Pathways to independence: towards producing and using trustworthy evidence

Abstract

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

Commercial influence and covid-19

“…This week, The BMJ published the initial list of signatories to our call for action to reduce commercial influence in how healthcare evidence is produced and used (www.bmj.com/commercial-influence-call-to-action). Signatories include professors, patient advocates, clinicians, and researchers who want to see product evaluation, medical education, and clinical practice much freer from commercial interests 1…”

“…There are valid arguments for “regulatory agility” during emergencies such as covid-19,5 but speed should not undermine basic standards for trustworthy evidence 6. As a 2017 report on Ebola from the US National Academy of Sciences noted, “despite [the] sense of urgency, research during an epidemic is still subject to the same core scientific and ethical requirements that govern all research on human subjects.”7 Clear evidence of the risk of bias in commercially funded research 1 should drive efforts to develop a new, but equally agile, system of independent evaluation of all tests and treatments.…”

Distancing design of phase III trials from drug company influence

“…Moynihan and colleagues propose ways to produce healthcare evidence independent of commercial interests 1…”

Cochrane Sustainable Healthcare: evidence for action on too much medicine

“…Much work is already underway to identify medical excess and mitigate its harmful consequences. This includes: e orts to improve the trustworthiness of the evidence base through transparency and independence from commercial influence; [11] [12] explicit considerations of benefits, harms, costs, and burdens when making clinical guideline recommendations; [13] campaigns to de-implement or deintensify low-value care; [14] initiatives to tackle the problem of inappropriately expanding disease definitions; [15] and participatory approaches to the development of care plans that are evidence-informed, responsive to problematic situations of patients, and minimally disruptive. [6] Generally, such e orts focus narrowly on particular manifestations of the problem rather than on broader considerations of the cultural, political, social, professional, scientific, and financial processes that encourage us to do something rather than nothing, even when it may do more harm than good.…”

“…11 Mayo Clinic, USA. 12 Cochrane Sustainable Healthcare, Denmark. 13 Cochrane Canada, McMaster University, Canada.…”