The British Medical Journal (BMJ) has launched a global campaign to change how medical evidence for new drugs and devices is produced, its editor says industry-funded research routinely delivers overly optimistic results.
The BMJ says doctors are being unduly influenced by industry-sponsored education events and industry-funded trials for major drugs.
Dr Fiona Godlee, says industry-funded trials cannot be trusted and governments ought to start funding independent trials of new drugs and medical devices.
Dr Godlee tells Kathryn Ryan that the cost of doing trials is enormous and it may be time to find a different way.
“It may be that we need to do less research and better research because the evidence is that the research that is funded by industry - or has principal investigators who are themselves supported by industry - is overall, systematically, more likely to favour the sponsors product and that is distorting the entire evidence base.”
She says the perception that medical science is immutable and subject to rigorous protocol is false.
“Medical science, just like any science, can be manipulated. Not only in how the studies are designed, but how they’re actually undertaken – which type of patients you use, which drugs to compare against – and then also how the studies are reported. You can get incomplete reporting of trials, you can get the positive findings overplayed, the negative findings underplayed.
“The result is that we do know the evidence base for healthcare is systematically biased towards optimism for the new drug versus the old drug, any drug versus no drug. There’s a tendency to drive too much medicine that is partly driven by commercial influence.”
Dr Godlee says there are many ways to make drugs look better than they are and studies funded by industry often won’t measure things such as lifestyle changes.
“I don’t want to imply that we don’t need industry. We do need a really good, thriving pharmaceuticals and devices industry. We need them to develop safe and effective interventions. What we don’t need them to be doing is actually being involved in evaluating the product. We wouldn’t allow that for judges, we wouldn’t allow it for journalists, we don’t allow sports referees to be in favour of one side or another.
“It’s really an extraordinary situation that we’ve tolerated for so long that industry is so closely involved.”
She says the really problematic phase of clinical trials are what are called phase three trials – the larger clinical trials in which patients rather than volunteers are used.
“Too often in the trials that are funded and managed by industry, the benefits are overplayed in all sorts of ways and the harms are underplayed. We have to recognise that we now know this to be the case. It’s not really new, it’s just that we’ve tolerated it for a long time.”
Dr Godlee says evidence also shows that doctors who are given gifts from industry are more likely to prescribe their medicines more frequently. However, she says she doesn’t want doctors to feel attacked or judged.
“It’s just that we as professionals need to pull ourselves away. We need to pay for our own education, or for our employers to pay, and we need to practice healthcare that is not influenced by the people who can benefit from a particular decision.”