Altman, Lawrence K. "Hidden Discord Over Right Therapy," New York Times, 24 December

 

Altman, Lawrence K. "Hidden Discord Over Right Therapy," New York Times, 24 December
1991, p. C3.

This Timesman is a physician and his column, if one can call it that, concerns physicians and
their special problems. The storyline taken here, in this telling of a scientific controversy, is that
"medical politics" can affect research.

The study at issue is one that has appeared elsewhere in this file and concerns the clinical
effectiveness of amoxacillin and the drug's use in treatment of pediatric middle-ear infections. In
a report published in The New England Journal of Medicine in 1987, Charles E. Bluestone
concluded that the treatment was effective. However, at that time, there were members of his
team of researchers at the University of Pittsburgh who disagreed. Indeed, they disagreed and
used the same data in their disagreement that Bluestone had used in his original paper.

Bluestone's paper, and a dissenting report by Erdem I. Cantekin, were both submitted for
publication in 1987 within weeks of one another. The editor, Arnold S. Relman, viewed the
dispute between the authors as one of property and asked the University to decide who was
"primarily responsible" for the data. The University and Children's Hospital told Relman that the
data were Bluestone's. Relman thereupon rejected the article submitted by Cantekin.

For his whistle-blowing, Cantekin paid a heavy price: he was fired by the research center. It was
"institutional hierarchy" not the patients, not the research enterprise, and certainly not the quality
of science.

What has emerged in this case is that Bluestone had received grants and research funds from drug
companies involved in his research. The OSIR has found "the appearance of conflict of interest."
How much is involved? Bluestone received $260,000 in honoraria and $3.5 million is research
funds.

What also emerged in this case is that Catekin's degree is a degree in engineering and not in
medicine. In this case, the profession carped that he was not a medical doctor.

In explaining why it has only now published Catekin's report (December, 1991) Altman
suggests, "The extroardinary delay in publishing Dr. Catekin's report also highlights several
important points about medical politics: academia's surprising aversion to dissent; the strong ties
between scientific journals, academia and the drug industry; professional jealousies over
credentials, and the unresolved issue of how and when critics can use data from publicly financed
studied in which they participat."

"Academia, scientific journals, practicing doctors and industry are heavily interdependent.

"Journal are a natural outlet for researchers who want to report advances and new findings, some
of which can have strategic importance to practicing doctors and patients.

"Journals also play a crucial role in academic politics. Faculty promotions in medical schools are
often geared to publication in prestigious journals. Editors of journals generally come from the
ranks of academia.

"Leading scientific journals profvit handsomely from drug company advertisements, and the
influence of industry on such publications has rarely been studied.

Good editors should welcome controversy because it can be so instructive buyt editors tend to
consider themselves as profesors, not journalists, and they seldom take the initiative in reporting
academic disputes like the one in Pittsburgh."

This whole story is instructive: "The affair exposes the disagreement that often lies hidden
behind standard therapies and a greater degfree of uncertainty about them than the medical
profession is often willing to acknowledge.