Source: DHHS/FDA/CDER transcript, Antiviral Drugs Advisory Committee (AVAC) Meeting, Tuesday, May 13, 2003. "NDA 21-567 and 21-568, ReyatazŸ (atazanavir sulfate) capsules and powder for oral use, Bristol-Myers Squibb Company, proposed for the treatment of HIV infection in combination with other antiretroviral agents"; † per 2000 disclosure; § (per 11/02 documents)

Angell: "It is impossible to know to what extent these financial deals influence judgments about... research priorities or the interpretation of results, but they certainly are cause for concern." TTATDC, p 105

Joseph J. Eron, Jr., M.D.
Consulting arrangements with GlaxoSmithKline, Merck, Triangle, Trimeris. Research grants: GlaxoSmithKline, Merck, Abbott, Agouron, Triangle, and Trimeris.

Roy (Trip) Gulick, M.D., M.P.H.
Consultancy fees from two pharma companies (not identified) of less than $20,000 a year; and research funding from two pharma companies (not identified) of less than $20,000 a year. # Consultancy fees from: Bristol-Myers Squibb, GlaxoSmithKline, Triangle, Trimeris; Speakers bureau services for: Abbott, Agouron, GSK, Pharmacia-Upjohn (now part of Pfizer), Triangle.

Ann C. Collier, M.D.
Consulting arrangements with Merck. Research grants: Agouron, Merck, Hoffmann-La Roche, Glaxo-Wellcome, and Anor Med.

Eric S Daar, M.D.
Consulting arrangements with Abbott, Boehringer Ingelheim, GlaxoSmithKline, Gilead, Serono, ViroLogics. Speaking honoraria from: Abbott, Boehringer Ingelheim, GlaxoSmithKline, Gilead, Roche, Merck, Serono, ViroLogics, Ortho. Research grants: Abbott, Bayer, GlaxoSmithKline, Gilead, Roche, Merck, ViroLogics, Serono. †

Margaret A. Fischl, M.D.
Consultancy arrangements with and grant support (not broken out in disclosure) from: Abbott, Agouron, Bristol-Myers Squibb, DuPont, GlaxoSmithKline, Triangle.§

Richard Haubrich, M.D.
Speakers bureau member for: Agouron, GlaxoSmithKline, Trimeris, ViroLogics; Grant support from same.†

Victoria A. Johnson, M.D.
(Nothing found)

John W. Mellors, M.D.
Consultancy fees from: Agouron, Bristol-Myers Squibb, DuPont (now part of BMS), GlaxoSmithKline, Gilead, Merck, Novirio, Pharmasett, Triangle, Virco, Visible Genetics††; Grant support: BMS, Chiron, DuPont (now part of Bristol), GlaxoSmithKline, Merck.

Andrew R. Zolopa, M.D.
Consulting arrangements with Abbott, Bristol-Myers Squibb, and Merck. Research grants: Abbott, Bristol-Myers Squibb, and DuPont.†

Angell: "Increasingly, panel members and med 'educators' are required to disclose their financial ties. And that disclosure is supposed to make it acceptable that they have them." TTATDC, p140

(U.S. based members only. Pharma ties of the six extra-U.S. panel members (Yeni, Cooper, Gatell, Gazzard, Montaner, Vella) are extensive.)

Scott Hammer, MD
Consultancy fees and grants (not broken out in disclosure): Boehringer Ingelheim, Bristol-Myers Squibb, Gilead, GlaxoSmithKline, Roche-Trimeris, Shionogi, Shire BioChem, Tibotec-Virco, Triangle.

Charles Carpenter, MD
"None to report"

Margaret Fischl, MD
Advisory fees and grant support (not broken out in disclosure) from: Abbott, Agouron/Pfizer, Bristol-Myers Squibb, DuPont, GlaxoSmithKline, Triangle.

Martin Hirsch, MD
Consultancy and lecture fees and grant support from: Bristol-Myers Squibb, GlaxoSmithKline, Merck, Schering-Plough, Takeda, Trimeris.

David Katzenstein, MD
Stock holdings, advisory fees, speaking honoraria and grant support (not broken out in disclosure) from: Boehringer Ingelheim, Bristol-Myers Squibb, Gilead, GlaxoSmithKline, Merck, ViroLogic, Visible Genetics, patent US 5,968,730 on PCR assay (October 15, 1999).

