion in Roman times'.
And do we know the role of doctors in crucifixion? Did their professionalism forbid them or were they willing—possibly unwilling—accomplices in state-funded atrocity just as doctors have been in the last hundred years (p. 175)? None of this debate on establishing cause of death and professional ethics is likely to interest Pfizer unless, of course, it might magically lead to crucifixion of its share price.
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