BMJ  2003;326:1171-1173 (31 May), doi:10.1136/bmj.326.7400.1171

Paper

Evidence b(i)ased medicine—selective reporting from studies sponsored by pharmaceutical industry: review of studies in new drug applications

Hans Melander, senior biostatistician1, Jane Ahlqvist-Rastad, senior medical officer1, Gertie Meijer, documentalist1, Björn Beermann, professor1

1 Medical Products Agency, Box 23, S-751 03 Uppsala, Sweden

Correspondence to: H Melander hans.melander{at}mpa.se

Objectives To investigate the relative impact on publication bias caused by multiple publication, selective publication, and selective reporting in studies sponsored by pharmaceutical companies.

Design 42 placebo controlled studies of five selective serotonin reuptake inhibitors submitted to the Swedish drug regulatory authority as a basis for marketing approval for treating major depression were compared with the studies actually published (between 1983 and 1999).

Results Multiple publication: 21 studies contributed to at least two publications each, and three studies contributed to five publications. Selective publication: studies showing significant effects of drug were published as stand alone publications more often than studies with non-significant results. Selective reporting: many publications ignored the results of intention to treat analyses and reported the more favourable per protocol analyses only.

Conclusions The degree of multiple publication, selective publication, and selective reporting differed between products. Thus, any attempt to recommend a specific selective serotonin reuptake inhibitor from the publicly available data only is likely to be based on biased evidence.


Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to StumbleUpon StumbleUpon   Add to Technorati Technorati    What's this?

Relevant Articles

The effects of excluding patients from the analysis in randomised controlled trials: meta-epidemiological study
Eveline Nüesch, Sven Trelle, Stephan Reichenbach, Anne W S Rutjes, Elizabeth Bürgi, Martin Scherer, Douglas G Altman, and Peter Jüni
BMJ 2009 339: b3244. [Abstract] [Full Text] [PDF]

Novel methods to deal with publication biases: secondary analysis of antidepressant trials in the FDA trial registry database and related journal publications
Santiago G Moreno, Alex J Sutton, Erick H Turner, Keith R Abrams, Nicola J Cooper, Tom M Palmer, and A E Ades
BMJ 2009 339: b2981. [Abstract] [Full Text] [PDF]

The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration
Alessandro Liberati, Douglas G Altman, Jennifer Tetzlaff, Cynthia Mulrow, Peter C Gøtzsche, John P A Ioannidis, Mike Clarke, P J Devereaux, Jos Kleijnen, and David Moher
BMJ 2009 339: b2700. [Abstract] [Full Text]

Build bridges with the drugs industry—but keep patients in mind
Ian Gilmore
BMJ 2009 338: b439. [Extract] [Full Text]

Discrepancies in sample size calculations and data analyses reported in randomised trials: comparison of publications with protocols
An-Wen Chan, Asbjørn Hróbjartsson, Karsten J Jørgensen, Peter C Gøtzsche, and Douglas G Altman
BMJ 2008 337: a2299. [Abstract] [Full Text] [PDF]

Management of depression in adults
Markku Timonen and Timo Liukkonen
BMJ 2008 336: 435-439. [Extract] [Full Text] [PDF]

Efficacy of antidepressants in adults
Joanna Moncrieff and Irving Kirsch
BMJ 2005 331: 155-157. [Extract] [Full Text] [PDF]

The influence of big pharma
R E Ferner
BMJ 2005 330: 855-856. [Extract] [Full Text] [PDF]

Reporting of clinical trials of drugs shows bias
BMJ 2003 326: 0. [Full Text]

This article has been cited by other articles:

