FOLLOW THE MONEY

A recent article in the NEW ENGLAND JOURNAL OF MEDICINE1 (NEJM) --the first research of its kind --shows pretty clearly that scientific and medical experts who take corporate money hold opinions that differ significantly from experts who don't take corporate money.[1]

Researchers in Toronto, Canada examined a medical controversy to see which scientists held what sorts of views. The controversy they studied was the use of calcium-channel blockers, which are used to treat high blood pressure and heart disease. In 1995 the National Heart, Lung and Blood Institute warned doctors that one such channel-blocker increased the risk of heart attack deaths.[2] Other channel-blockers fell under suspicion of being dangerous.

The Toronto researchers examined 70 articles on channel-blockers, classified the authors into three categories (supporters, neutral, and critical), then mailed surveys to the authors, asking about their financial ties to drug corporations. The 70 articles had a total of 86 authors, and 71 of those returned the surveys. The surveys were intended to answer 3 questions:

1. Whether supporters of calcium-channel blockers were more likely than other authors to have financial ties to manufacturers of calcium-channel blockers. The answer was yes. Ninety-six percent of the supportive authors had financial relationships with manufacturers, as compared with 60 percent of the neutral authors, and 37 percent of the critical authors.

2. Were critics of calcium channel-blockers more likely than other authors to have financial ties to manufacturers of competing products (beta-blockers, angiotensin-converting-enzyme inhibitors, diuretics, and nitrates). The answer was no. In fact, supportive and neutral authors were more likely than critical authors to have financial ties to manufacturers of competing products (88% and 53% respectively, vs. 37%).

3. Were supporters of calcium-channel blockers more likely than other authors to have financial ties with ANY pharmaceutical manufacturers? The answer was yes. One hundred percent of the supportive authors, compared with 67% of the neutral authors, and 43% of the critical authors, had financial ties to at least one pharmaceutical manufacturer.

The researchers noted that their study relied on self-reported data and therefore probably underestimated the actual ties between scientists and corporate funders.

The authors noted that in only 2 of the 70 articles did authors divulge their connections to corporations. They concluded, "The medical profession has failed to develop and enforce strict guidelines for disclosing conflicts of interest." And, "Full disclosure of relationships between physicians and pharmaceutical manufacturers is necessary to affirm the integrity of the medical profession and maintain public confidence."

Unfortunately, even the columns of the most prestigious medical journal in the U.S. --thE NEW ENGLAND JOURNAL OF MEDICINE (NEJM) --have been infiltrated by corporate shills posing as objective medical experts.

Last November 20th, the NEJM printed a scathing review of Sandra Steingraber's book, LIVING DOWNSTREAM: AN ECOLOGIST LOOKS AT CANCER --a book that, in our opinion, outshines Rachel Carson's SILENT SPRING. (See REHW #565). The review was signed "Jerry H. Berke, M.D., M.P.H., 49 Windsor Ave., Acton, MA 01720" --just the way any unaffiliated medical practitioner would sign such a review.[3]

Berke's review began with an attack on all environmentalists: "An older colleague of mine once suggested that the work product of an environmentalist is controversy. Fear and the threat of unseen, unchosen hazards enhance fund-raising for environmental political organizations and fund environmental research, he suggested." Berke's review went on to say that Steingraber's book is "biased" and "obsessed with environmental pollution." Berke ends, "The objective of LIVING DOWNSTREAM appears ultimately to be controversy."

This was the first negative review Steingraber's book had received. The book is now in its second printing and has been widely praised. Steingraber herself was recently named an "outstanding women of the year" by MS. magazine.

In early December, Bill Ravanesi, a Boston-based film producer, and Paul Brodeur, the well-known author of books on asbestos and electromagnetic radiation, revealed that Jerry H. Berke is director of toxicology for W.R. Grace, one of the world's largest chemical manufacturers and a notorious polluter. Grace is best-known as the company that polluted the drinking water of the town of Woburn, Massachusetts, and later paid $8 million to a group of children (or their surviving parents) who contracted leukemia. During the Woburn investigation, Grace was caught in two felony lies to U.S. Environmental Protection Agency (EPA), for which they paid a slap-on-the-wrist $10,000 fine.[4]

The Woburn story has been told in the best-selling book A CIVIL ACTION and will soon be re-told in a movie starring John Travolta as a hard-working attorney playing David against the Grace Goliath.

For its part, the NEW ENGLAND JOURNAL OF MEDICINE seems flustered and unable to get its story straight. In an interview, Sandra Steingraber said when she first phoned the office of NEJM's book review editor, Robert S. Schwartz, she spoke to Schwartz's assistant, Lisa Lum, who denied that Berke was currently employed by Grace. Lum told Steingraber that Berke was an independent consultant.

When Steingraber phoned back and spoke to Dr. Schwartz himself, Schwartz insisted that he did not know that Berke worked for Grace. Schwartz told Steingraber that reviewers must fill out statements saying they have no conflict of interest, but NEJM does no "background checks" on reviewers.

