Delve deeper to find the linksBMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39450.701262.3A (Published 10 January 2008) Cite this as: BMJ 2008;336:59
- John H Noble Jr, emeritus professor, State University of New York at Buffalo
The finding by Yank et al of no connection between results in meta-analyses and financial ties is surprising,1 given the greater deficiencies for reporting of harm outcomes among trials that were solely funded by industry (median 56% per trial) than among trials that were not (27%).2 Evidently the Oxman-Guyatt measure of scientific quality of research reviews used by Yank et al cannot capture discrepancies in original research protocols and their published form and the selective reporting of outcomes, both of which are prevalent in randomised trials.2
Firstly, bias in reporting outcomes acts in addition to and in the same direction as publication bias of entire studies to produce inflated estimates of the effects of treatment.2
Secondly, the antidote is to require registration of all trials and protocols in the public domain before completing the study and to assure that they be made available along with any manuscript undergoing peer review for journal publication.
Thirdly, belief that the collected raw data are somehow unaffected by the artefacts of research design, sampling, and measurement is mistaken. Epstein’s dismissal of the importance of the findings of Yank et al and his strained argument to justify problematic practices of the drug and medical device industry are based on such misunderstanding.3 Epstein’s assertion that nothing in the work of Yank et al suggests that the raw data from the drug sponsored studies were defective3 overlooks the use of the Oxman-Guyatt measure of research quality as a statistical control variable.
Epstein’s choice of more studies whose quality may be more biased over fewer studies of presumably better quality makes no sense except from the self interested perspective of the industry. His argument that government intervention in the form of legal restrictions would be economically dysfunctional asserts the interests of industry,4 whereas in welfare economics regulatory intervention is sometimes the solution for market failure. Widespread premeditated bias in published and unpublished reports of clinical trials linked to industry sponsorship is “smoking gun” evidence of market failure.5
Competing interests: None declared.