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ALMOST 2 years since the University of Sydney accepted $1.3 million from vitamins giant Blackmores to fund a new professional chair of integrative medicine, the seat remains vacant, and similar university partnerships face continuing criticism.
In a statement to MJA InSight last week, the University said that the recruitment of a suitable academic to undertake independent research and teaching in the Maurice Blackmore Chair of Integrative Medicine was ongoing and was hoped to be finalised by mid-year.
The University has not commented on the cause of the delay, but MJA InSight understands none of the applicants have been of a high enough calibre, and that the University wants to avoid a controversial appointment after recent furore surrounding industry-funded complementary medicines research at other universities.
Western Sydney University’s National Institute of Complementary Medicine (NICM), which is sponsored by several natural therapies companies, was nominated in 2016 for a Bent Spoon Award by the Australian Skeptics for “continuing to fully support and defend the use of homeopathy and other unbelievable complementary medicines”.
Professor Alan Bensoussan, who heads the NICM, wrote to the Skeptics to withdraw the nomination – a move that backfired after they published his correspondence on their website in December 2016.
Professor Bensoussan told MJA InSight that NICM’s mission was to “rigorously test key complementary medicine interventions and to support the integration of well evidenced treatments”, stressing that this did not include homeopathy.
“NICM has received the highest quality ranking for its research over the past 4 years under the Commonwealth Excellence in Research for Australia scheme,” he added.
Professor Bensoussan noted that industry funding for clinical research was not unique to complementary medicines, adding: “Universities have well established and governed processes for the distribution of these funds and ensuring the integrity of the research outcomes.”
In response to criticisms that NICM overplayed the benefits of natural therapies and downplayed negative results, he commented: “In the early days of researching complementary medicines, it is expected that positive results appear commonly in the literature, as researchers and industry will investigate the most established and promising traditional medicines with long established clinical use.”
“The Nobel prize-winning research into Artemisia annua (qinghaosu) is a good example of the recent validation of a traditional medicine used for centuries in managing malaria,” he added.
Public health academic Dr Ken Harvey, who quit his job at Victoria’s La Trobe University over its $15 million contract with Swisse vitamins in 2014, said he supported “well conducted research into both complementary and conventional medicines”.
However, he added, “some research into complementary medicines has clearly been designed for marketing, not science”.
He gave the example of EASEaCOLD, marketed as “clinically proven to shorten your cold” – a claim he said was not able to be substantiated.
It comes as a study in JAMA Internal Medicine found that financial ties of principal study investigators increased the likelihood of positive outcomes in a random sample of 190 randomised controlled trials of drug efficacy. The prevalence of financial ties of principal investigators was 76% among positive studies and 49% among negative studies. This association remained significant after adjusting for study funding source.
The University of Sydney’s Professor Lisa Bero commented in a linked editorial: “Some company run trials are authored by key opinion leaders with numerous financial ties, who act as window dressing to give a trial scientific credibility.”
She called on trial authors to share their data and participate in industry funded trials only if data were made publicly available. Journals should also reject research by authors unwilling to share their data, she said.
Meanwhile, in a separate commentary in The BMJ this month, Professor Bero and academic Ray Moynihan took aim at patient advocacy groups for their links to industry.
The pair warned that such alliances could “distort the patient voice” and undermine groups’ capacity to fight price gouging. They cited advocacy groups’ silence about EpiPen over-pricing in the US, and new evidence that advocacy groups with funding from opioid manufacturers were more likely to reject guidelines opposed to using opioids for chronic non-cancer pain.
In Australia, patient advocacy groups play a significant role in lobbying the federal government to fund new drugs on the Pharmaceutical Benefits Scheme (PBS) and many receive substantial industry funding.
Painaustralia for example, told MJA InSight that it received $189 000 from pharmacy industry supporters in 2016, representing 30% of its income. Likewise, industry funding made up 37.4% of Lung Foundation Australia’s annual revenue and 25% of Osteoporosis Australia’s.
Each of these groups provided statements to MJA InSight emphasising their transparency and efforts to guard their own independence and prioritise patients’ interests.
