A multicenter placebo-controlled clinical trial of oral metoclopramide in diabetic gastroparesis.

Metoclopramide tablets were compared with placebo in the treatment of gastrointestinal symptoms in 40 patients with diabetic gastroparesis. Results of a 3-wk double-blind study indicate that metoclopramide at a dosage of one 10-mg tablet four times daily reduced nausea, vomiting, fullness, and early satiety and improved meal tolerance better than placebo. Statistically significant differences were noted for nausea and postprandial fullness. Mean gastric emptying assessed by radionuclide scintigraphy was significantly improved in the metoclopramide-treated group when compared with their baseline result. Metoclopramide is an effective agent for improving the upper gastrointestinal motor function in diabetic patients with gastroparesis.

Review article: gastroenterology and the pharmaceutical industry.

Physicians' relationships with industry derive from the moral imperative to advocate and work for the best interests of patients. Private industry generally operates to satisfy the best interests of the stockholders or owners. Conflicts arise between these interests and are magnified by the inequality of the financial positions of physicians and industry. Because the ultimate consumer of the products (drugs, medical devices, etc.) of the biomedical industry must enlist a physician as an intermediary, the physician has become the target of industry in a sophisticated marketing effort that includes the offering of financial and other incentives. These conflicts and incentives are pervasive throughout clinical and research endeavors. Standards for resolution, if not elimination, of these conflicts have been proposed by various respected organizations. Individual physicians and medical organizations should evaluate these standards and, if pertinent and appropriate, endorse and follow them.