More MS news articles for April 2001

What to Believe

Last updated 11 April 2001 22:06:44 GMT

One of the hardest things for a patient to do is tell the difference between good and bad medical science. Anyone who has conducted medical research online has almost certainly come across examples of science that seems reasoned and legitimate, only to find additional information that casts serious doubt about its value and source. The result is confusion that leads to patients wondering what they should believe.

As you wade your way through the labyrinth that is online medical information, you should consider a number of factors before you decide what to believe.

Who Conducted the Study?

One would assume that one of the easiest things to determine about a scientific study is who conducted the research. However, there is growing evidence that even this most basic assumption is false.

Articles published in mainstream medical journals routinely have unidentified "ghost" writers, and give no indication of who actually conducted the research. The Boston Globe recently reported the study of 809 articles published in major journals, which found that 29 per cent of those had guest or "ghost" authors hired by drug companies. These articles appear under the name of a distinguished researcher who agreed to review them in exchange for a paycheck.

Do Scientists Have Financial Motives?

Marcia Angell, editor of the New England Journal of Medicine (NEJM), acknowledged problems in medical research and called for higher ethical standards in the editorial titled "Is Academic Medicine for Sale?" Angell said doctors must stop accepting lucrative speaking fees and gifts from pharmaceutical companies. She believed that doctors who benefit from the drug makers' largess are more likely to publish favorable results.

NEJM was forced to take a hard look in the mirror after an internal audit found that as many as 19 drug therapy review articles were penned by researchers with undisclosed ties to pharmaceutical companies. The internal audit was conducted after last fall's article in The New York Times drew attention to conflicts of interest in pharmaceutical research.

As an example, at a recent conference on medical ethics, a review of reports on 196 tests of nonsteroid anti-inflammatory drugs presented by Dr. Bodenheimer, internist at University of California at San Francisco, found questionable statements in as much as 76 per cent of the articles. Bodenheimer also cited instances in 1990 and 1996 in which pharmaceutical companies refused to allow researchers to publish data unfavorable to company products.

Additionally, Bodenheimer cited a recent review of reports on 196 tests of nonsteroidal anti-inflammatory drugs that found "doubtful or invalid statements" in 76 percent of the articles. He detailed five reviews of clinical trials made by other researchers that showed that "company-funded trials have a high likelihood of favoring the company's products."

The distortions don't stop at publishing reviews tilted in favor of drug manufacturers. Company-funded trials have a high likelihood of coming up with results that favor the company's products. These results can be obtained by tinkering with design of drug tests.

For instance, a study published in the Journal of American Medical Association examined effectiveness tests of two anti-fungal drugs. In a study comparing the new drug to the older one and funded by a maker of the new drug, 79 per cent of the patients received the older drug orally, while it was supposed to be administered intravenously. These manipulations virtually guarantee better results, but do not prove that the new drug is better than the old one.

The medical community and patients that are not aware of financial relationships between researchers and drug makers put their faith into flawed science and commercially driven research, which has potential of endangering both the patients' lives and the reputation of the medical field. Behind-the-scenes financial ties between pharmaceutical companies and academic research should not taint the information used for making vitally important decisions.

Was the Study Peer Reviewed?

Peer review is one of four requirements for good science (proper procedure, proper performance and repeatability are the other three). This fourth standard requires that the results of the study be published in a scientific journal or other publication that is peer-reviewed.

Peer review is an important component of the scientific method that ensures proper study design, sampling methodology and conclusions supported by the study's findings. Without rigorous peer review, articles constitute no more than one scientist's (or agency's) opinion and cannot be granted the same status as peer-reviewed publications.

Passing the hurdle of peer-reviewed publication is an assurance that quality control has been exercised in communicating the results to other scientists and meets a type of reliability norm on which decision-makers can rely. Any science that is not peer reviewed cannot be considered good.

Much more information can be on the website.