In the BMJ: the dodginess of drug company trials

[HuckleB]

http://www.badscience.net/2009/12/by-me-in-the-bmj-the-dodginess-of-drug-company-trials/

"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.

We will start with a tangible story, from a single field. Rochon analysed the literature on non-steroidal anti-inflammatory drugs (NSAIDs), and found all the studies that had ever been published where one NSAID was compared to another. In every single trial, the sponsoring company’s drug was either equivalent to, or better than, the drug it was compared to: all the drugs were better than all the other drugs. Such a result is plainly impossible.

A systematic review found 30 studies investigating whether industry funding is associated with outcomes that favour the funder: studies sponsored by drug companies were more than four times as likely to have outcomes favouring the funder, compared with studies with other sponsors.

How does this systematic bias come about? One answer is questionable trial design. Studies are conducted, for example, where the competitor drug is given at an inadequate dose, or worse, at a higher dose, increasing the risk of side effects, and so making the sponsor’s drug appear to be preferable.

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Mr. Goldacre has gained a fair reputation for pushing for evidence and science based medicine. He does not let any area of health care or science and pseudoscience go without critique, as this piece shows.

For those actually interested in the response to Goldacre's piece by a former drug company executive, there is a link to it on this page.

Cheers.

:hi: