By Terry A. Rondberg
A new study published by JAMA shows that among patients age 65 years and older, rosiglitazone (a medication for treating Type 2 diabetes) is associated with an increased risk of stroke, heart failure, and all-cause mortality (death) when compared with pioglitazone (another medication for diabetes).
In their conclusion, the authors wrote: “…in a population of more than 227,000 patients 65 years or older who initiated treatment with a thiazolidinedione, we found that, compared with pioglitazone, rosiglitazone was associated with an increased risk of stroke, heart failure, and death and the composite of AMI (heart attack), stroke, heart failure or death.” (JAMA.doi:10.1001/jama.2010.954)
Despite trying to put rosiglitazone in the most “favorable” light possible, researchers had to admit that “analysis showed no differences in the risk for heart attack between rosiglitazone and pioglitazone,” even though the study found that rosiglitazone was associated with a 1.25-fold increase in risk of heart failure compared with pioglitazone.
Obviously, BOTH medications have serious negative side effects, but the report’s wording seems somewhat biased to me so I delved a little deeper. Within the past five years, the study’s head researcher, Steven E. Nissen, MD, has received research support from numerous drug companies, including AstraZeneca, Atherogenics, Novartis, Pfizer, Resverlogix, Daiichi-Sankyo, Sanofi-Aventis and — most importantly — Eli Lilly and Takeda.
The drug that fared better in this study (branded name Actos) is manufactured by Eli Lilly and Takeda. Avandia, the branded version of rosiglitazone, is made by GlaxoSmithKline, a name curiously absent from the list of Nissen’s financial benefactors.
Probably just a coincidence, right? Yet, only this month, the BMJ (which used to be called British Medical Journal) published a report that explored a possible link between authors’ financial conflicts of interest and their position on the association of rosiglitazone with increased risk of myocardial infarction in patients with diabetes.
The research abstract noted: “Of the 202 included articles, 108 (53%) had a conflict of interest statement. Ninety authors (45%) had financial conflicts of interest. Authors who had a favourable view of the risk of myocardial infarction with rosiglitazone were more likely to have financial conflicts of interest with manufacturers of antihyperglycaemic agents in general, and with rosiglitazone manufacturers in particular, than authors who had an unfavourable view (rate ratio 3.38, 95% CI 2.26 to 5.06 and 4.29, 2.63 to 7.02, respectively). There was likewise a strong association between favourable recommendations on the use of rosiglitazone and financial conflicts of interest (3.36, 1.94 to 5.83)” (BMJ 2010;340:c1344)
In another, even more chilling report (also published in BMJ), the author writes: “Casually following the fortunes of the blockbuster diabetes drug rosiglitazone (Avandia), you can’t help but imagine a Hollywood thriller. There is the scene where a leading scientist secretly records a meeting with drug company executives, a high powered congressional investigation, and a bitter legal battle waiting in the wings. Yet when you look more closely, the facts are even stranger than fiction. An expensive new drug shown to raise the risk of heart failure and suspected of increasing the chance of heart attacks has been taken by millions of people around the world and is being kept on the market by an industry funded regulatory system, despite calls from senior safety experts to withdraw it.” (BMJ 2010;340:c1848)
I took a look at one other factor as well: pricing. The most common price I could find for Avandia — the drug touted as “safer” by the research paper — was $3.32 per pill (for 30 pills of 8mg, which is considered the normal dose). For Actos, the price was $1.34 per pill (for 30 pills of 30mg, again, considered the normal dose).
When it comes to this type of medical drug research, the saying “follow the money” seems to apply. Perhaps it’s also time to follow the advice of “X-Files” character Fox Mulder: TRUST NO ONE.
About Terry A. Rondberg, DC
Terry A. Rondberg is founder and CEO of the World Chiropractic Alliance. He is an ardent advocate for drug-free chiropractic care not just for back pain, but total body wellness. He has spoken globally on the issue of alternative care and the abuses of our current “health care” system.