Science, politics, and health in the brave new world of pharmaceutical carcinogenic risk assessment: technical progress or cycle of regulatory capture?

Are Corporations Re-Defining Illness and Health? The Diabetes Epidemic, Goal Numbers, and Blockbuster Drugs

While pharmaceutical industry involvement in producing, interpreting, and regulating medical knowledge and practice is widely accepted and believed to promote medical innovation, industry-favouring biases may result in prioritizing corporate profit above public health. Using diabetes as our example, we review successive changes over forty years in screening, diagnosis, and treatment guidelines for type 2 diabetes and prediabetes, which have dramatically expanded the population prescribed diabetes drugs, generating a billion-dollar market. We argue that these guideline recommendations have emerged under pervasive industry influence and persisted, despite weak evidence for their health benefits and indications of serious adverse effects associated with many of the drugs they recommend. We consider pharmaceutical industry conflicts of interest in some of the research and publications supporting these revisions, and in related standard-setting committees and oversight panels. We raise concern over the long-term impact of these multifaceted involvements. Rather than accept industry conflicts of interest as normal, needing only to be monitored and managed, we suggest challenging that normalcy, and ask: what are the real costs of tolerating such industry participation? We urge the development of a broader focus to fully understand and curtail the systemic nature of industry's influence over medical knowledge and practice.

Regulatory Capture in Pharmaceutical Policy Making: The Case of National Medicine Agencies Related to the EU Falsified Medicines Directive

BACKGROUND

Regulatory capture describes the phenomenon in which regulators (e.g. medical agencies) protect the interest of the companies they regulate rather than the interest of the public. Not much is known about the mechanisms of this potential threat within the area of pharmaceutical regulation.

OBJECTIVES

Through a comparison of two EU member states, the Netherlands and Denmark, this study aimed to investigate how regulatory capture could exist in pharmaceutical regulation. The EU Falsified Medicines Directive was used as the case, as it provided an opportunity for national medicine agencies to interact with various stakeholders.

METHODS

The processes of negotiation and implementation of the directive were mapped by interviewing 23 stakeholder representatives and triangulated with relevant documents. A meaning condensation method was applied to show how stakeholders were involved with authorities, and the theory of regulatory capture was used to interpret how the two countries were susceptible to capture.

RESULTS

The Danish Medical Agency was central in all relevant processes, whereas in the Netherlands, the Ministry of Health initiated the processes during the negotiation phase and, subsequently, three medical agencies shared responsibilities in the implementation phase. During the negotiation phase, the Dutch process was more focused on consensus among stakeholders while the Danish process focused on preparing the subsequent implementation. Neither member state prioritised transparency during implementation, but rather focused on timely implementation.

CONCLUSIONS

The processes of EU negotiations and implementation of the Falsified Medicines Directive were handled quite differently in Denmark and the Netherlands. It is possible that regulatory capture could be prevalent in both member states as policy makers were only in limited dialogue with patients. EU countries must decide whether this technocratic approach is acceptable, or whether they should make a more concerted effort to include the public.

The sociology of cancer: a decade of research

Biomedicine is often presented as the driving force behind improvements in cancer care, with genomics the latest innovation poised to change the meaning, diagnosis, treatment, prevention and lived experience of cancer. Reviewing sociological analyses of a diversity of patient and practitioner experiences and accounts of cancer during the last decade (2007-17), we explore the experiences of, approaches to and understandings of cancer in this period. We identify three key areas of focus: (i) cancer patient experiences and identities; (ii) cancer risk and responsibilities and (iii) bioclinical collectives. We explore these sociological studies of societal and biomedical developments and how sociologists have sought to influence developments in cancer identities, care and research. We end by suggesting that we extend our understanding of innovations in the fields of cancer research to take better account of these wider social and cultural innovations, together with patients, activists' and sociologists' contributions therein.

The potential ecotoxicological impact of pharmaceutical and personal care products on humans and freshwater, based on USEtox™ characterization factors. A Spanish case study of toxicity impact scores

