Not long ago, I asked a colleague for advice on a patient. He offered
up a couple of treatment options, then stopped to show me a
new medical app
on his electronic tablet. With a few swipes of his finger, he summoned a
compilation of research articles, synopses and even entire textbooks
that, printed and bound, would have filled shelves in a library.
Dr. Pauline Chen on medical care.
“But
do you know what the best part is?” he asked with a twinkle in his eye.
I thought of the exhaustive reference material and the seemingly
endless scroll of diagnoses that were all so easy to access on the small
screen balanced on his knees.
“The best part is that none of this is sponsored by Pharma!” he said with a broad smile. “There’s no bias.”
The
case highlighted the dangers of industry sponsorship of research into
new drugs, and the public became eager to expose any potential conflict
of interest, particularly for doctors. Within a few years, a new
standard of transparency in medicine emerged. Brightly labeled drug
company pens became an embarrassment; lunches on the drug company tab
and sponsored conferences turned suspect; and editors at numerous
medical journals
published lengthy screeds detailing their disclosure requirements.
The
new skepticism and transparency were no doubt good for patients and
doctors, but this recent study reveals that in our zeal to single out
the pharmaceutical industry’s biases, we may have become blind to our
own.
The researchers created several hypothetical drug studies,
then asked a group of practicing physicians to rate the “studies” and
the likelihood they would prescribe the new “drug.” The researchers
purposefully varied the quality of the studies and the disclosures –
some of the made-up studies disclosed that they had received
pharmaceutical company funding, others said they’d received support from
the National Institutes of Health, and the rest listed no funding
disclosures at all.
Most of the doctors were able to assess the
quality of the research pretty accurately. After reading the less
rigorous studies, the ones that weren’t designed, conducted or analyzed
well, the doctors were hesitant to prescribe the new drugs under study;
seeing the more rigorous studies, they were more willing to do so.
But
the researchers also found that the doctors were also unduly swayed by
any mention of industry funding. Regardless of the quality, if a study
was supported by a pharmaceutical company, doctors were less willing to
consider prescribing the studied drug and less likely to assess the
quality of the research with accuracy.
“Some amount of skepticism
is warranted,” said Dr. Aaron S. Kesselheim, lead author of the study
and an assistant professor of medicine in the division of
pharmacoepidemiology and pharmacoeconomics at the Brigham and Women’s
Hospital in Boston. “But ultimately it should be the quality of the
study and the impact of the results that determine your confidence about
using a new drug, not who was funding it.”
Being overly skeptical
has serious implications for patient care. The pharmaceutical industry,
along with medical device and biotechnology firms,
continues to finance a majority of current research. In 2007, for example,
industry was responsible for nearly 60 percent
of the more than $100 billion spent on research. Much
industry-supported research focuses on the side effects of new drugs. By
writing off such research, doctors risk overlooking findings that may
have important treatment implications for their patients, like a new
cholesterol-lowering drug that is found to have less of an effect on
energy and blood sugar levels than other similar medications.
Dr.
Kesselheim and his collaborators believe what is needed in biomedical
research is even greater transparency. Such openness would include more
independent third-party statistical reviews to ensure that data is not
being manipulated or misleading and wider use of public Web sites like
ClinicalTrials.gov, regardless of the source of funding.
ClinicalTrials.gov
lists study details like objectives, design and data gathered,
providing doctors and patients alike with a way to confirm that no data
is being selectively reported or distorted. But participation on the
site is voluntary, and pharmaceutical, medical device and biomedical
companies are often hesitant to share what they consider proprietary
data, choosing instead to list only selective details, or no information
at all.
Until full transparency is achieved and such details are
available to all on the Web or for independent statistical reviews, Dr.
Kesselheim and his collaborators suggest that both doctors and patients
remain alert to potential biases — Big Pharma’s, and also their own.
“Excessive skepticism,” Dr. Kesselheim observed, “is as much a bad thing as naïveté.”
Source:nyt
