Silver Bullet Awards: the winners

OK the judges have finished their deliberations, all the votes are in and it is time to roll out the blushing red carpet of shame and announce the worthy winner of this year’s Silver Bullet for the most egregious medical quackery.

 Many thanks to all of you who took time out from your busy on-line lives to vote, although I’m sorry none of you ticked my favourite for sheer barefaced cheek – the makers of the old Alzheimer’s drug Aricept, who massively boosted profits simply by putting out higher dose pill that came with extra side-effects.  This was apparently worth a three year extension of the about-to-expire patent.

Runner up with a quarter of the total votes was Roche makers of Tamiflu the flu treatment whose full unpublished  results of various trials have been hidden from prying eyes for over three years despite repeated requests they be revealed.

In the meantime the company earned billions from peddling a drug that, quite possibly when all the data does see the light, will be shown to be almost totally ineffective. Perhaps I should have mentioned that Donald Rumsfeld has been, and may still be, a major stakeholder.

And now the winner by a significant margin – getting over 50 per cent of the votes – is the three companies who were fined an astonishing total of 6 billion dollars for illegal marketing and other misdemeanours.

 Hucksters selling rancid meat

The lawsuits that caught them – all in America – depended heavily on the testimony and documents supplied by whistle-blowers, who then get a cut of the fines/damages which can run into tens of millions of dollars.  What I particularly like about these cases is that they are filed under a federal law originally intended to stop Civil War hucksters from selling rancid meat to the Union Army by paying bounties to tipsters.

There is clearly a lesson here for the government struggling to ensure that the horrors of Mid Staffs hospitals aren’t repeated. They’ve taken the first step by outlawing gagging clauses on staff who are paid off but if they want rapid and detailed accounts of uncaring care they need to start offering proper bounties to tipsters, supported by court cases involving massive damages.

So come up on stage Abbot, GlaxoSmithKline and Johnson and Johnson. Silver Bullets are of course a bit magical so don’t worry that a single one won’t be able to dispatch each of you quickly and cleanly, which can’t be said for all the recipients of your drugs.

Since the award was announced a couple of months ago there has been no shortage of new contenders. One reader suggested that the anti-inflammatory drug Vioxx taken off the market in 2004 after it was found to double the risk of heart problems – including death. The company Roche (again) was not entirely straightforward about this problem and has paid out billions in compensation – none in the UK though.

  Household drug can double heart disease risk

But that was just too long ago and too familiar. However there is another anti-inflammatory painkiller (NSAID) that is still very much on the market that also doubles the risk of heart disease in some patients. It’s called Diclofenac and a study last month called for its withdrawal.

If you start taking diclofenac after you have had a heart attack your risk of having another one goes up. The point of the recent paper was that the sensible thing would be to use another NSAID, which doesn’t have the risk. It’s quite a complicated story that I’ll be writing more about soon but it certainly seems like a worthy contestant.

I’ve also been wondering if we don’t need another award based on the famous Golden Fleece handed out by the redoubtable American Senator William Proxmire between 1975 and 1987 for particularly striking examples of wasteful government spending. Examples include 84,000 dollars to find out why people fall in love or 500,000  dollars for research into the conditions under which rats and monkeys clench their jaws.

The idea was prompted by an interview in the magazine CancerWorld  with Professor Richard Sullivan of Guys Hospital, London in which he pointed out that around 80% of research funding for cancer goes on basic biological research and drug development.

“However the public health benefit of all cancer drugs compared to other primary modalities,” he says “is just 20%.” And it’s not just cancer. “There are now 624 new molecular entities currently in phase I to III trials in high income countries. That is an unbelievable number.”  Sullivan is Professor of Cancer Policy and Global Health at the King’s Health Partners Integrated Centre.

 Pharma Fleece award

The idea would be to highlight the mismatch between the fact that most of our big killer diseases are now the result of lifestyle but research is heavily focused on drugs to deal with the symptoms. The award could be called The Pharma Fleece.

The hard part, of course, would be spotting which basic research wasn’t worthwhile. A recent example is ongoing  research into the workings of a molecule known as MC4R that is involved in regulating not only how hungry you are but also insulin production and blood pressure. A mutation in the MC4R gene can cause both obesity and type 2 diabetes.  The paper came with the usual promise that this could lead to “safe therapies to treat obesity and related conditions”.

Well maybe, but if experience obesity and diabetes drugs so far is anything to go by tinkering with such a major player in your metabolism is likely to have lots of unwanted side effects. The billion or so needed to bring a Mc4R drug to market could fund a huge amount of research into working out the most effective life-style combinations and how best to apply them.