A New England Journal of Medicine article (A Randomized Study of How Physicians Interpret Research Funding Disclosures) and accompanying editorial (Believe the Data) bemoan the finding that physicians appear to discount the methodological rigor of clinical trials that are sponsored by pharmaceutical companies. Unlike the authors, I am not bothered by this state of affairs. (Both of these articles are available for free and I encourage you to read them.)
In the study, researchers asked practicing internists to review abstracts of clinical trial results for three hypothetical drugs. The researchers varied the methodologic rigor (high, medium, low) and funding source (pharma, NIH, or undisclosed). The internists were able to differentiate the quality of the studies but when the trial was listed as pharma funded the internists were more skeptical, down-rated the level of rigor and said they’d be less likely to prescribe.
The article and editorial note that there may be reasons for skepticism, at least based on historical practices of the industry, but that readers should judge trials according to the quality of the methodology and ignore the funding source.
Here’s why I disagree:
- Only the abstract was presented, so the disclosure made up a large percentage of the total information presented. If the full article were provided maybe that would have changed the results
- Physicians understand that pharma has a vested interest in studies that show that drugs are effective, and so may be making an adjustment for the way the data are interpreted even if study design seems strong. They may also be thinking of the less flattering studies that never see the light of day
- There’s a big difference between filling out a survey indicating willingness to prescribe and actual prescribing behavior. In the real world pharma has plenty of tools to make sure that physicians prescribe effective drugs. They can follow through the journal articles with reprints, detailing, conferences, advertising and more. So I’m not worried that physician skepticism is leading to under-prescribing