On thinking about conflicts of interest in medicine

The following originally appeared on The Upshot (copyright 2015, The New York Times Company).

Most of what we know about prescription drugs and medical devices comes from industry-funded clinical trials. Does the source of funding affect study findings?

The question is at the heart of a longstanding debate about financial conflicts of interest in medicine and what to do about them. That debate was recently reinvigorated by a three-part series of articles on the subject in The New England Journal of Medicine. For many years that journal has, as have other medical journals,required study authors to disclose such conflicts.

The series, by Dr. Lisa Rosenbaum, a cardiologist, challenged readers to consider industry sponsorship in the context of many other sources of bias influencing clinical care, research results and the willingness to support a new drug. Recent analysis suggests industry-sponsored drug and device studies show more favorable results than those sponsored by other sources. Other work showed that Food and Drug Administration advisory panel members with financial ties to a drug company rendered judgments more favorable to it. Other ties to, or gifts from, drug companies, including paid travel to conferences, are associated with greater affinity for and prescribing of the drugs those companies manufacture.

But, as my colleague Aaron Carroll pointed out in The Upshot, other potential sources of conflicts of interest in medicine have not been as closely examined. Among them are personal relationships, professional ambition, political ideology, religious or moral beliefs, or personal experiences that can affect how studies are conducted and interpreted.

Among these sources of bias, financial conflicts loom large because they are the only potential conflicts that researchers tend to disclose. Disclosing them is appropriate and useful, but what effect do such disclosures have — and what effect should they have — on our interpretation of the studies they accompany?

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