Docs Want Censorship of Study Showing Cancer Risk from Heart Drug

Arguments of doctors who are angry at publication of a study documenting deadly results from a common heart drug are nothing short of bizarre.

by Heidi Stevenson

8 July 2010

When questioned about the recent study documenting increased rates of cancer in people taking the popular blood pressure ARB (angiotensin-receptor blockiers), many leading doctors responded with expletives. They're particularly horrified that the European Medicines Agency (EMA) has the gall to review ARBs for the increased risk. In short, they think the study should have been censored.

Nature of Complaints

Complaints about the study and its publication were quite varied, but taking them one-by-one, it's fairly obvious that the speakers are grasping at straws. Here are some examples⁽¹⁾:

The 'Someone Else Didn't Publish It' Argument

One complaint was that the Lancet refused to publish the study, though its daughter publication, Lancet Oncology accepted it. To be blunt, the simple fact of the matter is that a journal focused on cancer is a better place for publication than the more general parent journal.

The 'They Shouldn't Have Published It' Argument

According to Dr. Sverre Kjeldsen, Secretary of the European Society of Hypertension, "...nobody can explain why they accepted it. This is very strange." In fact, the paper went through the usual peer-review analysis. The only thing strange here is Kjeldsen's grasping at such an obviously nonsensical reason to distrust the study.

The 'Authors Live Too Near Each Other' Argument

The American Society of Hypertension president, Dr. George Bakris, finds it suspicious that the lead author of the paper and the author of a related editorial by the Lancet "...are both in the same town. I am a little concerned and would fault Lancet for not being more discriminating in who they got to write their editorial."

Oh my! Perhaps we need to refine the rules about relative distance between the homes of authors. If they live within, say, one mile, does it indicate a conflict of interest? Should they be allowed to live within the same county? The same state? Apparently, medical journals have been remiss in not defining an algorithm for acceptable distance between editorial and research authors.

The 'It Doesn't Cover Enough' Argument

Dr. Hermann Haller, of the Hanover Medical School in Germany, said, "I'm lacking words here. It's a very bad example of science, and Lancet should not have accepted the paper. Basic questions are not answered. We do not know about the other risk factors. It's an analysis that is very disturbing."

Certainly, the analysis is disturbing—for what it documents, not for what it doesn't. The study was a meta-analysis that looked at whether there's an increase in different kinds of cancer among people taking ARBs. While identifying other risk factors is of interest, the lack of them does not negate the value of the finding that a significant number of extra cancers develop—especially lung cancer—in those who take ARBs.

Haller's statement that the analysis is "very disturbing" is right on target. Also disturbing is his wholesale refusal to acknowledge that the study has documented significant cancer risk to patients.

The 'It Can't Be True' Argument

As modern medicine tends to do when faced with documentation that demonstrates the truth of something they don't want to believe, a standard fallback is, It can't be true because we don't see how it could be true.

In this instance, the claim is that it isn't possible to develop cancer in the short time period documented. The study showed cancers showing up within two years of taking ARBs.

The first problem with this argument is that facts is facts: Not understanding how something can be true doesn't have anything to do with whether it is, or is not, the truth.

Further, it's actually not that hard to come up with a suggestion as to how taking an angiotensin-receptor blocker could lead to cancer. ARBs interact with growth hormone. Changes in growth hormone could affect cell proliferation. Cells that proliferate without control are cancerous. The issue of excess growth hormone having the potential of causing cancer is being studied, so this connection is not far-fetched. No, I'm not suggesting that this is what happens—but for these doctors to claim that a connection between taking ARBs and developing cancer makes no sense...simply makes no sense.

The 'They Didn't Contact Me' Argument

Dr. Kjeldsen raised his attack on the study by claiming that the author, Dr. Ilke Sipahi of University Hospitals Case Medical Center in Cleveland, Ohio, didn't bother to contact him about his own study, named VALUE, of ARBs. (Just the name of the study clarifies that its goal was to find good things about these drugs.) Kjeldsen and other doctors made a big deal of this point. They even made the claim in a complaint letter to Lancet Oncology.

There is, though, a slight problem with this claim: It isn't true. Dr. Sipahi proved it by producing the e-mails to prove that the VALUE team had been contacted, stating

Although I did not systematically contact the investigators of all the ARB trials, VALUE was the exception because it was so large that it was difficult to ignore, and I was curious. I contacted the primary investigator, Dr Stevo Julius [University of Michigan, Ann Arbor], who replied that the incidence of neoplasms was not monitored in VALUE.

So, the claim of Kjeldsen and his cohorts was untruthful on two counts. First, though they claimed otherwise, they were approached about VALUE's results. Second, VALUE didn't pursue information relating to cancer.

Dr. Julius, who had been contacted by Dr. Sipahi for VALUE's results, dissembled on being questioned about the contact. He stated he doesn't recall the request and that he receives a large number of such requests. Since reporting on cancer data in such studies is now mandatory, he stated, "I did not have the data. The study files were kept by Novartis."

I see! Dr. Julius doesn't remember if he was contacted by Dr. Sipahi...but he might have been. In any case, he couldn't have produced such results, since he didn't have them. (And note that the holder of them was Novartis, a fact that doesn't speak well of their likely legitimacy.)

But that didn't stop a major attack on Dr. Sipahi and the ARB study. This is obviously nothing less than a smear campaign to prevent the truth about ARBs from being accepted.

Oh yeah, one last bit about Kjeldsen's argument: He now claims that Dr. Sipahi didn't try hard enough to get the VALUE cancer stats!

Of course, Kjeldsen claims that his stats would have negated all the other data in Dr. Sipahi's study. But after reading about Kjeldsen's gyrations in attempting to throw mud on Sipahi, I'll leave it to you to decide whether to believe him.

What's Going On?

Just think. These are the arguments made by leaders in the field of cardiology! Does that give you a comfy feeling about their logical and analytical ability—or their authority in determining what treatments are best for heart problems?

Dr. Kjeldsen says, "The ARBs are becoming the most preferred antihypertensive drugs because they are exceptionally well tolerated. Now, when becoming generic and cheap, they will undoubtedly be the number-one drugs on the market worldwide." It seems clear that he believes that this seemingly natural progression should not be interrupted.

There are three possibilities to explain what's going on here. First is that these leading doctors are right, in spite of not being able to muster decent arguments in favor of ARBs, but they're inept in putting forth their arguments.

The second possibility is that these doctors are more interested in being right than in what's best for their patients. Rather than accept the possibility of a study being correct when it counters one of their favorite prescribing practices, they attack the messenger. It's human, but certainly not professional, and even more surely demonstrates that these doctors value their own egos more than their patients' lives.

Or, there's a third possibility, that Big Pharma's money owns these guys. Kjeldsen certainly has a fiefdom to protect. He was the lead author of a study that whitewashed ARBs, almost certainly because it was paid for by a Big Pharma company. (Novartis makes Diovan.) The fact that Novartis held onto the cancer-related data, and that it was obviously not readily available to researchers, does seem to indicate that the company is hiding something.

Who ya gonna trust? Right now, Ghostbusters strike me as more trustworthy than ARBs.

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