New York, NY - The issue of expert opinion being potentially influenced by corporate research funding has again been highlighted—this time in an article on aspirin resistance in the Wall Street Journal [1]

The article, published on April 24, 2006, reports that much of the discussion of aspirin resistance has been instigated by doctors receiving research funds from companies making competitors to aspirin or tests for aspirin resistance.

Among those mentioned are Drs Daniel Simon (Harvard Medical School, Boston, MA) and Eric Topol (Case Western Reserve University, Cleveland, OH). The article notes that Simon wrote in Physician's Weekly last year that aspirin resistance may afflict as many as 30% of the 25 million Americans taking aspirin for cardiovascular protection and that these people may need other anticlotting drugs. Wall Street Journal reporter David Armstrong notes that the Physicians Weekly article did not mention that Simon receives research funding from Accumetrics Inc, which makes a test to measure aspirin resistance, and from Schering-Plough, which sells the antiplatelet agent eptifibatide (Integrilin). Physician's Weekly managing editor Keith D'Oria says the publication never discloses possible conflicts "and instead uses the information for other purposes, such as contacting drug companies listed by doctors to see if they might place an ad near the doctor's commentary."

Armstrong also quotes Simon arguing that most experts have some conflicts, as "industry is driving medical advances," so most unconflicted researchers are not truly expert.

Topol is reported as having coauthored an a study in 2003 that was said to show that heart patients resistant to aspirin were three times as likely to die or suffer a heart attack or stroke as those who responded normally to the drug. But Dr Steven Steinhubl (University of Kentucky, Lexington) is also quoted, pointing out that using a different method for determining aspirin resistance, Topol et al did not show a significant difference between the two groups, and the decision to publish only one result skewed the conclusion to a more alarmist one. Topol responds that the test used in the published study—central lab optical aggregometry—is the "gold standard," and that even with the other test (PFA-100, Dade Behring) there was an indication of risk from aspirin resistance.

Armstrong also draws attention to an Accumetrics press release issued in June 2004, in which Topol says that the company's aspirin test was "prototypic of the future of individualized medicine" and would allow doctors to "improve outcomes for a large number of patients."

Topol responds that he never authorized the quote in the press release and it is inaccurate. He further says he has always been careful to avoid recommending that patients be tested for aspirin resistance and has called for more thorough studies of the subject. In 2004, Topol severed all financial ties with industry to avoid the perception of conflicts. "I never profited in any way from my work with Accumetrics," he says in the article.

The main drug to benefit from reports of aspirin resistance is clopidogrel (Plavix, Bristol-Myers Squibb/Sanofi-Aventis), worldwide sales of which reached $5.9 billion last year, the article notes. It quotes Dr Sanjay Kaul (Cedars-Sinai Medical Center, Los Angeles, CA) as saying: "Before Plavix we rarely heard a mention of aspirin resistance. One has to wonder if the commercial implications of this phenomenon trump scientific reality." But Bristol-Myers Squibb is reported as denying seeking to undermine aspirin.

Other experts included in the article who agree that there is a problem are Drs John Eikelboom (McMaster University, Hamilton, ON) and Mark Feldman (Presbyterian Hospital, Dallas, TX). Eikelboom says: "There is a real issue of who you can get unbiased opinion from in medicine. It is a terrible problem. . . . I try to be honest with myself, but I can't pretend I will always be as honest as necessary." Feldman says much of the talk about aspirin resistance is generated by companies pushing aspirin-resistance tests.

And on the other side of the battleground, some the researchers defending aspirin are also reported to be conflicted. Armstrong points out that a New England Journal of Medicine review article published last December that concluded that none of the aspirin tests "is currently recommended" and that there was "no scientific basis for changing antiplatelet therapy" was written by doctors who all had financial ties to Bayer. And he also highlights a 2004 Circulation article warning that "current usage of the term aspirin resistance implies a linkage between a laboratory test and a clinical outcome that is presently unsubstantiated" that was written by three doctors with ties to Bayer, not all of which were disclosed.