Review

Aspects of the rationale for the Women's Health Trial.

A 5.5-fold range in breast cancer incidence rates in 21 countries shows strong correlation with national estimates of per capita intake of dietary fat, but not with other caloric sources (proteins and carbohydrates). It is argued that certain breast cancer and hormone factors may contribute little to the explanation of such international variations in incidence of this neoplasm.

Experimental evidence of dietary factors and hormone-dependent cancers.

Current awareness of the importance of environmental factors such as diet in the etiology of human cancer has stimulated renewed interest in animal models for studying effects of diet on tumorigenesis. Diet can influence cancer in animals by affecting the initiation or subsequent preneoplastic stage of tumorigenesis, but it has less effect on tumor growth. Caloric restriction has a general inhibitory influence on tumorigenesis. Dietary fat, on the other hand, tends to promote tumorigenesis, but only certain types of tumors, such as mammary tumors, are affected.

The pharmaceutical industry--to whom is it accountable?

The pharmaceutical industry is under mounting scrutiny because of rapidly increasing expenditures for drugs in the United States. Drug expenditures are now the fastest-growing component of health care costs, increasing at the rate of about 15 percent per year.1,2 They account for about 8 percent of health care spending, and at their current rate of increase, they will soon surpass spending for physicians' services and, for many health maintenance organizations (HMOs), the costs of hospitalization.

Getting it right: industry sponsorship and medical research.

Many of the policies and procedures for the ethical oversight of research were put in place in an era when public funding was much more prominent than it is now. Over the last 2 decades there havebeen major changes, with increasing pressure on universities, teaching hospitals and individual researchers to seek industry sponsorship for research, and the pharmaceutical industry has become the single largest direct funder of medical research in Canada, the United Kingdom and theUnited States.

What information do physicians receive from pharmaceutical representatives?

OBJECTIVE:
To assess the information pharmaceutical sales representatives provide to physicians.

DATA SOURCES:
A MEDLINE search from January 1966 to May 1996 was done using combinations of the terms pharmaceutical industry, drug information services, drug utilization, physician's practice patterns and prescriptions, and drugs. Studies identified from this search were supplemented by material from my personal library.

Interactions between physicians and the pharmaceutical industry: what does the literature say?

OBJECTIVE:
To determine the effect of three types of interaction between physicians and the pharmaceutical industry--company-funded clinical trials, company-sponsored continuing medical education (CME) and information for physicians supplied by pharmaceutical detailers--on orientation and quality of clinical trials, content of CME courses and physicians' prescribing behaviour.

DATA SOURCES:
MEDLINE and HEALTH searches for English-language articles published from 1978 to 1993, supplemented by material from the author's personal collection.

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