We all want to base our healthcare decisions on trustworthy evidence. Yet the landmark 2009 Institute of Medicine report identified widespread financial conflicts of interest across medical research, education, and practice. 1 It highlighted that extensive industry influence may be jeopardising "the integrity of scientific investigations, the objectivity of medical education, the quality of patient care, and the public's trust in medicine." 1 Problem of financial dependence Research Financial dependence on commercial companies is common within research, and in the United States almost 60% of medical research is industry funded. 9 It's been shown repeatedly that published outcomes of industry sponsored studies tend to favour sponsors' products, creating a "sponsorship bias" in the evidence base that overplays benefits and underplays harms. 10 In 2013, research by the German Institute for Quality and Efficiency in
The impetus for these essays on evidence in medicine and law is commonly called evidence-based medicine: the movement to evaluate the safety, effectiveness, and cost of medical practices using tools from science and social science and to base clinical practice on such knowledge.Evidence-based medicine is portrayed as an alternative to medicine based on authority, tradition, and the physician's personal experience. The role of politics is rarely mentioned. When discussed, politics is portrayed as what evidence-based medicine will avoid.Rational evaluation of evidence plays an important role in medicine. However, it is not an alternative to medical politics. Rather, evidence is a tool for institutional control and policy argument. Today evidencebased medicine is used to oversee individual physicians and the practice of medicine. It thus helps to alter the balance of power among doctors, payers, and patients. Changing medical practice requires the development of political, legal, and medical institutions that oversee medical care. Promoting medical practice based on evidence will therefore necessitate more, not less politics.
When physicians' conflicts of interest arise from ties with drug firms, we should shift our focus to the pharmaceutical industry and improper dependencies that cause institutional corruption. This article analyzes eight forms of improper dependencies on pharma and proposes reforms.
Today, the goals of pharmaceutical policy and medical practice are often undermined due to institutional corruption - that is, widespread or systemic practices, usually legal, that undermine an institution's objectives or integrity. In this symposium, 16 articles investigate the corruption of pharmaceutical policy, each taking a different look at the sources of corruption, how it occurs, and what is corrupted. We will see that the pharmaceutical industry's own purposes are often undermined. Furthermore, pharmaceutical industry funding of election campaigns and lobbying skews the legislative process that sets pharmaceutical policy. Moreover, certain practices have corrupted medical research, the production of medical knowledge, the practice of medicine, drug safety, the Food and Drug Administration's oversight of the pharmaceutical market, and the trustworthiness of patient advocacy organizations.
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