participated in the academic programme of the conference. Hardly surprising, considering the diversions available for them and their families in the form of tours and freebie distribution at the meet venue. Extracurricular participation was higher than academic participation.

Loud music boomed from the hospitality tent, films were screened and pearl, diamond and gold jewellery was sold at one end. Luxury cars zipped in and out of grounds picking up families or dropping people off. Bags, calendars, books, diaries, perfumes and chocolates were distributed for free from stalls. There were lucky draws and on-thespot quizzes to win prizes.

This jamboree was part of the 61st CSI annual conference in Kochi. Just over 3,300 of the 4,000 who had registered turned up. A glance through the scientific program of the conference would give the impression of a highly enlightening academic meet of accomplished doctors from across the country.

However, just about 2,000 are claimed to have attended the first day. The numbers dwindled as the days progressed. Barring the main hall where about 250-400 were found attending, two others had just 50-150 participants depending on the time of the day. The remaining five halls remained virtually empty.

A doctor, a veteran of many such annual conferences said: "In every large conference of this kind there are more doctors outside the conference than inside it. In fact the joke is that doctors attending conferences are divided into three kinds — the hallmarkers, who stay inside the halls, attend lectures dutifully, take notes and ask a lot of questions, the stalwarts who scour the pharma company stalls sweeping up all the freebies and the 'outstanding' ones who are always outside the conference venue making merry." The hallmarkers, quite obviously, were outnumbered at Kochi.

A good number of doctors never attended any session, and instead, were holidaying with family in Kumarakom, Munnar and other nearby hotspots, all at the cost of the drug company hosting them. Companies had also blocked hotel rooms in advance.
(Available from : http://economictimes.indiatimes.com/articleshow/5361055.cms?prtpage=1)

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We want raw data, now

This week’s BMJ is dominated by a cluster of articles on oseltamivir (Tamiflu). Between them the articles conclude that the evidence that oseltamivir reduces complications in otherwise healthy people with pandemic influenza is now uncertain and that we need a radical change in the rules on access to trial data.

Briefly, in updating their Cochrane review, published this week, Tom Jefferson and colleagues failed to verify claims, based on an analysis of 10 drug company trials, that oseltamivir reduced the risk of complications in healthy adults with influenza. These claims have formed a key part of decisions to stockpile the drug and make it widely available.

Only after questions were put by the BMJ and Channel 4 News has the manufacturer Roche committed to making "full study reports" available on a password protected site. Some questions remain about who did what in the Roche trials, how patients were recruited, and why some neuropsychiatric adverse events were not reported. A response from Roche is published in our letters pages and their full point by point response is also published online (doi:10.1136/bmj.b5374).

Should the BMJ be publishing the Cochrane review given that a more complete analysis of the evidence may be possible in the next few months? Yes, because Cochrane reviews are by their nature interim rather than definitive. They exist in the present tense, always to be superseded by the next update. They are based on the best information available to the reviewers at the time they complete their review. The Cochrane reviewers have told the BMJ that they will update their review to incorporate eight unpublished Roche trials when they are provided with individual patient data.

Where does this leave oseltamivir, on which governments around the world have spent billions of pounds? The papers in this week’s journal relate only to its use in healthy adults with influenza. But they say nothing about its use in patients judged to be at high risk of complications—pregnant women, children under 5, and those with underlying medical conditions; and uncertainty over its role in reducing complications in healthy adults still leaves it as a useful drug for reducing the duration of symptoms. However, as Peter Doshi points out (doi:10.1136/bmj.b5164), on this outcome it has yet to be compared in head to head trials with non-steroidal inflammatory drugs or paracetamol. And given the drug’s known side effects, the risk-benefit profile shifts considerably if we are talking only in terms of symptom relief.

We don’t know yet whether this episode will turn out to be a decisive battle or merely a skirmish in the fight for greater transparency in drug evaluation. But it is a legitimate scientific concern that data used to support important health policy strategies are held only by a commercial organization and have not been subject to full external scrutiny and review. It can’t be right that the public should have to rely on detective work by academics and journalists to patch together the evidence for such a widely prescribed drug. Individual patient data from all trials of drugs should be readily available for scientific scrutiny.
(Fiona Godlee, editor, BMJ In BMJ 2009;339:b5405; Published 10 December 2009)

"A lie gets halfway around the world before the truth has a chance to get its pants on."

Dear Fiona Godlee,

BMJ has come of age, thank you for this editorial. Writing a rapid response in your journal in September, I showed how hollow the claim about the safety and efficacy of the H1N1 vaccine was. (1) Thank you for publishing that and some others on connected topics. (2, 3, and 4).

Now readers can see how accurate those were. “We are being told that this new fast tracked, poorly tested vaccine is very safe and effective. The results of the testing on this vaccine were reported in the New England Journal of Medicine. It is instructive to learn that the tests for safety and to assess complications lasted only 7 days after the vaccine, an incredibly short period of follow-up.