Hepatitis Australia was the only advocacy group contacted by MJA InSight which declined to comment. It was part of lobbying efforts leading up to the PBS listing of three curative hepatitis C treatments in March 2016 – now Australia’s most expensive medicines, at a cost of $1 billion in 4 months. Hepatitis Australia’s advocacy at this time did not include publicly lobbying for a reduction in the price of these medicines.
Professor Bero and Mr Moynihan wrote: “Sponsored groups that want to be seen as
independent and credible need to decrease their industry sponsorship and ultimately disentangle, gaining in authority what they lose in resources.”
However, the pharmaceutical industry shows no sign of disengaging from patient advocacy groups. Bristol–Myers Squibb Australia is currently recruiting for the newly created role of Head of Patient Advocacy. The new recruit will ideally have a background in immuno-oncology, according to the job advertisement, with the aim of “driving towards broader and faster patient access to innovative medicines in Australia”.
Medicines Australia and Consumers Health Forum of Australia have jointly developed the Working Together Guide to support positive and responsible relationships between industry and health consumer organisations, with transparency and independence key recommendations.
To find a doctor, or a job, to use GP Desktop and Doctors Health, book and track your CPD, and buy textbooks and guidelines, visit doctorportal.
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We seem to be forgetting an important aspect. Are all industries equal? Will you support the tobacco industry to sponsor research at universities to study the (positive) effects of smoking? Surely not, and yet they are allowed to legally sell their products. The same goes for most of complementary medicine, although the latter might arguably be a bit worse. The long tern effects of smoking is well known whilst some complementary medicines can harm you right away – mainly because of neglect. Both industries are legally selling their products but I would argue that the CM industry is more damaging to the health of the public than smoking – and yet the debate centres around the need for industry sponsorship of universities – I honestly don’t get it. .
Industry funding is necessary in all areas of research, in part because it is far more efficient, and in part because there is only so much public (i.e., tax) funding to go around, particularly in times of growing public debt. Meanwhile USyd should be applauded — it’s an example of the market working when an institution demands quality in its research lest their image (and thus authority) is damaged; those institutions that are not so conscientious and churn out compromised research will have their reputations damaged and be ignored.
The answer to the problems as reported above can only come from regulation and vigilance of research *reporting* methods — journals requiring all author conflicts of interest be reported, the banning of ghost-writing, and implementation of Ben Goldacre’s initiative: “All trials registered, all trials reported” (see alltrials.net).
Meanwhile, government medical funding should be more focussed on the larger prospective trials, like ALLHAT and Framingham, that serve to check the claims of the most popular and costly medical interventions.
One cannot rule out that a key objective of funding the Chair by the company is to link the “Blackmores” brand to one of the oldest academic institutions in Australia and thereby gain credibility to the company’s products and services. The University needs to be mindful that the Chair, if indeed established, will inevitably be used by the company in a variety of communication materials to maximize the “hallo effect” not just in Australia but also in APAC countries in which Blackmores vitamins are being sold. To perform due diligence properly, the Management and the Board must undertake an independent and comprehensive review of the product claims (i.e. purpose of use) developed and used by the company to promote its products to consumers. Such an exercise will reveal the majority of products claims are not substantiated by evidence derived from studies of an appropriate experimental design. It makes no sense for the University of Sydney to receive funding to establish the Maurice Blackmore Chair, a name so closely linked to a leading brand of complementary medicines in Australia, and increasingly so in China, and diminish the reputation of the University that has taken years and long-standing academic excellence to achieve. I suspect research projects being funded in the future will be exploratory (i.e. hypothesis generating) rather than confirmative in nature and there is a high risk of such research being exploited for supporting promotional claims without follow up with confirmative studies. If the Chair is to go ahead, a risk-benefit analysis should be part of the due diligence process and the result of this should be published.
Surely following on from this article MJA InSight should be polling:
“Universities should not form research/financial partnerships with the pharmaceutical, biomedical or complementary medicine industry”
Conflicts of interest regarding Complementary Medicine are a mere drop in the ocean compared to the money invested by industry in mainstream health care.
Just like all stakeholders in health – industry needs to be managed. Disentangle that.