[Cz-biology] Merck proposal

[Anthony Sebastian]

All,

I agree with Gareth when he writes: "Personally, for article development at
least, I would expect that link to be a very valuable starting point for
authors, to cross check the comprehensiveness and accuracy of the CZ
article."

I've also made that point.  I add only that, for the general reader, we
mention that the Merck Manual articles we link contain no citations to the
evidence underlying their assertions and that a for-profit company sponsors
the articles.

I have used the Merck Manual articles for my own educational program for
many years, and have benefitted. 

Anthony.Sebastian


-----Original Message-----
From: cz-biology-bounces at mail.citizendium.org
[mailto:cz-biology-bounces at mail.citizendium.org] On Behalf Of Gareth Leng
Sent: Thursday, November 01, 2007 5:02 AM
To: Biology Workgroup List
Subject: Re: [Cz-biology] Merck proposal

I think we need some reality check here. As I understand it we're not  
talking about using pharmaceutical company text in articles, but about  
adding, to relevant articles, systematically external links to  
material published in a very large and well respected compendium. If  
we don't like any particular link we can simply delete that link, the  
default would be inclusion. Personally, for article development at  
least, I would expect that link to be a very valuable starting point  
for authors, to cross check the comprehensiveness and accuracy of the  
CZ article.

I've declared a conflict of interest, my own respect for (and former  
collaboration with) particular Merck research scientists. Of course  
its a company and if the pharmaceutical industry didn't put commercial  
sussess first we wouldn't have large and successful companies  
generating new drugs. What is forgotten is that the scale of pure  
research within the pharmaceutical industry is vast, and Merck is a  
company that employs (literally) thousands of post docs on basic  
research. These are massive research enterprises, there is a huge  
pyramid of basic research (and hundreds of millions of dollars spent  
on research) underneath every single new drug that emerges. These  
people are not salesmen, - only when the R and D job is done and  
there's a product do the salesmen come in. My point is that thinking  
of Merck as about selling drugs is only a part - the Merck manuals  
aren't sales literature, but literature in support of the R and D, and  
it just has to be good.

Actually, we all have conflicts of interest - we may promote  
particular models of medicine that we happen to be a part of,  
particular models of education - I promote the value and importance of  
fundamental research: that is what I do, and of course I will benefit  
directly or indirectly if the Government funds more of it.

Ethical issues are tough, and in this case multifacetted. Merck (and  
the FDA equally) have been heavily criticised over Vioxx  e.g.  
(http://pmid.us/15470193 <http://pmid.us/15470193> ), this though in  
my view smacks of hindsight, and criticism on some specific technical  
issues (e.g. non inclusion of adverse events that occurred after the  
scheduled trial from the overall statistical analysis) is just  
wrongheaded. Merck withdrew Vioxx voluntarily, however  although Vioxx  
clearly has a greater cardiovascular risk, it also has clear benefits,  
and overall the risk/benefit ratio is not clear. The current  
regulatory advice in the US (FDA) and Canada supports continued  
marketting of Vioxx (  
http://www.fda.gov/ohrms/dockets/ac/05/minutes/2005-4090M1_Final.htm).  
Accordingly it could be argued that Merck is acting unethically in  
continuing to withold Vioxx.

This is not a general defence of pharma. There are many examples of  
outrageously unethical behaviour; notably involving collusion with  
clinicians and (usually) clinical scientists. The blame is not just  
with pharma, but also lies within our own ranks here


So these are complex issues. It's tempting to see pharma links as  
commercially compromised, and we tend not to recognise other conflicts  
of interest in ourselves, but medicine and education too are  
businesses, and have business interests even when funded publicly. The  
fact is that industry is also a massive source of R and D and  
knowledge, and in some areas is a resource that dwarfs that of  
academic research. Sometimes we (academics) need humility in seeing  
that we are not the only experts, and not the only ones with white  
hats, and sometimes our own hats are not so white...




Gareth Leng
Professor of Experimental Physiology
Centre for Integrative Physiology
School of Biomedical Sciences
University of Edinburgh College of Medicine and Veterinary Sciences
Hugh Robson Building
George Square
Edinburgh EH8 9XD UK

-- 
The University of Edinburgh is a charitable body, registered in
Scotland, with registration number SC005336.


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