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Healthy Skepticism Library item: 6911

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

Krimsky S.
Conflict of interest and cost-effectiveness analysis.
JAMA 1999 Oct 20; 282:(15):1474-5
http://jama.ama-assn.org/cgi/content/full/282/15/1474


Abstract:

The growth in academic-industry collaborations has created uneasiness among some observers. Those who support policies on disclosure of financial interests believe it can foster public trust. Others see no justification for requirements that raise suspicions without contributing to the scientific agenda. Several studies (four are cited) have shown that clinical decisions are affected by physicians’ financial incentives or interactions with drug companies. In this issue Friedberg et al. have focused the question of conflict of interest on health economics. Studies funded by pharmaceutical companies were nearly 8 times less likely to reach unfavorable qualitative conclusions than similar studies funded by nonprofit organizations. These results are consistent with the hypothesis that funding sources can bias outcomes of pharmacoeconomic studies. However, there are other hypotheses that can account for the results. The primary challenge is to distinguish among several plausible explanations for apparent biases in cost-effectiveness analyses. Without a standard set of methods it is not possible to make comparisons across studies. Government agencies that depend on such studies can contribute guidelines that will help in promoting standards. Biomedical journals should consider developing guidelines for the submission and review of cost-effectiveness studies. Clearly defined guidelines should enable clinicians and policymakers to better interpret and more appropriately apply the results of pharmacoeconomic analyses to patient care decisions.

Keywords:
*editorial/United States/ Biomedical Research* Clinical Trials Conflict of Interest* Cost-Benefit Analysis Disclosure* Drug Industry* Drugs, Investigational/economics* Economics, Pharmaceutical/standards* Editorial Policies* Organizations, Nonprofit/economics Publication Bias* Research Support*

 

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Cases of wilful misrepresentation are a rarity in medical advertising. For every advertisement in which nonexistent doctors are called on to testify or deliberately irrelevant references are bunched up in [fine print], you will find a hundred or more whose greatest offenses are unquestioning enthusiasm and the skill to communicate it.

The best defence the physician can muster against this kind of advertising is a healthy skepticism and a willingness, not always apparent in the past, to do his homework. He must cultivate a flair for spotting the logical loophole, the invalid clinical trial, the unreliable or meaningless testimonial, the unneeded improvement and the unlikely claim. Above all, he must develop greater resistance to the lure of the fashionable and the new.
- Pierre R. Garai (advertising executive) 1963