This interchange and its "Big Pharma" riff suggests other variations on the original theme of "Best of..."
One is that perhaps we should all remember Voltaire's "The best is the enemy of the good." (Le meilleur est l'ennemi du bon.)
Another - Whatever the percent of research and publication that has no pharmaceutical backing, there are diverse reasons. One may be the most obvious, that the issue has little or nothing to do with Rx treatment. Alternatively, the pharmaceutical agent concerned may be so inexpensive to make that little to no profit is projected, or even cost recovery of research investment. It has been suggested that one reason that peri-conception folic acid prophylaxis against neural tube defects has been so slow to penetrate public knowledge and behaviour is that no pharmaceutical company can afford to invest in its advertising as the stuff is so cheap to produce. In contrast, just about every pregnant woman in the northern hemisphere has been convinced that they need "prenatal vitamins", regardless of diet and personal circumstances, and their care providers probably believe so as well. But the evidence suggests that all that results in for most of them is expensive urine. Why the difference? Profit and marketing.
At least in Canada, regular strength "ASA" can be bought cheaper than borscht. Not so for "mini" strength though, now widely marketed for prophylaxis in middle aged types such as myself for fatal MI prophylaxis. 81 mg, even in bulk, costs much more than 325 mg and cleverly, nobody is producting the latter in tabs that can be broken into quarters. Why the difference? Profit and marketing.
In counterpoint, there are consistent undertones in this string and elsewhere that pharmaceutical companies are intrinsically evil. Consider what John le Carré did with this theme in The Constant Gardener, ramped up in the Hollywood-ized version, Oscars and al. I am not sufficiently naive to suggest that for profit motivation whether in drug production or anywhere else does not corrupt motives and practices. Vigilance, including self-vigilance, by all means. But season it with reason. Not all pharmaceutical companies, even the big ones, have plants located on the moral outskirts of Bhopal.
Winnipeg, Manitoba, Canada
(Manitoba partially funded, and Winnipeg had two brief scenes in Constant Gardener, and Capote was filmed completely here, for readers' unlikely interest)
(and Brokeback Mountain was filmed in Alberta)
>>> Paul Glasziou <[log in to unmask]> 3/9/2006 12:56 AM >>>
Good question. The pharmaceutical companies do
invest *much* more in research than government
and not-for-profit groups (in the UK this is
about 5:1). However, often the research is me-to
or marketing research that doesn't answer our
clinical questions. So the research relevant to
clinicians may be better balanced. I can't tell
you how many of the 20,000 new randomised trials
published each year are non-pharmaceutical
interventions, but in a review of things we
picked for the EBM journal we found about a 50:50
split over 3 years. The split we found is similar
to the split you can find in Figure 3 of a recent
UK analysis of non-commercial trials:
Chalmers I, Rounding C, Lock K. Descriptive
survey of non-commercial randomised controlled
trials in the United Kingdom, 1980-2002. BMJ. 2003 Nov 1;327(7422):1017.
Philip F. Hall, MD BScMed FRCSC
Professor, Faculty of Medicine, University of Manitoba
Director, Fetal Assessment, Manitoba Obstetric Outreach and Maternal-Fetal Medicine Programs
President of Medical Staff
St.Boniface General Hospital, 409 Tache Avenue D2044
Winnipeg, Manitoba, Canada R2H 2A6
ph 204-237-2547 FAX 204-233-1751
(Past Chair, Obs & Gyn Specialty Committee,
Royal College of Physicians & Surgeons of Canada)
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