I just came across a recently published study which revealed that SSRIs (the most popular class of antidepressants) can cause gastrointestinal bleeding. The first thing I always do when reading a study is check to see who the authors are, where they receive funding from and who the sponsor is.
So you can imagine my surprise when I learned that this study, which casts antidepressants in an unfavorable light, was sponsored by a large pharmaceutical company (AstraZeneca).
Could drug companies be experiencing a change of heart? A pang of conscience? Could this mark a new era of integrity and honesty in the reporting of results from drug trials?
Not so much.
Being the skeptic that I am, I thought for a moment about why a drug company would sponsor and then publish a study investigating the side effects of antidepressant when the results are so clearly negative? We know from my previous article on conflicts of interest in the medical field that drug companies are under no obligation to publish study results – and often they do not when the results are unfavorable.
Turns out that’s exactly what’s happening here. AstraZeneca is the manufacturer of Nexium, one of the most popularly prescribed medications for heartburn. Nexium works by inhibiting the production of acid in the stomach.
Now, check out how the study was designed. There were three groups. The first group was people taking SSRIs only. The second group was people taking SSRIs and NSAIDs (ibuprofen, aspirin, etc.) and other anti-inflammatory drugs known to be harmful to the stomach lining. The third group took SSRIs along with acid-suppressing agents (agents like Nexium, for example).
People taking the SSRIs were more likely to have G.I. bleeding than people on placebo, and those taking both SSRIs and anti-inflammatory drugs were even more likely to bleed than people on SSRIs alone.
But guess what? Acid suppressing agents (like, um, let’s say… Nexium) were associated with a reduced risk of upper GI bleeding in those taking SSRIs.
We can see where this is leading, right? The solution to the G.I. bleeding caused by SSRIs is not to stop taking the SSRIs. The solution is to take another drug! In this case, a drug that is manufactured by the company who sponsored the study.
A common scenario might be someone takes an SSRI for depression, but it causes anxiety. So the doctor prescribes something for anxiety. Unfortunately, many medications for anxiety also cause constipation. But there’s a pill for that too, which the doctor also prescribes. Then the patient finds they’re getting some acid reflux (a side effect of some of the medicines for constipation), so the doctor prescribes an acid-suppressing agent.
You might be laughing (or crying) as you read this, but I am not exaggerating. This is very often how it works, especially in the elderly who now take an average of 6-8 medications every day.
And this is bound to continue to happen as long as research is primarily sponsored by pharmaceutical companies. The author of the study, Dr. García-Rodríguez, has received “unrestricted research grants from Pfizer Inc., AstraZeneca and Novartis Pharmaceuticals Group”.
There’s no way to prove that Dr. Garcia-Rodriguez’s work is being unduly influenced by his close connection with drug companies. But common sense, as well as many published scientific studies, indicates that this is very likely. For example, several studies have shown that researchers who produce data that is contrary to the interests of the pharmaceutical industry risk legal, professional, or even personal attack – directly or indirectly financed by the industry. (Bosley, 2002; Healy, 2002; Monbiot, 2002).
But they are facing the opposition of a $500 billion dollar industry with more lobbyists than there are members of Congress. It’s not going to be easy.