When I picked up this week’s BMJ, as posted through our front door, I noticed that it had a wrap-around advert that you had to break through to get inside. This wrap-around promoted a new drug called Daridorexant [QUVIVIQ]. I had not heard of it. The wrap-around explained that this was a new treatment for insomnia and that the “product will be available in the UK following NICE review, expected 1st October 2023”:
It is unlikely that this BMJ wrap-around will be recorded in the archives.
This wrap-around advert was by Idorsia Pharmaceuticals Ltd and provided links to further information:
It is routine for the brief references given in promotional adverts to begin by sharing a ‘Summary of Product Characteristics’. The second, and only other reference to this new drug was this:
Interestingly this review article was published in 2018 [since this time there have been many more published papers on this ‘new treatment for insomnia’]. The 2018 article provided the following conclusions:
This summary argues the potential for dorexin receptor antagonists to be used as a treatment option in elderly subjects with insomnia and more specifically for those diagnosed with Alzheimer’s Disease [AD]. It should be noted that the latter argument is based on at least two separate hypotheses.
The authors of this 2018 review had no competing interests:
As stated, I am no expert in the understanding of dorexin receptor antagonists! I am a retired NHS doctor who now enjoys gardening among several other interests. However, my wife still works as a GP and so the BMJ still arrives through our door. I have always considered it to be one of the most important medical journals.
I am now nearly as old as many of the patients that I gave my working life to try and help.
My sleep pattern is very poor and has been significantly affected by a drug that I was prescribed in my youth. Given this, I was naturally keen to learn more about this new treatment for insomnia.
The first article that I came across was this:
The above peer-reviewed paper provided a comprehensive disclosure:
There was of course not enough space for such disclosures to be shared in the wrap-around promotion circulated by the BMJ to all its readers. If only we had one place to go to! To type in [whatever latest drug name] and find all disclosures. Fully listed, itemised, in date order, explaining in full, all payments to whom and what for, career or institution. To be archived forever. With nothing left out.
When I was working as an NHS doctor I gave up much of my own time [and family time] in raising a petition [PE1493] that asked the Scottish Government to introduce Sunshine Legislation. This led to a consultation with the Scottish public and established that the majority of those consulted agreed for the need for the introduction of Sunshine legislation to ensure a single, searchable database of all competing financial interests for all those involved in science and healthcare. However the Scottish Government chose to ignore us all.
That was a decade ago. Today we do have a little more transparency [little being the most important word in this sentence]. As a result I have been able to establish the following [forgive me for saying . . . but I doubt most could find the following information]:
There is no way of establishing if any of the above ABPI declarations relate to the promotion of this ‘new treatment for insomnia’ as advertised on the BMJ wrap-around.
What is clear is that Royal Colleges, Royal Societies and paid opinion leaders are receiving significant amounts of money from commercial interests. Without full transparency how can we trust them to put our interests first?
I am heading towards the latter stage of my life. I have put together this post because science matters to me. It will to my dying day. Science, by definition, should be disinterested. I fear that this ideal, an almost impossible ideal, has become increasingly secondary to commercial interests.
Important footnote: My son Andrew developed Type 1 diabetes in childhood and only lives because of the progression of science. Scientific progression has continued to improve his life.