Should we ignore industry-funded research in clinical medicine?

A quick update to explain our most recent editorial [pdf] on evidence-based medicine published in the Journal of Comparative Effectiveness Research. It’s free for anyone to access.

What do we know?

Industry funded research does not always lead to biases that are detrimental to the quality of clinical evidence, and biased research may come about for many reasons other than financial conflicts of interest. But there are clear and strong systemic differences in the research produced by people who have strong financial ties to pharmaceutical companies and other groups. These differences have in the past been connected to problems like massive opportunity costs (ineffective drugs) and widespread harm (unsafe drugs).

[Spoiler alert]

What do we think?

Our simple answer is no, we don’t think that industry-funded research should be excluded from comparative effectiveness research. To put it very simply, around half of the completed trials undertaken each year are funded by the industry, and despite the overwhelming number of published trials we see, we still don’t have anywhere near enough of them to properly answer all the questions that doctors and patients have when trying to make decisions together.

Instead, we think improvements in transparency and access to patient-level data, the surveillance of risks of bias, and new methods for combining evidence and data from all available sources at once are much better alternatives. You can read more about all of these in the editorial.

Bonus:

Also, check out the new article from our group on automated citation snowballing published in the Journal of Medical Internet Research. It forms the basis of a recursive search and retrieval method that finds peer-reviewed articles online, downloads them, extracts the reference lists, and follows those links to find and retrieve articles recursively. It is particularly interesting because it can automatically construct citation networks back from a single paper.

Financial conflicts of interest in guidelines

A new study published in the BMJ shows the prevalence of financial conflicts of interest in the panel members producing clinical guidelines. For consumers of healthcare delivery (that means everyone), I think it is valuable to know that doctors get their information from guidelines, and about half of the people developing those guidelines have financially-based conflicts of interest (e.g. they get money from pharmaceutical companies). The fact that this is not a surprise is probably the most worrying issue.

This is the second time that we’ve heard that journals have become “an extension of the marketing arm of pharmaceutical companies”.

Unfortunately, the double-edged sword is that many talented people do excellent work, and get money from pharmaceutical companies. Removing financial conflicts of interest would remove their talent from the construction of evidence and guidelines. 

Measuring only skin deep conflicts of interest won’t help

Conflicts of Interest in Cardiovascular Clinical Practice Guidelines

In the most recent issue of Archives, a group of US researchers have analysed the cardiovascular clinical practice guidelines on which clinicians rely to make informed decisions about how best to treat patients. Conflicts of interest are contentious in this area because they are known to influence how evidence is reported in a number of interesting ways.

The authors find that conflicts of interest were not as large a problem as many might imagine them to be. My argument here is that 56% of the authors of the clinical practice guidelines may be supported partially (or more) by pharmaceutical companies but they are still writing guidelines based on evidence that may be more dependent on big pharma, from clinical trials that may be funded and designed by big pharma, and with the concerted effort of a 900 billion dollar industry helping them reinforce the need for more pills.