good news…

Posted on Tuesday 26 February 2013

While the details aren’t totally clear to me, Pharmalot is reporting a red letter day for the cause of Clinical Trial transparency. Tamiflu, a treatment to ameliorate the intensity of flu symptoms has been stockpiled to the tunes of billions of dollars in anticipation of a flu epidemic. When the Cochrane Group wanted to do a meta-analysis of the trial data, Roche balked and wouldn’t release the patient level data. A campaign by the Cochrane Group, Peter Doshi and Tom Jefferson [see below], Fiona Godlee at the BMJ, Ben Goldacre, almost everyone else in their right mind, and the subsequent AllTrials petition seems to be finally paying off:
Roche Peels Back The Curtain On Clinical Trial Data
By Ed Silverman
February 26th, 2013

In response to enormous criticism over its handling of Tamiflu clinical trial data, Roche announced a new plan to increase access to such information and its approach mimics steps begun recently by GlaxoSmithKline. Specifically, Roche will work with an “independent” group of “recognized experts” to evaluate and approve requests to access patient-level data and will also support the release of case study reports for all of its licensed medicines.

The move comes after Roche found itself in a heated row with researchers at the Cochrane Collaboration, who two years ago complained they were repeatedly stymied in their efforts to fully assess up-to-date efficacy information for the influenza treatment. More recent attempts to obtain data prompted a response from the drugmaker that critics called stonewalling. Roche then responded with a compromise offer to form a multi-party advisory board for determining which data should be accessed, but that went nowhere [back story].

“We understand and support calls for our industry to be more transparent about clinical trial data with the aim of meeting the best interests of patients and medicine,” Daniel O’Day, the chief operating officer at Roche Pharma, says in a statement. “At the same time, we firmly believe that health authorities need to remain the gatekeeper for drug assessment and approval. We believe we have found a way in which patient data can be provided to third party researchers in a legitimate environment that ensures patient confidentiality and avoids the risk of publishing misleading results or giving rise to public health scares and consequences”…
Last year, Peter Doshi and Tom Jefferson had this to say:
Drug Data Shouldn’t Be Secret
New York Times
April 10, 2012

In the fall of 2009, at the height of fears over swine flu, our research group discovered that a majority of clinical trial data for the anti-influenza drug Tamiflu — data that proved, according to its manufacturer, that the drug reduced the risk of hospitalization, serious complications and transmission — were missing, unpublished and inaccessible to the research community. From what we could tell from the limited clinical data that had been published in medical journals, the country’s most widely used and heavily stockpiled influenza drug appeared no more effective than aspirin. After we published this finding in the British Medical Journal at the end of that year, Tamiflu’s manufacturer, Roche, announced that it would release internal reports to back up its claims that the drug was effective in reducing the complications of influenza. Roche promised access to data from 10 clinical trials, 8 of which had not been published a decade after completion, representing more than 4,000 patients from every continent except Antarctica. Independent verification of the data seemed imminent. But more than two years later, and despite repeated requests, we have yet to receive even a single full trial report. Instead, the manufacturer released portions of the reports, most likely a very small percentage of the total pages. [One of us, Tom Jefferson, has been retained as an expert witness in a lawsuit relating to some of these issues].

This is entirely within Roche’s rights. After all, regulators have never required drug or medical device manufacturers to share their data with independent researchers or academics. They are required to show the information only to the regulators themselves, who treat the data as secret. Some may argue that, because the Food and Drug Administration approves drugs for the United States market based on these data, this is not a major cause for concern. But the actual use of drugs is often driven by assumptions about drug safety and effectiveness put forth by articles in peer-reviewed journals [sometimes written by doctors affiliated with the drug manufacturers] and clinical practice guidelines that can be entirely inconsistent with the F.D.A.’s assessments…

The only agency in the United States that seems to have independently reviewed the original trial data never made these claims. The F.D.A.’s conclusion — which it required Roche to print on Tamiflu’s product labeling — is that “Tamiflu has not been shown to prevent” complications like serious bacterial infections [for instance, pneumonia]. It seems that federal agencies like the C.D.C. and H.H.S., instead of conducting an independent evaluation of Tamiflu, advocated stockpiling by referencing claims in journal publications written by the drug’s manufacturer, ignoring the F.D.A.’s assessment that those very claims were unproven. Why would they do this? Unwarranted trust in the peer-review process of medical journals probably has something to do with it. So, too, does wishful thinking; lacking good alternatives, it’s tempting to hope that the drug we have works wonders. And it’s important to remember that correcting the statements of medical journals or public health agencies falls outside the F.D.A.’s jurisdiction — when it comes to drugs, the F.D.A. is responsible for regulating industry, not other government agencies…

Nevertheless, the data point to a drug of minimal benefit. In accordance with the F.D.A.’s findings, it appears to shave a day off the duration of influenza symptoms, but we found no decrease in risk of hospitalization and no evidence that it could stop the spread of the virus. More worrisome, we found suggestive evidence that Tamiflu interfered with the body’s ability to produce antibodies against influenza — which could affect the body’s response to influenza vaccine and its ability to fight off future influenza infections. But to do a complete analysis, including evaluating Tamiflu’s potential harms, we need the remainder of the data — the full “clinical study report” — promised by Roche, but never delivered.

In response to our conclusions, which we published in January, the C.D.C. defended its stance by once again pointing to Roche’s analyses. This is not the way medical science should progress. Data secrecy is a disservice to those who volunteer their bodies for clinical trials, and is dangerous to those being asked to swallow approved medicines. Governments need to become better stewards of the scientific process. The European regulator’s announced intention to release clinical study reports after it finishes reviewing a manufacturer’s application is an important precedent. But the F.D.A. — guardian of arguably more trial data than any other entity in the world — appears stuck in the era of data secrecy. We should not have to wait for patients to be hurt by the medications they take, as recently happened with the diabetes drug Avandia, before reviewing this wealth of data.
And Peter Doshi also had something to do with GSK finally publishing the Paxil Study 329 subject level data [a movement…]. As much time as we’ve spent decrying the abortive DSM-5 effort, the Clinical Trial transparency trumps it in importance. Without all the voodoo trial publications, the corrupt side of psychopharmacology would have been stopped in its tracks and we might have some clarity in understanding these psychoactive drugs more clearly.  The movement in the Tamiflu story is the best of news, and a real sign that all the various campaigns are bearing fruit at last…
    berit bj
    February 27, 2013 | 3:48 AM

    “Governments need to become better stewards of the scientific process.”
    Amen to that, to transparancy and prison for culprits selling drugs of minimal benefit and unknown harm for billions and billions – cheating vulnerable populations and the public coffers.
    A doctor hospitalized in Bodö was offered Tamiflu the other day, as they had an outbreak of influenza. She declined, chose to be discharged instead.
    Governments, independent researchers and law enforcement must bring the global racketeers to justice and jail. Or are they too big to fall…?

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