Pharmaceutical and personal care products (PPCPs) are being increasingly included in Life Cycle Assessment studies (LCAs) since they have brought into evidence both human and ecological adverse effects due to their presence in different environmental compartments, wastewater facilities and industry. Therefore, the main goal of this research was to estimate the characterization factors (CFs) of 27 PPCPs widely used worldwide in order to incorporate their values into Life Cycle Impact Assessment studies (LCIA) or to generate a toxicity impact score ranking. Physicochemical properties, degradation rates, bioaccumulation, ecotoxicity and human health effects were collected from experimental data, recognized databases or estimated using EPI Suite™ and the USEtox™ software, and were subsequently used for estimating CFs. In addition, a Spanish toxicity impact score ranking was carried out for 49 PPCPs using the 27 newly calculated CFs, and 22 CFs already available in the literature, besides the data related to the occurrence of PPCPs in the environment in Spain. It has been highlighted that emissions into the continental freshwater compartment showed the highest CFs values for human effects (ranging from 10^-9 to 10^-3Cases·kg^-1), followed by emissions into the air (10^-9 to 10^-5Cases·kg^-1), soil (10^-11 to 10⁵Cases·kg^-1) and seawater (10^-12 to 10^-4Cases·kg^-1). CFs regarding the affectation of freshwater aquatic environments were the highest of those proceeding from emissions into continental freshwater (between 1 to 10⁴PAF·m³·day·kg_emission^-1) due to the direct contact between the source of emission and the compartment affected, followed by soil (among 10^-1 to 10⁴PAF·m³·day·kg_emission^-1), and air (among 10^-2 to 10⁴PAF·m³·day·kg_emission^-1) while the lowest were the CFs of continental seawater (among 10^-28 to 10^-3PAF·m³·day·kg_emission^-1). Freshwater aquatic ecotoxicological CFs are much higher than human toxicity CFs, demonstrating that the ecological impact of PPCPs in aquatic environments must be a matter of urgent attention. According to the Spanish toxicity impact score calculated, the PPCPs with the highest impact are hormones, antidepressants, fragrances, antibiotics, angiotensin receptor blockers and blood lipid regulators, which have already been found in other kinds of score rankings. These results, which were not available until now, will be useful in order to perform better LCIA studies, incorporating the micro-pollutants whose CFs have been estimated, or in order to carry out single hazard/risk environmental impact assessments.

Can animal data translate to innovations necessary for a new era of patient-centred and individualised healthcare? Bias in preclinical animal research

Background

The public and healthcare workers have a high expectation of animal research which they perceive as necessary to predict the safety and efficacy of drugs before testing in clinical trials. However, the expectation is not always realised and there is evidence that the research often fails to stand up to scientific scrutiny and its 'predictive value' is either weak or absent.

Discussion

Problems with the use of animals as models of humans arise from a variety of biases and systemic failures including: 1) bias and poor practice in research methodology and data analysis; 2) lack of transparency in scientific assessment and regulation of the research; 3) long-term denial of weaknesses in cross-species translation; 4) profit-driven motives overriding patient interests; 5) lack of accountability of expenditure on animal research; 6) reductionist-materialism in science which tends to dictate scientific inquiry and control the direction of funding in biomedical research.

Summary

Bias in animal research needs to be addressed before medical research and healthcare decision-making can be more evidence-based. Research funding may be misdirected on studying 'disease mechanisms' in animals that cannot be replicated outside tightly controlled laboratory conditions, and without sufficient critical evaluation animal research may divert attention away from avenues of research that hold promise for human health. The potential for harm to patients and trial volunteers from reliance on biased animal data¹ requires measures to improve its conduct, regulation and analysis. This article draws attention to a few of the many forms of bias in animal research that have come to light in the last decade and offers a strategy incorporating ten recommendations stated at the end of each section on bias. The proposals need development through open debate and subsequent rigorous implementation so that reviewers may determine the value of animal research to human health. The 10Rs + are protected by a Creative Commons Attribution 3.0 Unported License and therefore may be 'shared, remixed or built on, even commercially, so long as attributed by giving appropriate credit with a link to the license, and indicate if changes were made.’

Electronic supplementary material

The online version of this article (doi:10.1186/s12910-015-0043-7) contains supplementary material, which is available to authorized users.

Divergence and convergence of commercial and scientific priorities in drug development: The case of Zelmid, the first SSRI antidepressant

Based on a realist conceptualization of interests, this paper explores how commercial and scientific priorities appear to have converged and diverged during the development of the antidepressant Zelmid. The drug represents the first of the selective serotonin reuptake inhibitors (SSRIs) to reach the market. Zelmid was synthesized in 1971 and launched by the Swedish firm Astra in 1982, but subsequently withdrawn the next year because of adverse neurological effects. This paper draws on in-depth interviews with scientists representing both industry and academia who had high-level involvement in various phases of the project (experimental, pre-clinical and clinical), as well as on textual sources such as scientific articles and memoirs. Zelmid was a product of mechanism-based or "rational" drug discovery from the early 1960s and the associated intermingling of science and commerce. It is argued that both scientists and the pharmaceutical company shared an interest in embracing mechanism-based drug discovery because it simultaneously promised medico-scientific advances and profits. However, the intermingling of science and commerce also strained the relationship between scientific and commercial priorities further along the trajectory of the drug; for example, concerning issues such as dosage strategy and drug use in primary care, where corporate management allegedly took decisions contrary to the recommendations of both academic and company scientists. On such occasions the asymmetry in power became apparent in scientists' narratives: commercial considerations trumped those of science since, ultimately, decisions rest with management, not with scientists. In addition, temporality appears to be associated with the divergence of commercial and scientific priorities. While rare during experimental and pre-clinical phases, divergence was concentrated downstream to the clinical testing and post-marketing phases. It is hypothesized that a similar pattern of convergence and divergence of commercial and scientific priorities may exist in the trajectory of other drugs.