I find it a bit disturbing that I, as a journalist reporting on the
controversy about industry funding of the Cochrane Collaboration, should
be attacked by Dr. Andrew Moore and Professor Henry McQuay for supposedly
writing an “inaccurate” report. It is far easier, it appears, for Moore
and McQuay to attack a journalist than it is to counter the statements
made by the authorities I quoted (and quoted completely accurately, I
might add). Do Dr. Moore and Prof McQuay want to claim otherwise? I hope
this merely represents some misunderstanding on their part, rather than a
diversionary tactic to deflect attention from important issues.
Moore and McQuay dispute two fundamental ideas made by the
authorities I quoted. First, they claim that I accused them of a “big
invisible bias.” It was of course Hilda Bastian, the former consumer
advocate for the Cochrane Collaboration, rather than me, who pointed out
that selective reporting by the Cochrane on only two triptans, among a
field of triptans, created the possibility of a “big invisible bias.” Her
concern was echoed by many people I interviewed, and although I was not
the author of this sentiment, I must admit that it seems to me to be an
extremely reasonable concern – especially as one of the two drugs
reviewed, fortuitously enough, just happens to be sold by one of the
industry sponsors of the review.
Moore and McQuay, two of the four authors of the Cochrane review in
question, acknowledge that they receive funding from drug companies, but
offer as evidence of their own lack of bias an article they wrote in Pain,
which reviewed all of the triptans. I won’t address here whether or not
receiving drug company funding creates a conflict of interest for the
authors, because it seems to me the “invisible bias” of which Ms Bastian
warns has to do with the Cochrane itself, and not the authors of this
review. In that regard it is worth noting Moore and McQuay’s comment that
they offered the “whole work” to the headache section of the Cochrane
Collaboration, “and they [Cochrane] chose to take just two drugs,
eletriptan and riaztriptan.”
This is where the “big invisible bias” appears. What might explain
the Cochrane’s rationale for selecting only two triptans to review?
Herein lies the rub (and perhaps the reason for the diversionary attack on
the conveyor of this saga). It is here, it seems to me, that Hilda
Bastian’s concerns resonate so loudly. Why were only two triptans
selected? Were all the other triptans less effective? More dangerous?
More expensive? So much so that it wasn’t worth even reviewing the
evidence for physicians and the public to see for themselves? And could
it have anything to do with the fact that the review itself was
substantially funded by one of the drug’s manufacturers?
I personally don’t know the answer to these questions, but I do
believe that it is critical that they be asked. To claim that funding has
no effect on the selection of drugs reviewed (when some are reviewed and
others aren’t) proves nothing. Unless one truly believes, as Moore and
McQuay profess to believe, that there is “no good empirical evidence that
the results of reviews sponsored by industry differ from results of the
same reviews sponsored by not-for-profit sources.”
Really?
If Moore and McQuay, so outspoken on this subject, are totally
unaware of the “avalanche” of studies (in the words of Dr Drummond Rennie)
showing how strongly commercial funding affects published conclusions,
then I refer them to organizations such as Healthy Skepticism, Health
Action International, and Nofreelunch, or to the special article
collections in any number of medical journals such as the BMJ, JAMA, CMAJ,
etc., on bias, in which they which kindly categorize the astonishing
number of ways in which “gifts” from industry influence scientific
pronouncements.
The failure to report certain studies or to give only partial reviews
of data because they don’t promise a good “return on investment” is well-
described in a recent editorial1 – but one of the most remarkable aspects
of bias seems to be that those affected remain blissfully blind to their
own biases: (other doctors, most everyone acknowledges, might be affected
by financial conflicts of interest – “but I’m certainly not”).2
Drug company funding of research is increasing geometrically. Such
funding takes many forms, including funding of third party intermediaries
such as universities, contract research organizations, and even now, one
of the most prestigious, and purportedly “disinterested” organizations,
the Cochrane Collaboration. This may be why so many people with whom I
spoke expressed a sense of consternation.
But if I am allowed to express a personal opinion here (which I did
not do in my article, despite the implications of the attack by Moore and
McQuay), I would suggest that even if drug companies are no longer allowed
to fund Cochrane, and reviews are merely based on research as currently
done and reported, then drug company influence (the big invisible bias)
will persist mostly unabated, unless the Cochrane, among others, can
establish a mechanism by which health priorities – rather than proprietary
research priorities – are systematically researched and reported.
It is hard to overestimate the powerful, although occasionally
invisible, influence of for-profit companies on not only the research that
is done, but also the way it is interpreted and spun, regardless of how
“disinterested” most observers claim to be. No amount of diversion by
attacking a journalist can hide this fundamental difficulty of for-profit
corporate influence on health care today.
Jeanne Lenzer, medical investigative journalist
Reference List
(1) The "file drawer" phenomenon: suppressing clinical evidence.
Canadian Medical Association Journal 2004; 170(4):437.
(2) Dana J, Loewenstein G. A Social Science Perspective on Gifts to
Physicians From Industry. JAMA 2003; 290(2):252-255.
Competing interests:
I was the author of the article.