  • Vedula, S. S., Bero, L., Scherer, R. W., Dickersin, K. (2009). Outcome Reporting in Industry-Sponsored Trials of Gabapentin for Off-Label Use. NEJM 361: 1963-1971 [Abstract] [Full text]  
  • Barbui, C., Cipriani, A., Furukawa, T. A, Salanti, G., Higgins, J. P T, Churchill, R., Watanabe, N., Nakagawa, A., Omori, I. M, Geddes, J. R (2009). Making the best use of available evidence: the case of new generation antidepressants: A response to: Are all antidepressants equal?. Evid. Based Ment. Health 12: 101-104 [Full text]  
  • Okike, K., Kocher, M. S., Wei, E. X., Mehlman, C. T., Bhandari, M. (2009). Accuracy of Conflict-of-Interest Disclosures Reported by Physicians. NEJM 361: 1466-1474 [Abstract] [Full text]  
  • Nuesch, E., Trelle, S., Reichenbach, S., Rutjes, A. W S, Burgi, E., Scherer, M., Altman, D. G, Juni, P. (2009). The effects of excluding patients from the analysis in randomised controlled trials: meta-epidemiological study. BMJ 339: b3244-b3244 [Abstract] [Full text]  
  • Puhan, M. A., Schunemann, H. J. (2009). How to increase the value of randomised trials in COPD research. Eur Respir J 34: 552-558 [Abstract] [Full text]  
  • Wynia, M., Boren, D. (2009). Better regulation of industry-sponsored clinical trials is long overdue.. J Law Med Ethics 37: 410-419  
  • Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gotzsche, P. C., Ioannidis, J. P.A., Clarke, M., Devereaux, P. J., Kleijnen, J., Moher, D. (2009). The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration. ANN INTERN MED 151: W-65-W-94 [Abstract] [Full text]  
  • Moreno, S. G, Sutton, A. J, Turner, E. H, Abrams, K. R, Cooper, N. J, Palmer, T. M, Ades, A E (2009). Novel methods to deal with publication biases: secondary analysis of antidepressant trials in the FDA trial registry database and related journal publications. BMJ 339: b2981-b2981 [Abstract] [Full text]  
  • Greenland, S. (2009). Accounting for uncertainty about investigator bias: disclosure is informative: How could disclosure of interests work better in medicine, epidemiology and public health?. J. Epidemiol. Community Health 63: 593-598 [Full text]  
  • Liberati, A., Altman, D. G, Tetzlaff, J., Mulrow, C., Gotzsche, P. C, Ioannidis, J. P A, Clarke, M., Devereaux, P J, Kleijnen, J., Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339: b2700-b2700 [Abstract] [Full text]  
  • Gilmore, I. (2009). Build bridges with the drugs industry--but keep patients in mind. BMJ 338: b439-b439 [Full text]  
  • Chan, A.-W., Hrobjartsson, A., Jorgensen, K. J, Gotzsche, P. C, Altman, D. G (2008). Discrepancies in sample size calculations and data analyses reported in randomised trials: comparison of publications with protocols. BMJ 337: a2299-a2299 [Abstract] [Full text]  
  • House, E. R. (2008). Blowback: Consequences of Evaluation for Evaluation. American Journal of Evaluation 29: 416-426 [Abstract]  
  • Doucet, M, Sismondo, S (2008). Evaluating solutions to sponsorship bias. J. Med. Ethics 34: 627-630 [Abstract] [Full text]  
  • Noble, J. H. Jr, Sharav, V. H. (2008). Protecting People With Decisional Impairments and Legal Incapacity Against Biomedical Research Abuse. Journal of Disability Policy Studies 18: 230-244 [Abstract]  
  • Timonen, M., Liukkonen, T. (2008). Management of depression in adults. BMJ 336: 435-439 [Full text]  
  • Turner, E. H., Matthews, A. M., Linardatos, E., Tell, R. A., Rosenthal, R. (2008). Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy. NEJM 358: 252-260 [Abstract] [Full text]  
  • Dartnell, J., Hemming, M., Collier, J., Ollenschlaeger, G. (2008). Putting evidence into context: some advice for guideline writers. Evid. Based Nurs. 11: 6-8 [Full text]  
  • Timimi, S. (2008). Child psychiatry and its relationship with the pharmaceutical industry: theoretical and practical issues. Adv. Psychiatr. Treat. 14: 3-9 [Abstract] [Full text]  
  • Vandenbroucke, J. P., Elm, E. v., Altman, D. G., Gotzsche, P. C., Mulrow, C. D., Pocock, S. J., Poole, C., Schlesselman, J. J., Egger, M., for the STROBE initiative, (2007). Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and Elaboration. ANN INTERN MED 147: W-163-W-194 [Abstract] [Full text]  
  • Dartnell, J., Hemming, M., Collier, J., Ollenschlaeger, G. (2007). Putting evidence into context: some advice for guideline writers. Evid. Based Med. 12: 130-132 [Full text]  
