quinta-feira, 24 de maio de 2007

Transparência e Inteligência: a fase dos dados públicos

No episódio do mensalão, um dos envolvidos tornou célebre a frase: “transparência demais é burrice”. No caso Avandia, parece que esse foi o caso, com uma tinta de ironia, por favor. Explico, depois de uma disputa judicial com o o Estado de Nova Iorque, a Glaxo Smith Kline comprometeu-se a divulgar os resultados de todos os estudos relativos aos seus produtos. A partir desses dados foi possível, o cálculo do risco do medicamento. Ao contrário da frase cínica acima reproduzida, o fato mostra a importância da internet e do controle social sobre produtos de interesse coletivo, que não eram questionados tão rapidamente como agora. Que se torne obrigatória a divulgação de todos os resultados de pesquisas na web, incluindo os da indústria, como os originados por fundos públicos. Nesse último caso haveria um período de tempo para que os dados fossem publicados em revista com revisão por pares. Abaixo, artigo do The New York Times explicando o ocorrido entre os dados da Glaxo e a publicação no The New England Journal of Medicine. For Drug Makers, a Downside to Full Disclosure When GlaxoSmithKline settled a lawsuit three years ago with the State of New York over the antidepressant medication Paxil, the company agreed to take an unusual step: publicly disclosing the results of its clinical trials for Paxil and other drugs. The company, which was criticized at the time for failing to publicize all pediatric trials of Paxil, not just the positive ones, made good on its promise. The first posting on a new Web site was about 65 studies involving its popular diabetes drug, Avandia. This week, GlaxoSmithKline learned what that greater disclosure could mean. A cardiologist at the Cleveland Clinic, Dr. Steven Nissen, stumbled onto the Glaxo Web site while researching Avandia last April. He and a colleague quickly analyzed the data, and on Monday, The New England Journal of Medicine released its finding that Avandia posed a heightened cardiac risk. “It was a treasure trove,” Dr. Nissen said about the Web site. GlaxoSmithKline has disputed the journal’s interpretation. Officials with the Food and Drug Administration said they were reviewing whether to take any action on Avandia. Whatever the drug’s fate, the episode is likely to fuel efforts by some medical experts, including Dr. Nissen, to persuade lawmakers to require makers of drugs and medical devices to disclose study results publicly. Currently, producers are not required to do so, but Congress is considering legislating a requirement. Many companies besides GlaxoSmithKline already post results from some studies or trials on their Web sites, or one operated by the Pharmaceutical Research and Manufacturers Association, a trade group in Washington. Dr. Bruce M. Psaty, a cardiologist at the University of Washington, said that having such information can play a critical role, as the case of Avandia suggests, in spotting signals of a drug’s possible dangers. Other experts have argued that the relative efficacy or cost of competing drugs can be compared only when all study results, rather simply those that a company chooses to publicize, are available. Studies have found that the vast majority of drug and medical device studies are never published in medical journals. “The more information, the better,” Dr. Psaty said. Dr. Ronald L. Krall, chief medical officer for Glaxo, said his company sharply disputed the methodology of Dr. Nissen’s study, and a top F.D.A. official said that the agency had previously informed doctors about Avandia’s heart risks. Dr. Krall said his company was aware when it created its database of study results a few years ago that it might lead to controversy. Other scientists might look at its data or choose to analyze it differently than company officials did, he said. “We are committed to the principle of transparency,” Dr. Krall added. “But we knew that when starting this, by putting the data in the public, many things could happen, some of which could be trouble.” Some experts also believe that releasing the results of hundreds of studies involving drugs or medical devices might create confusion and anxiety for patients who are typically not well prepared to understand the studies or to put them in context. “I would be very concerned about wholesale posting of thousands of clinical trials leading to mass confusion,” said Dr. Steven Galson, the director for the Center for Drug Evaluation and Research at the F.D.A.

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