Further to my recent spray about the TGA accepting gifts, and Elmore Oil’s dubious research offerings, there has been a lot of chatter recently regarding conflicts of interest in research settings – and specifically, research sponsored by drug companies.
This article in the Age quotes a researcher from the Cochrane Collaboration calling for more transparency in any trials conducted. The trouble is this: trials done with private money often keep the results in-house and claim confidentiality. This means the researchers can ‘cherry pick’ data – highlighting the data that supports their product, and hiding the data which doesn’t. In fact, in some cases positive data is used multiple times to boost the results even further.
The article quotes a couple of examples, but the literature is full of them.
And this debate has been going on for years, with little progress, even though that evidence is clear. This article by Ben Goldacre writing in the British Medical Journal made the argument strongly in 2009. Ben writes:
The practice of medicine is based on evidence. We need this evidence base to be complete, and of the highest quality, so that we can make the right decisions, but at present, drug companies produce most of the evidence we use. There is no doubt that these companies have a conflict of interest when they conduct trials: they want to sell their products, and so naturally they want a positive result from the trials they sponsor. But there is now good evidence from systematic reviews, meta-analyses, and case studies that this conflict of interest results in bad evidence, which distorts medical decision making and so harms patients
A systematic review published in the BMJ found that in a review of 30 studies, research funded by drug companies was less likely to be published than research funded by other sources, and that studies sponsored by pharmaceutical companies were 4 times more likely to have outcomes favouring the sponsor than were studies with other sponsors.
While the above focuses on drug companies, the same can be said of all sorts of ‘alternative’ therapies like chiropractic and homeopathy or in fact any pseudoscience.
The bottom line is that if anyone is making claims which may have a financial or health outcome, there is a need for strong regulation, not just soft voluntary codes of behaviour. One approach would be that all clinical trials must be registered with a central authority so that ‘bad’ results can’t be hidden. This means not just notification that a trial is being done, but also prior notice of the methodology, so that changes in approach can’t be made to suit the researcher. In that way, any proponent of a drug, therapy or device can only rely on any claims made if those claims are based a registered trial. In turn, doctors and the public can have confidence that trial results can be relied upon as a basis for sound decision making.