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Shill considered.

I could not agree more with Shannon Brownlee's excellent article "Doctors Without Borders" (April) on why we should not trust medical journals. Although I once required my students to restrict their research to the journals as the only authoritative source, I now tell them to read journals with caution.

I have been researching drug-company-sponsored articles for four years. It is sad that patients cannot trust the very people who are supposed to be caring for them and that supposedly objective scientific studies cannot be relied upon to give accurate information about pharmaceutical products.

Barry Turner

Department of Biological Sciences

University of Lincoln London, England

"Doctors Without Borders" is a great piece of journalism on a disturbing topic. As an anthropologist who lectures on ethical research in most of my courses, I have never before discussed ethics in the context of publication of research. I will now. You have given me some nourishing lecture fodder.

Raymond Hames

Professor of Anthropology

University of Nebraska Lincoln, Neb,

Shannon Brownlee's article about conflict of interest in the pharmaceutical industry and medical science is dead on. My child has regressive autism and once we started looking into the possible causes (i.e. vaccines, mercury, etc) and began to really scrutinize the research, we learned to distrust any data that comes from drug companies. Hopefully the recent cover-up of antidepressant studies will force the CDC and FDA to rethink their evaluation of new drugs. Unfortunately, because of the skeptic that I have become, I doubt it. They do have their own jobs to protect.

Cynthia Zahoruk

Via email

I enjoyed very much Shannon Brownlee's article and agree that those who write editorials should not accept industry money, and that full disclosure is very important. I do take issue with three things she wrote. First, regarding her comparison of expensive calcium-channel blockers for hypertension with "over-the counter" diuretics: The diuretics are inexpensive and very effective, but do require a prescription. Second, her assertion that a cholesterol-lowering drug may simply cause muscles and kidneys to break down rather than benefit a patient is misleading and factually incorrect. Statin drugs risk liver failure, not kidney failure. Moreover, there is no doubt that among certain groups of people--those at very high risk for heart disease and those with known heart disease--statin drugs save lives by reducing the incidence of heart attack and stroke. This has been well shown in independent studies. To suggest that physicians may be represcribing a statin only because they have been influenced by a drug company runs the risk of encouraging people to avoid a potentially lifesaving therapy. Last, Brownlee's assertion that medical residents get used to accepting drug-company blandishments because they are not paid a living wage is simply wrong. As the director of a residency training program, I know that, by and large, residents are paid between $40,000 and $50,000 a year in most of the Northeast states. This may be a small amount compared to future earnings, but it is certainly enough to support an individual and allow them to buy beer and pizza on occasion. Student loans, which are a very heavy burden, are deferrable for at least part of residency and are tax-deductible. Given what truly impoverished people must endure, to suggest that residents in training are paid less than a living wage is preposterous. It is, rather, incumbent upon the profession to rid the "free lunch" concept from our culture.

William Wertheim, M.D.

Via email

Shannon Brownlee replies: Thanks to Dr. Wetzheim for his kind words, and my apologies for misstating that diuretics are over-the-counter medications. Dr. Wertheim is also correct in pointing out that the statins, or cholesterol lowering drugs, can reduce the risk of heart attack and stroke in patients with serious heart disease. But doctors are prescribing statins to millions of patients whose only symptom is elevated cholesterol! which turns out to be a poor predictor of heart disease. One of the potential--thought--rare--side-effects of taking a statin drug is a condition known as rhabdomyolysis, a break-down of the muscles that can lead to renal failure, but I should have made it clearer in the piece that rhabdomyolysis does not strike every patient on statins. Finally, apparently my attempt at writing 'tongue-in-cheek about medical residents' salaries fell flat. The issue is not whether they can afford to buy beer and pizza, of course, but rather their willingness to accept gifts that all evidence suggests will shape their judgment when they take out the prescription pad.
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Article Details
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Title Annotation:Letters
Author:Brownlee, Shannon
Publication:Washington Monthly
Article Type:Letter to the Editor
Date:Jun 1, 2004
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