Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Curbing bias in medical research

Robert Pearl, MD
Physician
August 3, 2014
Share
Tweet
Share

To improve patient care, doctors rely on research and published information.

According to an American Medical News report, professional journals are still the most popular source of up-to-date medical information among doctors.

These medical publications inform physicians on new drugs and treatments, and they contain peer-reviewed studies that both physicians and patients assume are scientifically accurate.

But all too often, research findings aren’t as scientific as they should be. And some are flat-out biased.

Research studies confirm bias in research

In 2012, the report “Industry sponsorship and research outcome” concluded that studies sponsored by a drug or device company lead to “more favorable results and conclusions” about the products studied than independently sponsored ones.

And a recent study from the Harvard Medical School on plastic surgery outcomes concluded, “Studies authored by groups with conflicts of interest are significantly associated with reporting lower surgical complications and therefore describing positive research findings.”

This was especially true when manufacturer-marketed products were used in the study, according to the study’s abstract.

Perhaps the most damning study comes by way of the National Center for Biotechnology Information.

In it, the authors identified 24 peer-reviewed studies published in highly respected medical journals. Each study compared two different types of suction devices that help wounds heal faster.

One device uses a sponge-type material while the other relies on a gauze-wound interface.

The researchers asked five independent surgeons to read all 24 papers and determine which product was judged as better in each study.

The conclusion: Seven papers seemed to favor the first treatment, 15 favored the second and 2 didn’t reach a definitive judgment.

ADVERTISEMENT

Now, here’s the kicker

Of the 24 studies, 19 were funded by a manufacturer of one of the two devices. Lo and behold, based on determinations made by the independent surgeons, 18 of those 19 papers recommended the product made by the manufacturer who funded the research. Just one manufacturer-funded study was deemed to have a neutral conclusion.

From a statistical perspective, this is nearly an impossible outcome.

Flip a coin 19 times and there’s a 1 in 524,288 chance it comes up heads each time.

We might expect that if the two alternative products were relatively equivalent and the research truly unbiased, the product sold by the non-funding company should come out on top about half the time. To have no study go against the funding company yields nearly impossible odds.

And if they are not equivalent, the better product should be identified in nearly all studies, regardless of the source of the researcher’s funding.

There is no way to interpret these results, except to assume the researchers themselves were biased based on who paid for their work.

Biased outcomes like these would raise red flags in any other context. They would have signaled some sort of inappropriate influence. The scientific results would have been rejected by medical journals.

But not under these circumstances.

How bias gets by in medical research

No manufacturer is foolish enough to demand that investigators reach a specific conclusion in their research. Discovery of such a quid pro quo relationship could result in a major scandal for the company and the termination of the researchers.

The origin of bias in these manufacturer-funded studies may be subconscious, but no less effective.

Researchers and research sponsors interact at events and meetings during the time the work itself is being performance and during subsequent clinical trials.

And social science literature has clearly demonstrated people have a strong desire to reciprocate a gift.

At a minimum, grateful researchers unconsciously want to “return the favor” to their funding organizations.

And given the constant pressure in academia to “publish or perish,” this bias could be more overt as researchers fear losing funding – even if a threat is never explicitly conveyed.

Regardless of the etiology, research bias and skewed results are real when medical companies fund studies on their products. And whether it’s conscious or unconscious, bias is inappropriate in any scientific context.

Curbing bias in medical research 

Over the past decades, attempts have been made to limit the inappropriate influence of bias in research.

Today, authors of peer-reviewed articles and presenters at accredited meetings are required to disclose any personal financial benefit from the research. They must also disclose financial dealings with the manufacturer – but not any of the details.

Researchers receiving federally funded grants must register their trials on ClinicalTrials.gov and publish their results even when findings don’t favor the funding organization.

The days of sponsors suppressing unfavorable outcomes or helping investigators write their papers before submission are largely behind us.

But as the data demonstrate, today’s system is far from effective at ensuring scientific integrity.

The negative consequences of manufacturer-funded research

Physicians rely on published data to determine the best treatment for their patients. When it is contaminated by inappropriate influence, doctors can’t provide the best possible care.

As a result, patients end up with lower quality care, increased complications and higher costs.

Public and private entities could take a number of big steps to curb medical research bias.

For starters, peer-reviewed journals could refuse to publish articles funded by a single company.

If manufacturers wanted to advance medical knowledge, competing drug and device companies could contribute to a common, independent research fund for their particular industry. This would eliminate the manufacturer-researcher relationship from a study’s equation.

