Loading the dice?

Loading the dice?Pharmaceutical companies sponsor trials of already approved products to demonstrate their superiority to other therapies. Somehow the sponsor's product tends to look good.From the Washington Post (Comparison of Schizophrenia Drugs Often Favors Firm Sponsoring Study)

Pharmaceutical giant Eli Lilly and Co. recently funded five studies that compared its antipsychotic drug Zyprexa with Risperdal, a competing drug made by Janssen. All five showed Zyprexa was superior in treating schizophrenia.

But when Janssen sponsored its own studies comparing the two drugs, Risperdal came out ahead in two out of three.

In fact, when psychiatrist John Davis analyzed every publicly available trial funded by the pharmaceutical industry pitting six new antipsychotic drugs against one another, nine in 10 showed that the best drug was the one made by the company funding the study.

Why might this be? One possibility is that the companies only publicize studies that come out in their favor. If so we may soon gain a better perspective now that the industry has agreed to make public almost all trials. (Read the press releases here.) Another possibility is that sponsors introduce just enough bias into their study designs --e.g., by selecting certain patient sub-populations or comparing a more effective dose of their own product against a weaker dose of a competitor's-- in order to influence the results.

Probably both things are occurring. If so, the impact of greater transparency might be to increase sponsors' use of "exploratory studies." These studies, which help establish hypotheses for broader testing, are excluded from the industry's commitment to fuller transparency. That means increased scrutiny of study design and the funding of comparison trials by neutral parties remain vital.