Doug Richman, MD
Consultancy arrangements with Abbott, Bristol-Myers Squibb, Chiron, Gilead, GlaxoSmithKline, Merck, Pfizer, Roche, Takeda, Triangle, ViroLogic.

Mike Saag, MD
Grant support from or served as a consultant (not broken out in disclosure) or on the speakers bureau for Abbott, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead, GlaxoSmithKline, Hoffmann-La Roche, Ortho Biotech/JNJ, Pfizer/ Agouron, Pharmacia & Upjohn, Schering-Plough, Shire, TherapyEdge, Tibotec/Virco, Triangle, Trimeris, and ViroLogic.

Mauro Schecter, MD
Consultancy fees, speaking honoraria and grant support (not broken out in disclosure) from: Abbott, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead, GlaxoSmithKline, Merck, Roche.

Melanie Thompson, MD, MPH
Consultancy and advisory fees, lecture sponsorship, speaking honoraria and grant support (not broken out in disclosure) from: Abbott, Agouron, Agouron/Pfizer, Boehringer Ingelheim, Bristol-Myers Squibb, Chiron, DuPont, Gilead, GlaxoSmithKline, Merck, Oxo-Chemie, Roche, Serono, Triangle, Trimeris, ViroLogic.

Chip Schooley, MD
Stock holdings (options), consultancy and lecture fees, honoraria and grant support (not broken out in disclosure) from: Agouron, AnorMed, Bristol-Myers Squibb, Merck, Mojave, Pan Pacific Pharmaceuticals, Hoffmann-La Roche, Tanox Biosystems, Triangle, Vertex, ViroLogic.

Paul Volberding, MD
Consultancy fees and honoraria from: Abbott, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead, GlaxoSmithKline, Merck.

† Medscape disclosures, 2001; § JAMA required disclosures from IAS guidelines panels, 2004 (IAS itself does not make this information available); # FDA AVAC transcript (see source reference on preceding page); †† per JAMA 1999

[Self-test: Inquire for yourself from those resources you use most often]

Medscape.com
Bangkok conference coverage on the site paid for by Bristol-Myers Squibb, GlaxoSmithKline, and Gilead.

ACT UP Again—What you can do:

Angell: "You need to know that your doctor's decisions are based solely on what is best for you. And doctors need to be weaned from their dependence on drug company largesse." TTATDC, p 262

What you can do:

1. What is the evidence that this drug is better than an alternative drug or some other approach to treatment?
2. Has the evidence been published in a peer-reviewed medical journal?
3. Are you relying on information from drug company reps?
   Insist on a straight answer and, if necessary, a reference to a journal article or a medical textbook.
4. Is this drug better only because it is given at a higher dose?
5. Would a cheaper drug be as effective if it were given at an equivalent dose?
   Remember, there is usually no reason to think new drugs are better than olds ones. And the older the drug, the better its safety record is likely to be.
6. Are the benefits worth the side effects? The expense? The risk of interactions with other drugs I take?
   Every drug has side effects, and it may be better not to treat self-limited or trivial ailments.
7. Is this a free sample?
8. If so, is there a generic drug or an equivalent drug I can use that is cheaper when the free samples run out?
   Free samples are a false economy. They are designed to get you and your doctor hooked on the newest, most expensive drugs.
9. Do you have any financial ties with the company that makes this drug?
10. For example, do you consult for the company?
11. Other than free samples, do you receive gifts from drug companies?
12. Are you being paid to put me on this drug or to enroll me in a drug company study?
13. Do you make time for visits from drug company representatives?

If the answer to any of these questions is yes, you should consider changing doctors.

You need to know your doctor's decisions are based solely on what is best for you. And doctors need to be weaned from their dependence on drug company largesse.

⇒ And ask your senator and representative in Congress this question:

There is no doubt that this industry largely writes its own ticket in Washington, and you have to [help] put a stop to that.

⇒ Pay no attention to direct-to-consumer ads for prescription drugs. These are meant to sell drugs—not educate consumers—and they only add to the prices you pay.

⇒ Finally, remember the admonition of the Washington Post editorial (6/9/2003,A20) to question those arguing Big Pharma's case about its sources of income. I can think of no better advice. Nowadays, even the most distinguished and apparently unbiased academics may be on the pharmaceutical industry's payroll. If they are, you need to be especially skeptical about their pronouncements.