Paul Roblin on Dobson et al’s Lancet Tamiflu re-analysis: an independent review group. Really?

On 30 January 2015 the Lancet published a re-analysis of oseltamivir effects in symptomatic influenza like illness “Oseltamivir treatment for influenza in adults: a meta-analysis of randomised controlled trials.” This was authored by Joanna Dobson, Richard J Whitley, Stuart Pocock, and Arnold S Monto.

The Lancet supplemented this re-analysis with an article by Heath Kelly and Benjamin Cowling, entitled “Influenza: the rational use of oseltamivir.” The Kelly and Cowling article claims that the re-analysis was done by an independent research group. I am concerned that not all the relevant links of the authors of the Dobson Lancet paper have been declared in the competing interests section.

The Dobson paper contains the following:

Page 9 of the paper has the text below
JD did the statistical analyses and prepared data tables and figures. All authors contributed to writing of the manuscript and made substantial contributions to conception and design of the study, and analysis and interpretation of data.
Declaration of interests
ASM reports fees from Biocryst and Roche outside of the submitted work. RJW reports fees as a board member of Gilead Sciences, funding for travel from Roche to attend an Influenza Resistance Committee meeting, and fees as associate editor of the Journal of Infectious Diseases. JD and SP declare no competing interests.
This study was funded by the Multiparty Group for Advice on Science (MUGAS) Foundation through an unrestricted grant from Roche Pharmaceuticals. Neither party had a role in analysis, interpretation, reporting or the decision to submit for publication. We thank Roche for providing the data and answering data specific queries.

Page 4 of the paper has the text below
Role of the funding source
The meta-analysis was funded by the Multiparty Group for Advice on Science (MUGAS), which assembled a multidisciplinary team to examine the overall data from trials of oseltamivir in adults. The team agreed an individual patient data analysis was the most robust approach, and to cover the costs the MUGAS board applied for an unrestricted grant from Roche. This unrestricted grant stipulates that Roche would not be involved in the actual review process in any way other than providing the requested data dictionaries and datasets. The results were not shared with Roche until the analysis was completed. The London School of Hygiene and Tropical Medicine received a grant from MUGAS to partly fund Joanna Dobson’s salary while she worked on this project. No other monies were received by any of the authors.

I have looked into the biographies of the authors and found the following:
1. Professor Richard J Whitley is a paediatrician interested in viruses and works with/for the CDC. His declaration given above seems inadequate. The relevance of the reference to Gilead is that Gilead Science holds the patent for Tamiflu and this should be explicitly stated. Gilead directors are listed here. Dr Whitley joined Gilead’s board of directors in 2008. Should something like this not be declared in the Lancet paper? (It is unclear precisely what the Lancet requires in terms of competing interest disclosures.)

2. Professor Arnold Monto. He reports fees from Biocryst and Roche outside of the submitted work but also received about US $ 41,000 from GSK in 2009-13. See this list. GSK produces Relenza (zanamivir), the other antiviral product advocated for flu.

There are further issues about the trial being funded by MUGAS
One comment about MUGAS can be found here (see block of text below). In 2013, Roche announced that in the interests of transparency it would supply any data requested by what it described as a “third party group,” the Multiparty Group for Advice in Science (MUGAS).

In fact, while the name might lead you to imagine an independent body bringing together representatives of a number of organisations to consider a range of issues (rather like All-Party Groups in the UK Parliament), MUGAS is funded by Roche and is led by four scientists, three of whom are advisers to Roche. It appears to have been set up specifically as part of the attempt to counter the Cochrane’s criticisms.

Another organisation involved is European Scientists Working on Influenza (ESWI). On their websites, MUGAS and ESWI give as their point of contact the same mobile telephone number in Belgium [13, 14]. The name MUGAS is a registered trademark of Semiotics, a company that describes its mission as “translating science to the world,” but whose actual activity seems mostly to be concerned with influenza and in particular oseltamivir [15].

Details of Semiotics can be found here. Both MUGAS and ESWI are brands of Semiotics
See also and

We need to know a lot more about how Semiotics, MUGAS, and ESWI are funded and who influences what they say and do.

Paul Roblin is a GP and CEO of BBOLMC. This blog is his personal view.

Competing interests: He was recently involved in an email and media debate with PHE and NHSE over Tamiflu for well patients in care homes.

This blog was originally published on the CEBM blog.