26 July: Ana Cantu was a human guinea pig in a drug trial for $4,800: “The study started out with 20 subjects… For about a week there were 14 subjects. Then they started dropping… Now, we’re down to 7.”Vera Hassner Sharav Alliance for Human Research Protection
Ana Cantu was one of the healthy volunteers –“a human guinea pig” as she describes herself– in a month long study that tested the effects of Norvir, an HIV drug made by Abbott Laboratories, when coupled with the antidepressant Wellbutrin, made by GlaxoSmithKline.”
Her first-hand experience provides insight about the immense “pressure for positive results in clinical trials,” the level of discomfort a human subject is expected to endure from the adverse effects of the tested drug (or combination of drugs), and the dilemma for drug manufacturers whose drug causes adverse effects so severe, the test subjects in pre-marketing trials drop out in droves. The FDA accepts study results – even if only 7 of 20 subjects complete the study. Companies are loathe to scrap a negative study: they held on to the last seven subjects despite severe adverse effects. The “volunteers” suffer for the payment which they would forfeit if they quit.
Ana describes how and why corporate sponsors (in her case, GSK and Abbott Labs) conceal adverse event data that may damage a drug’s chances for approval.
Despite federal law that requires companies to fully disclose to the FDA all adverse events in pre-marketing clinical trials, drug companies have repeatedly violated the law with impunity: they have failed to include in their submission of data to the FDA, the worst adverse events suffered by subjects who, as a result, dropped out of the trials.
Her observations, published in The American Statesman are disturbing and insightful:
“The study started out with 20 subjects, but 6 were eliminated during the in-patient stay by the drug company sponsoring the trial for various reasons (including drinking caffeine within 24 hours of check-in). For about a week, there were 14 subjects. Then they started dropping. The first one to go was a girl with a pronounced Texas twang named Denise, who had severe jaw and tooth pain. Then extreme nausea and emesis (the clinical term for vomiting, I discovered) claimed April. Jo Kay, Paula, Amy, Alyssa and Carrie went one after another. Now we’re down to 7.”
Ana experienced severe black outs–clearly an adverse effect of the experimental drug–but she was kept in the trial against her best interest:
“The day got off to a bumpy start when I started to black out while reporting my side effects. Darkness closed in from my peripheral vision and then I saw nothing but big colored spots.
“That morning, we were standing around in the cafeteria waiting to dose. All of a sudden, I couldn’t see and lost the ability to balance. If I hadn’t been standing between two of my fellow subjects, who grabbed me and held me up, I would’ve slammed into the floor. I knew I hadn’t fainted; I could still hear just fine, but all I heard was chaos as everyone around me freaked out. I dropped into the nearest chair and put my head between my legs while the study coordinator called the on-site paramedics. While the coordinator frantically called the staff doctor, a paramedic checked and re-checked me. I did fine as long as I wasn’t on my feet for too long. The doctor cleared me to keep dosing.”
Ana explains why her continued “participation” in the trial–disregarding the danger the black outs posed to her well-being–was to accommodate the sponsoring company’s need to maintain a minimum of 7 subjects in the trial:
“The drug company had a dilemma. To submit trial results to the FDA, the study couldn’t fall below seven participants. But, unfortunately, one showed signs of serious side effects and if those results were submitted, approval was highly unlikely. If my results were dropped, the FDA would never know about the problem and the drug company could start fresh with a third trial. However, the first clinical trial had to be scrapped because too many subjects dropped out as a result of their side effects, and it looked like the second study could soon follow the same path. To gather enough healthy volunteers who fit the protocol for a third trial would require a lot of time and money, and it wasn’t something the sponsor was willing to do. So, in the end, my results and I stayed in the study.”
“Because the trial ended with the magic number of seven volunteers, the results could be submitted for review and the FDA had the opportunity to see the data. But what happens in the trials in which drug companies drop some of the subjects with the worst side effects?”
Ana Cantu’s first-hand experience confirms the finding reported by FDA’s safety officer, Dr. Thomas Marciniak, who analyzed the raw data from GSK’s Avandia trial, and found that the company concealed from the FDA the worst adverse event data, resulting in its approval precipitating preventable heart attacks and deaths.
An editorial in today’s New York Times, calls upon the FDA to revoke its questionable approval of Avastin for breast cancer because it failed to extend patients’ lives while it caused serious side effects. The drug had gained “accelerated approval” without adequate testing.
Vera Hassner Sharav is the founder and president of the Alliance for Human Research Protection (
AHRP), which serves as an information resource, a public interest watchdog and a catalyst for public debate whose goal is to unlock the walls of secrecy in biomedical research and to bring accountability to that endeavor. She is a professional law librarian turned public advocate for human rights. Additional information about this and other stories are posted here and here.