Who Funds the Science? A Chiropractor's Impolite Question
- Dr. Lucas Marchand
- 2 days ago
- 5 min read
By Lucas Marchand, DC
There is a paragraph — one paragraph, 101 words — that helped reshape how an entire generation of American physicians thought about opioid addiction. It was published in the New England Journal of Medicine in 1980. It was not a study. It had no methodology section, no data tables, no discussion of limitations. It was a letter to the editor, authored by two Boston University researchers, observing that among hospitalized patients receiving opioids, addiction appeared rare.
That letter was cited 608 times by 2017. Purdue Pharma used it — without disclosing that the patients in question were hospitalized, closely monitored, and not sent home with pill bottles — to build the scientific scaffolding for OxyContin's launch. Purdue Pharma trained its sales representatives to say that the risk of addiction among patients using OxyContin was less than one percent, citing the Porter & Jick letter as their source. By 2001, OxyContin was generating nearly $1.1 billion annually. By 2021, opioid overdoses had killed more than 500,000 Americans.
This is what misrepresented research looks like at scale.
Now consider Vioxx.
Merck's arthritis painkiller was approved by the FDA in 1999 and withdrawn in 2004 — but not before an estimated 88,000 Americans suffered heart attacks from taking it, with roughly 38,000 dying. The cardiovascular risk had appeared in Merck's own data early. When the VIGOR trial showed patients on Vioxx experienced heart attacks at more than four times the rate of those on naproxen, Merck's explanation was that naproxen must be protecting patients' hearts — making Vioxx only look risky by comparison. Union of Concerned Scientists Independent cardiologists later dismantled that explanation using Merck's own FDA-submitted data.
Merck employees ghostwrote twenty scientific articles and published them under the names of respected outside academics. Union of Concerned Scientists The New England Journal of Medicine — the same journal that published the opioid letter — later said it had been "hoodwinked." An FDA scientist testified before the Senate that the agency's failure to act earlier amounted to the single greatest drug safety catastrophe in the history of the country. He estimated 55,000 premature deaths and 100,000 unnecessary heart attacks. Union of Concerned Scientists
Merck paid $4.85 billion in settlements. No executives went to prison.
Here is where it gets structural.
Research has consistently found that pharmaceutical industry-sponsored studies tend to favor the sponsor's products more than studies with other sources of funding. PubMed Central One analysis found "roughly 30% more likely" more likely to report statistically significant efficacy estimates than non-industry-sponsored studies. National Academies This is not a fringe finding from a disgruntled academic. It has been replicated across dozens of meta-analyses and reviewed by the National Academies of Sciences.
The mechanism isn't always outright fraud. Industry sponsorship bias operates through study design, choice of comparators, selective reporting of outcomes, and non-publication of unfavorable results. Catalogofbias You don't have to falsify data to tilt a conclusion. You just have to ask a slightly different question, choose a slightly weaker comparison drug, and quietly not publish the trial that didn't go your way.
In 2002, the FDA convened an advisory panel to consider whether opioid prescribing had expanded beyond clinical warrant. Eight of the ten outside experts on that panel had financial ties to pharmaceutical companies, including Purdue. They advised the FDA against narrowing the indication. American Medical Association An opportunity to slow the crisis was lost. By 2013, enough opioids were prescribed annually to supply every American adult with a full bottle.
I am a chiropractor. I run a mobile cash-based practice out of a Ford Transit van in Sioux Falls, South Dakota. I mention this so you understand where I'm sitting when I hear, for the thousandth time, that chiropractic lacks rigorous scientific credibility.
Maybe. It's a fair conversation to have.
But I'd like to have it with people who are also willing to discuss a system that approved a drug based on a letter to the editor, ghostwrote its supporting literature, stacked its regulatory panels with consultants on its own payroll, and then expressed surprise when the bodies accumulated. A system where, as one analysis found, Merck issued a relentless series of publications and sponsored countless continuing medical education symposiums to debunk cardiovascular concerns New England Journal of Medicine — all while sales topped $2.5 billion a year.
Science is not the problem. Science, done independently and reported honestly, is how we know any of this happened in the first place. The problem is treating institutional proximity as a substitute for scientific integrity, and then using that confusion to adjudicate who deserves a seat at the credibility table.
Chiropractors should be held to high evidentiary standards. So should everyone else.
The 500,000 dead would probably agree.
Dr. Lucas Marchand is a chiropractic physician and founder of MyChiro, a mobile cash-based practice serving Sioux Falls and surrounding communities. Book at mychirohousecall.com.
1. The Porter & Jick Letter (1980) Porter J, Jick H. "Addiction rare in patients treated with narcotics." New England Journal of Medicine, 1980;302:123.
The citation analysis — 608 citations, 72.2% used as evidence addiction was rare, 80.8% failed to note patients were hospitalized — comes from: Leung PTM, et al. "A 1980 Letter on the Risk of Opioid Addiction." NEJM, 2017. The NEJM subsequently added an editor's note to the original letter warning it had been "heavily and uncritically cited." The letter's own co-author, Dr. Hershel Jick, told the Associated Press he was "essentially mortified" by how drug companies weaponized it.
2. Vioxx / Merck The figures on heart attacks (88,000–139,000) and deaths (estimated 55,000) come from the Senate Finance Committee testimony of Dr. David Graham, Associate Director of the FDA's Office of Drug Safety, November 18, 2004. Graham called it "the single greatest drug safety catastrophe in the history of this country or the history of the world."
The ghostwriting figure — 16 of 20 papers had a Merck employee as original lead author, replaced by outside academics in published versions — is documented by the Union of Concerned Scientists: Merck Manipulated the Science about the Drug Vioxx, ucs.org.
The naproxen spin (framing Vioxx's cardiovascular risk as naproxen being protective) is documented in the same source and in Senate testimony by Dr. Gurkirpal Singh of Stanford.
3. Industry Funding Bias The "30% more likely" figure comes from Dr. Lisa Bero, one of the world's leading researchers on publication bias, in an interview published in Issues in Science and Technology (issues.org, October 2024). The underlying systematic review is: Lundh A, et al. "Industry sponsorship and research outcome." Cochrane Database of Systematic Reviews, 2017, Issue 2. That review analyzed 75 papers and found industry-sponsored studies were significantly more likely to report favorable efficacy results (RR: 1.27) and favorable conclusions (RR: 1.34).
A note on the original essay's phrasing: the "30 times more likely" figure in the essay was an error — the correct finding is approximately 27–34% more likely, not 30 times. This should be corrected before publishing. The accurate line reads: "industry-funded research is roughly 30% more likely to favor the sponsor's product." Still damning. Just accurate.
4. OxyContin Sales The $1.1 billion figure for OxyContin sales by 2001 is widely cited; original sourcing traces to Purdue Pharma's own filings and reporting by the New York Times (Barry Meier's coverage) and ProPublica's opioid reporting archive.