I don't blog much about conflicts of interest and the ethics of clinical research (outside of the therapeutic misconception), though my professional work and some of my writing implicate relevant issues in both. In any case, the cast at Health Care Renewal Blog and Dr. Howard Brody, at the Hooked Blog, address the discourse better than I could hope to, especially because the medical humanities are (obviously) larger than this particular set of issues.
But the discourse is one central to thinking about Plato's question in clinical practice and in research: how should we live? The Renaissance humanists, of course, opposed the burgeoning neo-Platonic movement, and sought not metaphysical comfort but guidance in living virtuously amidst the ambiguity and uncertainty of intricate social practices.
That aside, Roy Poses has an excellent post following up the initial concern voiced over problems with the ENHANCE trial of ezetimibe
and how the trial was designed and implemented seemed meant to increase the likelihood of a favorable result for the sponsors' interests. Particularly controversial was the sponsors' decision to change the definition of the trial's outcome variable after the data was collected. That decision was then reversed.
Indeed, the shifting goalposts is a marker of significant ethical concern. Poses continues with the latest developments:
Today, Matthew Herper, writing in Forbes, described how the decision to change the outcome variable was made. First, the decision was made apparently entirely without any involvement by the ostensible principal investigator of the study.
[ . . . ]
Next, Herper listed the members of the supposedly independent panel.
[. . . ]
But all five panel members had other financial arrangements with multiple pharmaceutical companies, and three had other financial arrangements with Merck, or both Merck and Schering-Plough.
Troubling, but not necessarily surprising developments. Go read the whole post.
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