Alternatively, a small fee could be added to the sales price of medical devices and drugs to fund independent research. Organizations like the National Institute of Health (NIH) could oversee the distribution of these dollars.

Of course, we should expect manufacturers to resist such changes. After all, drug and device companies aspire to drive product sales, not produce unbiased research.

But the problems created by the current system are far too serious to accept the status quo.

We need to stop hiding our heads in the sand. The data is clear. Change is essential.

Robert Pearl is a physician and CEO, The Permanente Medical Group. This article originally appeared on Forbes.com. 

Prev

A cruel paradox when it comes to mental disorders

August 3, 2014 Kevin 4
…
Next

What is the most important trait in a doctor?

August 3, 2014 Kevin 21
…

Tagged as: Primary Care

Post navigation

< Previous Post
A cruel paradox when it comes to mental disorders
Next Post >
What is the most important trait in a doctor?

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Robert Pearl, MD

  • The emotional toll of a broken health care system

    Robert Pearl, MD
  • Medicare’s cobra effect: How a well-intentioned policy spiraled into a health care crisis

    Robert Pearl, MD
  • Empowering patients: Navigating medical information with AI

    Robert Pearl, MD

More in Physician

  • From basketball to bedside: Finding connection through March Madness

    Caitlin J. McCarthy, MD
  • The invisible weight carried by Black female physicians

    Trisza Leann Ray, DO
  • A female doctor’s day: exhaustion, sacrifice, and a single moment of joy

    Dr. Damane Zehra
  • The hidden cost of malpractice: Why doctors are losing control

    Howard Smith, MD
  • How scales of justice saved a doctor-patient relationship

    Neil Baum, MD
  • Rediscovering the soul of medicine in the quiet of a Sunday morning

    Syed Ahmad Moosa, MD
  • Most Popular

  • Past Week

    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • “Think twice, heal once”: Why medical decision-making needs a second opinion from your slower brain (and AI)

      Harvey Castro, MD, MBA | Tech
    • The hidden cost of delaying back surgery

      Gbolahan Okubadejo, MD | Conditions
    • Rethinking medical education for a technology-driven era in health care [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Internal Medicine 2025: inspiration at the annual meeting

      American College of Physicians | Physician
    • Residency as rehearsal: the new pediatric hospitalist fellowship requirement scam

      Anonymous | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • The hidden bias in how we treat chronic pain

      Richard A. Lawhern, PhD | Meds
    • Are quotas a solution to physician shortages?

      Jacob Murphy | Education
  • Recent Posts

    • Rethinking medical education for a technology-driven era in health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • From basketball to bedside: Finding connection through March Madness

      Caitlin J. McCarthy, MD | Physician
    • In medicine and law, professions that society relies upon for accuracy

      Muhamad Aly Rifai, MD | Tech
    • Diabetes and Alzheimer’s: What your blood sugar might be doing to your brain

      Marc Arginteanu, MD | Conditions
    • How motherhood reshaped my identity as a scientist and teacher

      Kathleen Muldoon, PhD | Conditions
    • Jumpstarting African health care with the beats of innovation

      Princess Benson | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 6 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • “Think twice, heal once”: Why medical decision-making needs a second opinion from your slower brain (and AI)

      Harvey Castro, MD, MBA | Tech
    • The hidden cost of delaying back surgery

      Gbolahan Okubadejo, MD | Conditions
    • Rethinking medical education for a technology-driven era in health care [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Internal Medicine 2025: inspiration at the annual meeting

      American College of Physicians | Physician
    • Residency as rehearsal: the new pediatric hospitalist fellowship requirement scam

      Anonymous | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • The hidden bias in how we treat chronic pain

      Richard A. Lawhern, PhD | Meds
    • Are quotas a solution to physician shortages?

      Jacob Murphy | Education
  • Recent Posts

    • Rethinking medical education for a technology-driven era in health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • From basketball to bedside: Finding connection through March Madness

      Caitlin J. McCarthy, MD | Physician
    • In medicine and law, professions that society relies upon for accuracy

      Muhamad Aly Rifai, MD | Tech
    • Diabetes and Alzheimer’s: What your blood sugar might be doing to your brain

      Marc Arginteanu, MD | Conditions
    • How motherhood reshaped my identity as a scientist and teacher

      Kathleen Muldoon, PhD | Conditions
    • Jumpstarting African health care with the beats of innovation

      Princess Benson | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Curbing bias in medical research
6 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...