Rapid Response:
Shooting the messenger
I find it a bit disturbing that I, as a journalist reporting on the
controversy about industry funding of the Cochrane Collaboration, should
be attacked by Dr. Andrew Moore and Professor Henry McQuay for supposedly
writing an “inaccurate” report. It is far easier, it appears, for Moore
and McQuay to attack a journalist than it is to counter the statements
made by the authorities I quoted (and quoted completely accurately, I
might add). Do Dr. Moore and Prof McQuay want to claim otherwise? I hope
this merely represents some misunderstanding on their part, rather than a
diversionary tactic to deflect attention from important issues.
Moore and McQuay dispute two fundamental ideas made by the
authorities I quoted. First, they claim that I accused them of a “big
invisible bias.” It was of course Hilda Bastian, the former consumer
advocate for the Cochrane Collaboration, rather than me, who pointed out
that selective reporting by the Cochrane on only two triptans, among a
field of triptans, created the possibility of a “big invisible bias.” Her
concern was echoed by many people I interviewed, and although I was not
the author of this sentiment, I must admit that it seems to me to be an
extremely reasonable concern – especially as one of the two drugs
reviewed, fortuitously enough, just happens to be sold by one of the
industry sponsors of the review.
Moore and McQuay, two of the four authors of the Cochrane review in
question, acknowledge that they receive funding from drug companies, but
offer as evidence of their own lack of bias an article they wrote in Pain,
which reviewed all of the triptans. I won’t address here whether or not
receiving drug company funding creates a conflict of interest for the
authors, because it seems to me the “invisible bias” of which Ms Bastian
warns has to do with the Cochrane itself, and not the authors of this
review. In that regard it is worth noting Moore and McQuay’s comment that
they offered the “whole work” to the headache section of the Cochrane
Collaboration, “and they [Cochrane] chose to take just two drugs,
eletriptan and riaztriptan.”
This is where the “big invisible bias” appears. What might explain
the Cochrane’s rationale for selecting only two triptans to review?
Herein lies the rub (and perhaps the reason for the diversionary attack on
the conveyor of this saga). It is here, it seems to me, that Hilda
Bastian’s concerns resonate so loudly. Why were only two triptans
selected? Were all the other triptans less effective? More dangerous?
More expensive? So much so that it wasn’t worth even reviewing the
evidence for physicians and the public to see for themselves? And could
it have anything to do with the fact that the review itself was
substantially funded by one of the drug’s manufacturers?
I personally don’t know the answer to these questions, but I do
believe that it is critical that they be asked. To claim that funding has
no effect on the selection of drugs reviewed (when some are reviewed and
others aren’t) proves nothing. Unless one truly believes, as Moore and
McQuay profess to believe, that there is “no good empirical evidence that
the results of reviews sponsored by industry differ from results of the
same reviews sponsored by not-for-profit sources.”
Really?
If Moore and McQuay, so outspoken on this subject, are totally
unaware of the “avalanche” of studies (in the words of Dr Drummond Rennie)
showing how strongly commercial funding affects published conclusions,
then I refer them to organizations such as Healthy Skepticism, Health
Action International, and Nofreelunch, or to the special article
collections in any number of medical journals such as the BMJ, JAMA, CMAJ,
etc., on bias, in which they which kindly categorize the astonishing
number of ways in which “gifts” from industry influence scientific
pronouncements.
The failure to report certain studies or to give only partial reviews
of data because they don’t promise a good “return on investment” is well-
described in a recent editorial1 – but one of the most remarkable aspects
of bias seems to be that those affected remain blissfully blind to their
own biases: (other doctors, most everyone acknowledges, might be affected
by financial conflicts of interest – “but I’m certainly not”).2
Drug company funding of research is increasing geometrically. Such
funding takes many forms, including funding of third party intermediaries
such as universities, contract research organizations, and even now, one
of the most prestigious, and purportedly “disinterested” organizations,
the Cochrane Collaboration. This may be why so many people with whom I
spoke expressed a sense of consternation.
But if I am allowed to express a personal opinion here (which I did
not do in my article, despite the implications of the attack by Moore and
McQuay), I would suggest that even if drug companies are no longer allowed
to fund Cochrane, and reviews are merely based on research as currently
done and reported, then drug company influence (the big invisible bias)
will persist mostly unabated, unless the Cochrane, among others, can
establish a mechanism by which health priorities – rather than proprietary
research priorities – are systematically researched and reported.
It is hard to overestimate the powerful, although occasionally
invisible, influence of for-profit companies on not only the research that
is done, but also the way it is interpreted and spun, regardless of how
“disinterested” most observers claim to be. No amount of diversion by
attacking a journalist can hide this fundamental difficulty of for-profit
corporate influence on health care today.
Jeanne Lenzer, medical investigative journalist
Reference List
(1) The "file drawer" phenomenon: suppressing clinical evidence.
Canadian Medical Association Journal 2004; 170(4):437.
(2) Dana J, Loewenstein G. A Social Science Perspective on Gifts to
Physicians From Industry. JAMA 2003; 290(2):252-255.
Competing interests:
I was the author of the article.
Competing interests: No competing interests