Failure to discount for conflict of interest when evaluating medical literature: a randomised trial of physicians

Abstract

Context Physicians are regularly confronted with research that is funded or presented by industry. Objective To assess whether physicians discount for conflicts of interest when weighing evidence for prescribing a new drug. Design and setting Participants were presented with an abstract from a single clinical trial finding positive results for a fictitious new drug. Physicians were randomly assigned one version of a hypothetical scenario, which varied on conflict of interest: 'presenter conflict', 'researcher conflict' and 'no conflict'. Participants 515 randomly selected Fellows in the American College of Obstetricians and Gynecologists' Collaborative Ambulatory Research Network; 253 surveys (49%) were returned. Main object measures The self-reported likelihood that physicians would prescribe the new drug as a first-line therapy.Results Physicians do not significantly discount for conflicts of interest in their self-reported likelihood of prescribing the new drug after reading the single abstract and scenario. However, when asked explicitly to compare conflict and no conflict, 69% report that they would discount for researcher conflict and 57% report that they would discount for presenter conflict. When asked to guess how favourable the results of this study were towards the new drug, compared with the other trials published so far, their perceptions were not significantly influenced by conflict of interest information. Conclusion While physicians believe that they should discount the value of information from conflicted sources, they did not do so in the absence of a direct comparison between two studies. This brings into question the effectiveness of merely disclosing the funding sources of published studies.

Undue influences on drugs and device industries distort healthcare research, and practice

“…Declarations of the conflict of interests of expert panels and researchers are thought to guarantee transparency and integrity in the evidence base and clinical recommendation generation process. Nevertheless, there appears to be a gap between the intended purpose and practice as financial conflict of interests are severely under-reported in drug trial metaanalyses and panel guidelines 34 and practitioners very rarely discount for such conflicts when evaluating the evidence base 40 . Besides clinical guidelines formation, narrative review and editorials by key opinion leaders also have a major impact on clinical practice decisions and the medical community in general 41,42 .…”

Pharmacy and Therapeutics Committees: Leadership Opportunities in Medication Safety for Medical Toxicologists

“…This is complicated by the inherent belief by some that physicians are not subject to such influence [15]. The specialist may, in fact, be viewed as the person with the greatest insight into the clinical utility of the new drug lulling the committee to overlook the influence that industry marketing may bear [16].…”

The Impact of Financial Disclosure on Attendee Assessment of Objectivity in Continuing Medical Education Programs in Psychiatry: A Randomized, Controlled Trial

“…If these models are in fact applicable to medicine, they are not encouraging, as they indicate that greater levels of disclosure make it harder, not easier, for learners to correctly perceive bias in information presented to them [8,9]. The single empirical study that examined the effects of financial disclosure in a medical context involved a hypothetical situation and showed no effect of disclosure on physicians' behavior [10].…”