ADVANTAGE: Merck Does Say No

TO THE EDITOR:

In their article on the ADVANTAGE seeding trial, Hill and colleagues (1) seem to put the blame on Merck and participating physicians. I think, however, that it is the system that is mostly at fault. Merck is a commercial enterprise whose major goal is to make a profit by using every legal tool available. It tried to make its customers believe that its product is better than others in a competitive market. As major religions did in their early stages, Merck proselytized to the most disadvantaged group. Among the U.S. physician force, this group is the primary care physicians, who are often looked at by their academic colleagues with a lesser degree of respect. Besides money, Merck offered primary care physicians something much more valuable: an opportunity to participate in clinical research and be consultants and experts in drug therapy, a prestige that primary care physicians covet highly. No wonder they were enrolling in this study in droves. Should they have noticed that this was a seeding trial? How could they, if even Annals published it later on (2)? Now, in their editorial, Sox and Rennie (3) preach to primary care physicians to refuse participating in seeding trials. The reason that seeding trials exist, they argue, is because physicians say yes to them. They even quote our parents, who warned us to ask question when we are offered easy money. Those greedy community physicians! Just say No! What contempt. Nevertheless, as long as there are enterprises whose goal is to make a profit and a group of practitioners who lack respect and desperately need it (why do you think we have a crisis in primary care?), the practice will continue. Moralization will not help. Involvement of primary care physicians in academic affairs will.