Ted.Harding writes " Details of the steps being taken by the Lancet
BMJ, JAMA etc. to see that "the researchers involved
are guaranteed scientific independence", failing which
"Medical editors around the world will now refuse from
next month to print drug-company sponsored studies"?
That looks after that in some ways
But not all motivated research, is sponsored by drug companies.
I write this to see if the real experts on this list agree with me.
In a market economy goods are sold at prices that cover cost of
production and also yield profit to the manufacturers but which is
yet competitive in the market. Buyers evaluate cost benefit to
themselves and decide whether to buy or not to buy.
If buyers are few prices come down. If the selling price a commodity
commands is less than its cost for manufacture, the commodity
fades out of the market.
The case of vaccine manufacturers is unique - they have broken
lose from these market imperatives - using a subtle but potent
form of blackmail. They have convinced organizations like the WHO
that vaccine research is expensive and that new investment
in vaccine research can be expected only if good returns are
demonstrated in the uptake of recently produced vaccine.
The onus of demonstrating cost benefit shifted from the
manufacturer to the consumer - organizations like the WHO
If benefits do not match costs, benefits are exaggerated,
to convince nations to utilize vaccines. As an illustration I use
an article that appeared in The Journal of Health Economics 2000; 9: 19-35
(Miller MA etal of Children's Vaccine Initiative WHO Geneva).
The highest rate of hepatocellular carcinoma (HCC) related to Hepatitis B
is reported among Taiwanese males - 495 per 100,000 carrier years
(Beaslet RP 1988 Cancer 61:1942-56) The author states in the same article,
that this is 3 or 4 times the incidence of HCC in women, although the
carrier rate of Hepatitis B is the same in both sexes in Taiwan.
Taken as a whole, in a population made up equally of men and women, the
rate of HCC in
Taiwan is about 320/100,000 carrier years. The rate in Japan is 240
(Sakuma K etal 1988 Hepatology ; 8:1642-64).
In Alaska it is 256 (McMohan BJ etal 1990 Arch of Int Med ;150:1051-4) and in
Montreal, Canada it was 0 (Villeneuve J-P et al 1994 Gastroenterology
When there is such variability in the incidence of HCC ranging
from 320/100000 in Taiwan to 0 in Canada, what figures are used to
project benefits of the vaccine? The authors (Miller MA et al 2000)
use the rate of 495/100 000 for their calculations
( 20 - 28% of carriers will die at age 45 - Table 1 footnote)
My question to the list is - Am I unfairly biased from my penny-pinching
Third World perspective or is this an instance of the misuse of health
Residence eMail: [log in to unmask]
Residence Phone: 00-91-11-2946388
Efax UK 07092-124285
Work Phone: 00-91-11-3966021 to 27
Jacob M. Puliyel
Department of Pediatrics
St Stephens Hospital
Sara Varughese FRCS
Dept. of Ophthalmology
St Stephens Hospital