Intended for healthcare professionals

Rapid response to:

Education And Debate

Users' guide to detecting misleading claims in clinical research reports

BMJ 2004; 329 doi: (Published 04 November 2004) Cite this as: BMJ 2004;329:1093

Rapid Response:

Albumin, science and the money trough

Montori and colleagues cite the systematic review of albumin
administration in critically ill patients that was conducted by the
Cochrane Injuries Group as an example of a review that provided results
that were consistent with the interests of the funders of the review. They
claim that our review was funded by the NHS who they say pays for albumin
use, and go on to claim that our assertion that albumin should only be
used in the context of rigorously conducted randomised controlled trials
was therefore in the interest of the funders. This is wrong on both
counts. The systematic review of human albumin administration was not
funded by the NHS. Indeed, none of the authors received any external
funding for the work undertaken on this review. In common with most UK
based Cochrane Collaborative Review Groups, the infrastructure of the
Cochrane Injuries Group is supported by the NHS Research and Development
Programme but the decision to conduct this review was entirely independent
of the NHS who were in fact deeply embarrassed by its findings. The NHS
was embarrassed by the results because the NHS is the largest manufacturer
of human albumin in England and they had declined to provide the authors
of the review with details of any unpublished trials. This was covered
extensively in the British media. However, it is not surprising that
Montori and colleagues have rehearsed this slur on the Cochrane Injuries
Group Albumin review because considerable sums of money have been spent by
the Plasma Proteins Therapeutic Association on just this activity. The
systematic review conducted by Wilkes and Navickis from Hygeia Associates
in California was indeed funded by the Plasma Proteins Therapeutic
Association who have now published nine papers promoting the use of
albumin many of which were co-authored by leading university based
intensive care physicians. Although the Wilkes review was presented as a
response to the Cochrane review, their review used different inclusion
criteria, a fact also overlooked by Montori and colleagues, in which case
it is not surprising that the results were different. As Montori and
colleagues point out there is compelling evidence that funding influences
the conclusions from research but in this case the links are somewhat more
complicated than Montori and colleagues appreciate.

Competing interests:
None declared

Competing interests: No competing interests

28 November 2004
Ian Roberts
Professor of Epidemiology and Public Health
London School of Hygiene & Tropical Medicine