The Washington Post has an extensive story about the drug and device industry’s influence on the outcomes of clinical trials, which are published in leading medical journals and which then shape the prescribing decisions of physicians everywhere. Below the fold, I share some of my own thinking on this issue, and link to some of my relevant publications.
In an experiment published in the New England Journal of Medicine this year, we found that physicians also worry that drugmakers are biasing the scientific trials they support. We found that disclosures of industry funding cause physicians to discount their reliance on journal articles, reducing the likelihood of prescribing the studied drug. I hope that more journals will add meaningful summary disclosures to the abstracts themselves, rather than merely putting them in a box at the end of the articles, which many clinicians will not see. The readers of their journals have shown that they will rely on that information, if provided in an intelligible and convenient format. To physicians, this information about conflicts of interest is as important as the abstract’s description of the methodological rigor of the study.
Nonetheless, even if we improve the disclosure regime, in another article presenting my lab experiments, I have argued that disclosures are only half the solution. The disclosures say “don’t rely too much on this article, because it may be biased.” But the disclosures fail to tell physicians how much reliance may nonetheless be appropriate. Physicians need affirmative information — an alternative unbiased source of scientific expertise. Of course, a huge influx of funding to the National Institutes of Health could provide that affirmative science, but public money is scarce.
I have argued for a solution that I call the “Money Blind,” where industry may continue to fund the bulk of biomedical science, but do so in a way that avoids biasing influence. Our NEJM article suggests that companies may have a rational interest in doing this themselves to improve the credibility of the research they fund, at least when they have bona fide safe and effective drugs, whose merits will be clear in a neutral study. Even if the companies fail to rise to the occasion, I argue that the federal government has several policy levers available to cause such a change, without violating the First Amendment.