  • Hampson, L. A., Joffe, S., Fowler, R., Verter, J., Emanuel, E. J. (2007). Frequency, Type, and Monetary Value of Financial Conflicts of Interest in Cancer Clinical Research. JCO 25: 3609-3614 [Abstract] [Full text]  
  • Bero, L A (2006). Clinical trial registration at Tobacco Control. Tobacco Control 15: 417-418 [Full text]  
  • Abbass, A. (2006). Merits of psychotherapies.. CMAJ 175: 61-61 [Full text]  
  • Chalmers, I. (2006). From optimism to disillusion about commitment to transparency in the medico-industrial complex. JRSM 99: 337-341 [Full text]  
  • Psaty, B. M., Rennie, D. (2006). Clinical Trial Investigators and Their Prescribing Patterns: Another Dimension to the Relationship Between Physician Investigators and the Pharmaceutical Industry. JAMA 295: 2787-2790 [Full text]  
  • Heres, S., Davis, J., Maino, K., Jetzinger, E., Kissling, W., Leucht, S. (2006). Why Olanzapine Beats Risperidone, Risperidone Beats Quetiapine, and Quetiapine Beats Olanzapine: An Exploratory Analysis of Head-to-Head Comparison Studies of Second-Generation Antipsychotics. Am. J. Psychiatry 163: 185-194 [Abstract] [Full text]  
  • Bryan-Brown, C. W., Dracup, K. (2006). Disentangling The Web. Am J Crit Care 15: 7-9 [Full text]  
  • MESHNICK, S. R., ALKER, A. P. (2005). AMODIAQUINE AND COMBINATION CHEMOTHERAPY FOR MALARIA. Am J Trop Med Hyg 73: 821-823 [Full text]  
  • Goodman, D. C. (2005). When an Asthma Drug Has an Inferiority Complex: A Noninferiority Trial. Pediatrics 116: 493-495 [Full text]  
  • Moncrieff, J., Kirsch, I. (2005). Efficacy of antidepressants in adults. BMJ 331: 155-157 [Full text]  
  • Spitz, B., Abramson, J. (2005). When Health Policy Is the Problem: A Report from the Field. Journal of Health Politics, Policy and Law 30: 327-366 [Abstract]  
  • Ferner, R E (2005). The influence of big pharma. BMJ 330: 855-856 [Full text]  
  • Moncrieff, J., Hopker, S., Thomas, P. (2005). Psychiatry and the pharmaceutical industry: who pays the piper?: A perspective from the Critical Psychiatry Network. Psychiatr. Bull. 29: 84-85 [Full text]  
  • Lexchin, J. R (2005). Implications of Pharmaceutical Industry Funding on Clinical Research. The Annals of Pharmacotherapy 39: 194-197 [Abstract] [Full text]  
  • Lexchin, J., Mintzes, B. (2004). Transparency in drug regulation: Mirage or oasis?. CMAJ 171: 1363-1365 [Full text]  
  • Chan, A.-W., Krleza-Jeric, K., Schmid, I., Altman, D. G. (2004). Outcome reporting bias in randomized trials funded by the Canadian Institutes of Health Research. CMAJ 171: 735-740 [Abstract] [Full text]  
  • van de Laar, F. A, Lucassen, P. L.B.J (2004). No evidence for a reduction of myocardial infarctions by acarbose. Eur Heart J 25: 1179-1179 [Full text]  
  • Hanefeld, M.G (2004). Meta-analysis of long-term studies to assess the effect of acarbose on cardiovascular risk reduction - scientifically credible: Reply. Eur Heart J 25: 1179-1180 [Full text]  
  • Chan, A.-W., Hrobjartsson, A., Haahr, M. T., Gotzsche, P. C., Altman, D. G. (2004). Empirical Evidence for Selective Reporting of Outcomes in Randomized Trials: Comparison of Protocols to Published Articles. JAMA 291: 2457-2465 [Abstract] [Full text]  
  • Bryan-Brown, C. W., Dracup, K. (2004). Evidence-Based Pandemonium. Am J Crit Care 13: 10-12 [Full text]  
  • Walker, B. F (2003). Risk of suicide remains high fifteen years after deliberate self-harm. Evid. Based Ment. Health 6: 106-106 [Full text]  
  • Wager, E. (2003). Good practice in publication of clinical trial results. Br. J. Psychiatry 183 : 464-465 [Full text]  
  • Als-Nielsen, B., Chen, W., Gluud, C., Kjaergard, L. L. (2003). Association of Funding and Conclusions in Randomized Drug Trials: A Reflection of Treatment Effect or Adverse Events?. JAMA 290: 921-928 [Abstract] [Full text]  
  • (2003). Bias in Pharmaceutical-Sponsored Research?. Journal Watch Cardiology 2003: 4-4 [Full text]  
  • (2003). Bias in Pharmaceutical-Sponsored Research?. JWatch General 2003: 4-4 [Full text]  
  • Abbasi, K., Smith, R. (2003). No more free lunches. BMJ 326: 1155-1156 [Full text]  

Rapid Responses:

Read all Rapid Responses

EBM: the new religion - a further thought
Luis Vitetta, et al.
bmj.com, 30 May 2003 [Full text]
At least, there is a bias in a lot of results...
Sergio Stagnaro
bmj.com, 1 Jun 2003 [Full text]
Debate about whether antidepressants are better than placebos
D B Double
bmj.com, 2 Jun 2003 [Full text]



Access jobs at BMJ Careers
Whats new online at Student 

BMJ