Gullian Barre paralysis can occur even months after a vaccine as can seizures, behavioral problems and neuro-developmental disorders in children. It is interesting to note that the authors of the safety study for our swine flu vaccine were all employees of the maker of the vaccine CSL Biotherapeutics and eight held equity interest in the company. This admission is part of the disclosure policy of the New England Journal of Medicine. It is always important to keep in mind when you hear about this vaccine being safe and produced just like the seasonal flu vaccine -- What else do they not know about this vaccine that they will discover months, years or even decades later. Once injected with the vaccine and you develop a complication there will be little that can be done to treat the life-long degenerative disorder it produces. ” (5)

To cap it now comes the bombshell from Denmark which bares it all. Katrina Megget, a journalist, writing in the Pharma Times of the 3rd Decemebr 2009 has this to say under the title Swine ‘Flu labeled a conspiracy. “The swine flu pandemic has been named as the “most ambitious scam and corruption of our time” after pharma has been found to be in bed with the World Health Organization. Journalists from Denmark have reported links between the World Health Organization and pharmaceutical companies where firms have been covertly paying top WHO scientists. In the meantime, pharma profits from flu drugs have soared.

The journalists from the newspaper Information claim the public and political hysteria to swine flu is a result of an efficient public relations campaign, spearheaded by the WHO experts that have been prejudiced by pharma’s ready cash.” (http://www.pharmatimes.com/WorldNews/article.aspx?id=17017)

She goes on: “The lead target in the allegations is Dutch doctor Albert Ostenhaus, who has promoted the need for vaccinations through the WHO and the media and headed a panel that advised the WHO to announce that swine flu had reached pandemic level. Reports claim Ostenhaus is paid by several vaccine manufacturers and the Netherlands government is believed to be investigating his activities. Other WHO advisors are understood to also advise big pharma and have been allegedly concealing their pharma- funded salaries. Meanwhile, further questions have been raised about the WHO’s independence over the H1N1 flu virus after various documents found medicines and vaccinations were mentioned more than 40 times while traditional hand washing and the use of masks to combat the disease were only mentioned twice. The pharma industry is expected to make between seven and 10 billion Euros in 2009 from the sales of swine flu related drugs, according to JP Morgan.

“One of the extraordinary features of this influenza — and the whole influenza saga — is that there are some people who make predictions year after year, and they get worse and worse. None of them so far have come about, and these people are still there making these predictions. For example, what happened with the bird flu, which was supposed to kill us all? Nothing. But that doesn’t stop these people from always making their predictions. Sometimes you get the feeling that there is a whole industry almost waiting for a pandemic to occur,” said Jefferson. Jefferson states that pharmaceutical companies have built a machine around the impending pandemic and are already cashing in. “And there’s a lot of money involved, and influence, and careers, and entire institutions! And all it took was one of these influenza viruses to mutate to start the machine grinding,” writes Tom Jefferson. (6) in the German news Spiegel Online.
Now I understand why my articles and blogs get rejected. I think ahead of times! Telling the truth could be sacrilege.

Yours ever,
B. M. Hegde

References:

1) Hegde BM. In the information society nobody thinks. BMJ 2009; 339: b3471 eletter
2) Hegde BM. It is amazing how complete is the delusion that medical care is health care? BMJ 2009; 339: b4444. eletter.
3) Hegde BM. The science and the art of medicine BMJ 2009; 339: b4125 eletter.
4) Hegde BM. Be careful about reading health books, you may die of a misprint. BMJ 2009; 339: b4010. eletter.
5) Blalock R. Swine ‘flu-one of the most massive cover ups in American history. articles.mercola.com/.../What-We-Have-Learned-About-the-Great- Swine-Flu-Pandemic.aspx - Cached -
6) Jefferson T. Swine ‘Flu Fear mongering. German News. Spiegel Online.

High court issues notice

The Delhi High Court Wednesday issued a notice to the union health ministry on introduction of vaccines without proper medical research.
A division bench of Chief Justice Ajit Prakash Shah and Justice S. Muralidhar said, “This is a serious issue. It shows that medical facilities provided by the government are just mockery.”

The court asked the health ministry to respond to the notice by Jan 13. The court was hearing a petition that alleged that vaccines are being introduced in the public health system by the government under the influence of vaccine manufacturers and international agencies like the World Health Organization (WHO), without proper epidemiological and medical studies.

“We just want to highlight how in the absence of a rational vaccine policy, newer and newer vaccines are being pushed by the government into the national immunization programme. Vaccines which are either of little utility or not required at all are being introduced and promoted by the government at the behest of these vested interests,” advocate Prashant Bhushan said in his petition.

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