Monday, October 24, 2011

Industry Funded Studies

One of the advantages of being a blogger is the comments, feedback and communications I receive from readers.  Though not all of it is positive, many of these interactions with people from across the globe that I do not know has been quite enjoyable for me personally.

One email I received from a reader had to do with industry funded studies.  This is not an uncommon concern, and one that frequently shows up on this blog and others.  The email encapsulates many people's concerns with industry funded studies.

Dear Dr. Mintz,

I am staring at my computer unable to formulate the words to express my opinion on a very important subject. I do not want to come across as rude, condemning or complaining, yet I am compelled to share with the medical community my honest patient perspective.

I view the medical profession as one of the most respected on earth. But it isn't perfect. As a patient I become very discouraged when I see a medical professional look towards industry funded drug studies to make medical decisions.

Now for the painfully honest part. When I see a Doctor subscribe to "results" from an industry funded drug study, my image of that physician goes to pot in a heartbeat. "How can he/she be so gullible" and "Incompetent" are thoughts that pass through my mind. I quickly lose trust in that physician's ability to make smart decisions in my health care, and the doctor loses my business.

On on the contrary, I asked a physician what he thought about industry funded drug studies, he answered "I ignore them." This doctor won me over in three words.

Obviously it takes excellent academic ability to become a physician, but I look for more than that. I look for wisdom and integrity when choosing a physician.

There is no question that industry studies are biased by nature.  The drug company is beholden to its stockholders to increase sales.  Therefore, they have a fiduciary obligation to make sure that their research puts their products in the best light.  This is not unlike any product in the US where a manufacturer does research stating that people prefer it or it works better than a competitor.  Unlike these products, medications are heavily regulated in the United States.  Thus, for a medication to get approval or to make any claims, all studies, including ones funded by the industry have to go through the FDA.

Here's the real problem:

Almost all research done on medications is funded by the industry. I would love it if instead of relying on industry sponsored studies, I could rely on non-biased information.  However, when it comes to medications, these studies are few and far between.  In 2005, the industry spent close to $40 billion dollars on research.  Compare this to the entire NIH budget that same year of less than $30 billion.  Also, understand that the NIH spends very little money on actual drug studies.  They focus more on finding a cure to cancer, not whether expensive medicine X is just as good as the older generic medication. 

When I want to know whether to buy product X vs. product Y, I can go to an independent source such as Consumer Reports, which does their own, independent research.  There is really no such independent source for drug information.  In fact, prescription drugs is one of the only areas that Consumer Reports does not do their own research.  All their recommendations on which medicine is "right for you" come from drug company sponsored studies.
If we ignored all industry funded studies, we be ignoring most of the data.  In addition, since these studies are heavily regulated, we would be ignoring mainly good, helpful data, even if biased.  The simple alternative is to fund the NIH or similar organization equally to the drug companies in order to do independent research.  Of course this would likely require significant government spending, which is likely a non-starter.

The good news is that independent comparisons of treatment, called comparative effective research, are starting to be done, and (whether you like health care reform or not), there is funding for this research in the Affordable Care Act.  Unfortunately, this funding is not nearly enough to compete with the drug companies.  Thus, unless you are willing to pay considerably more in taxes or drop some needed services, physicians and patients still need to rely on industry funded research. Many studies from the industry are actually quite good and useful, though, because of inherent bias, should always be looked at with a skeptical eye.

1 comment:

Jayant Rana said...

Brilliantly answered. There's a need for people to understand that you can't have your cake and eat it too. U.S. is already one of the world's most regulated markets. And obviously pharma companies have their "fiduciary obligations", but that doesn't make all their research despicable. Somewhere, people need to understand. Skepticism works...