Yesterdays’ blog entry discussed how patient selection affects the external validity of studies (According to the study which you would never qualify for…).  Today, we look at how physicians interpret studies based on a relevant article (NEJM 2012; 367: 1119-27).

In a randomized study, 269 respondents (from a pool of 503 board-certified internists)were presented with a series of three hypothetical abstracts (27 in all) and were queried about their confidence in the results.  The presumption was that “the methodologic rigor of a trial, not its funding disclosure, should be a primary determinant of its credibility.”  One of the questions that was asked was the following: “Do you think that pharmaceutical company funding is likely to influence the outcome of scientific studies…in favor of the drug in question?”

Results:

• Physicians were more likely to identify high-rigor trials as rigorous (odds ratio, 3.95); in turn, physicians were more willing to prescribe drugs reported in high-rigor trials.
• Physicians were less likely to view a trial as having a high level of rigor if funding source was a pharmaceutical company (odds ratio 0.63).

Both the article and the editorial (pages 1152-53) indicate a good deal of concern that industry-funded studies are “downgraded” as compared to NIH-funded studies.  Though, is it really surprising?  There have been well-publicized controversies with industry-funded research:

• Withholding of critical data and negative results (eg. rofecoxib Alzheimer studies)
• Ghostwritten articles (eg. promotion of gabapentin)

In addition, the perception is that industry-sponsored studies are more prone to bias due to a financial stake in the outcome.

Due to these previous problems, gaining full confidence in industry-funded studies could take a long time.  As stated by Friedrich Nietzsche:

“I’m not upset that you lied to me, I’m upset that from now on I can’t believe you”

A much more expansive discussion on the issue of industry-funded studies can be found at the following link (thanks to Jeff Lewis for this):

http://www.guardian.co.uk/business/2012/sep/21/drugs-industry-scandal-ben-goldacre

I think if the authors of the study and the NEJM editor read this link they might change their tune from “Believe the data” to “Missing data poisons the well for everybody.”  A particularly insightful example in the link includes how the industry withheld negative data on paroxetine in pediatric patients for commercial reasons.

You really should read the attached link to understand why skepticism of industry-funded studies is justified.

Additional references:

• -Am Heart J 2012; 164: 186-93.  Rofecoxib: under-reporting of cardiovascular events in Alzheimer studies.
• -JAMA 2008; 299: 1800-12.  Promotion of rofecoxib with guest authorship.
• -Ann Intern Med 2006; 145: 284-93.  Promotion of gabapentin.