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Healthy Skepticism Library item: 6852

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.


Publication type: Journal Article

Friedberg M, Saffran B, Stinson TJ, Nelson W, Bennett CL.
Evaluation of conflict of interest in economic analyses of new drugs used in oncology.
JAMA 1999 Oct 20; 282:(15):1453-7


Context  Recent studies have found that when investigators have financial relationships with pharmaceutical or product manufacturers, they are less likely to criticize the safety or efficacy of these agents. The effects of health economics research on pharmaceutical company revenue make drug investigations potentially vulnerable to this bias. Objective  To determine whether there is an association between pharmaceutical industry sponsorship and economic assessment of oncology drugs. Design  MEDLINE and HealthSTAR databases (1988-1998) were searched for original English-language research articles of cost or cost-effectiveness analyses of 6 oncology drugs in 3 new drug categories (hematopoietic colony-stimulating factors, serotonin antagonist antiemetics, and taxanes), yielding 44 eligible articles. Two investigators independently abstracted each article based on specific criteria. Main Outcome Measure  Relationships between funding source and (1) qualitative cost assessment (favorable, neutral, or unfavorable) and (2) qualitative conclusions that overstated quantitative results. Results  Pharmaceutical company–sponsored studies were less likely than nonprofit-sponsored studies to report unfavorable qualitative conclusions (1/20 [5%] vs 9/24 [38%]; P=.04), whereas overstatements of quantitative results were not significantly different in pharmaceutical company–sponsored (6/20 [30%]) vs nonprofit-sponsored (3/24 [13%]) studies (P=.26). Conclusions  Although we did not identify bias in individual studies, these findings indicate that pharmaceutical company sponsorship of economic analyses is associated with reduced likelihood of reporting unfavorable results.

*systematic review/oncology/drug company sponsored research/pharmacoeconomic analysis/reporting of results/ETHICAL ISSUES IN PROMOTION: LINKS BETWEEN HEALTH PROFESSIONALS AND INDUSTRY/SPONSORSHIP: RESEARCH Biomedical Research* Clinical Trials*/economics Conflict of Interest* Cost-Benefit Analysis Disclosure Drug Industry/economics* Drug Utilization/economics Drugs, Investigational/economics* Economics, Pharmaceutical/standards Medical Oncology/economics* Medical Oncology/standards Organizations, Nonprofit/economics* Publication Bias Research Support* Research Support, Non-U.S. Gov't Treatment Outcome United States


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Far too large a section of the treatment of disease is to-day controlled by the big manufacturing pharmacists, who have enslaved us in a plausible pseudo-science...
The blind faith which some men have in medicines illustrates too often the greatest of all human capacities - the capacity for self deception...
Some one will say, Is this all your science has to tell us? Is this the outcome of decades of good clinical work, of patient study of the disease, of anxious trial in such good faith of so many drugs? Give us back the childlike trust of the fathers in antimony and in the lancet rather than this cold nihilism. Not at all! Let us accept the truth, however unpleasant it may be, and with the death rate staring us in the face, let us not be deceived with vain fancies...
we need a stern, iconoclastic spirit which leads, not to nihilism, but to an active skepticism - not the passive skepticism, born of despair, but the active skepticism born of a knowledge that recognizes its limitations and knows full well that only in this attitude of mind can true progress be made.
- William Osler 1909