Schwartz told Steingraber that reviewers are selected from a database of names of people who have expressed an interest in writing book reviews for NEJM. Lisa Lum told me (1/14/98) that the database DOES contain the affiliations of potential reviewers. "Oh, yes," she said, "affiliations are in there." How then did they miss Berke's affiliation? Ms. Lum would not say.

According to Steingraber, recently NEJM has changed its story once again, saying they knew Berke was affiliated with W.R. Grace, but they thought W.R. Grace was a hospital.

Jerry Berke told Michele Landsberg, a columnist for the TORONTO STAR, that (1) the conflict-of-interest form he signed for NEJM clearly identified his Grace connection; (2) all his correspondence from Schwartz was addressed to him at W.R. Grace.[5] Furthermore, Berke was identified as a Grace employee in another book review he published in NEJM in 1995.[6] Nevertheless, Schwartz insists he knew nothing of Berke's connection to Grace and wouldn't have asked him to review Steingraber's book if he HAD known.

Berke says Grace officials decided at the last minute to make him remove his affiliation from the NEJM review.[7] Grace evidently wanted to avoid fueling the anti-Grace flames that will probably erupt when the Travolta movie is released later this year. However, having admitted that his superiors at Grace made him remove Grace's name to avoid obvious controversy, Berke still insists he had no conflict of interest. Berke told columnist Michele Landsberg he is "shocked" that his statement of a "personal vision" should be construed as a conflict of interest.[5]

The editor-in-chief of NEJM, Jerome P. Kassirer, told the Associated Press, "It's laughable that Berke would think that he could write an objective review of the book given that he was an employee of W.R. Grace."[7] Unfortunately, Kassirer himself doesn't always recognize a conflict-of-interest when he sees one. In late 1997, Kassirer turned over the editorial columns of NEJM to Stephen Safe, a researcher who during 1997 was receiving $150,000 (20% of Safe's research budget) from the Chemical Manufacturers Association (CMA).[8] Safe's editorial --like Jerry Berke's review --began with an irrational attack against environmentalism: "Chemophobia, the unreasonable fear of chemicals, is a common public reaction to scientific or media reports suggesting that exposure to various environmental contaminants may pose a threat to health." Surely this is an odd message from a scientist. He is saying, if you fear chemicals because scientific reports indicate that they might harm your health, you are suffering from an irrational phobia. Perhaps Dr. Safe did not write the editorial in his capacity as a scientist. Perhaps he wrote it as an acolyte of the CMA. (See REHW #574.)

In any case Safe himself told BOSTON GLOBE reporter Larry Tye, "I felt a little twinge" about the potential for a conflict of interest when writing the editorial, "but it was not much of a twinge," he said. However, "I can see why people would bring it up," he said. Safe defended himself saying, "There's hardly any life scientist in the country who hasn't had funding from the industry" --the old "Everybody's doing it" defense.

Unfortunately, just about everybody IS doing it. In modern times, it pays to be alert when you are receiving opinions from "unbiased" scientific and medical investigators. As George Annas, professor of health law at the Boston University School of Public Health points out, "Almost all experts in the field at some point have taken grant money or an honorarium from someone." In other words, if you want to understand "objectivity" in the science and medicine of environment-and-health these days, the same advice applies as it does in politics: follow the money. Increased corporate funding of science and medicine has the potential to corrupt almost anyone.

[2] Richard A. Knox, "Study finds conflict in medical reports," BOSTON GLOBE January 8, 1998, A12.

[3] Jerry H. Berke, "Book Review: Living Downstream: An Ecologist Looks at Cancer and the Environment," NEW ENGLAND JOURNAL OF MEDICINE Vol. 337, No. 21 (November 20, 1997), pg. 1562.

[4] Peter B. Lord, "How Important is One Negative Book Review?" PROVIDENCE [Rhode Island] JOURNAL-BULLETIN December 24, 1997, pg. A-1.

[5] Michele Landsberg, "Famed journal's objectivity gets a black eye," TORONTO STAR December 21, 1997, pg. A2.

[6] Jerry H. Berke, "[Book Review] Textbook of Clinical Occupational and Environmental Medicine," NEW ENGLAND JOURNAL OF MEDICINE Vol. 332, No. 5 (February 2, 1995), pgs. 340-341. This review is signed, "Jerry H. Berke, M.D., M.P.H., Lexington, MA 02173 W.R. Grace & Co."

[7] Associated Press, "Medical Journal Apologizes for Ethics Blunder," WASHINGTON POST December 28, 1997, pg. A3..

[8] Larry Tye, "Journal fuels conflict-of-interest debate," BOSTON GLOBE January 6, 1998, pgs. B1, B8.

Descriptor terms: new england journal of medicine; conflict of interest; science; jerry berke; stephen safe; chemical manufacturers association; cma; corporations; sandra steingraber; living downstream; bill ravanesi; paul brodeur; woburn, ma; a civil action;