A large proportion of biomedical research is funded by the pharmaceutical industry. The extent to which this affects the outcome of academic research was investigated by Patsopoulos et. al. in the British Medical Journal.[1] The authors conclude that industry funding of randomised controlled trials are a form of advertising for the products that are the subject of the study. This is due to weight of numbers: there are more studies on drugs than on lifestyle interventions or non-patentable medicines (such as herbal medicine for example), which results in the drug studies being cited more often in academic papers.

The research found that:

"Since 1994, biotechnology and drug companies have provided funding to an increasing proportion of frequently cited studies", and

"Industry funding has become ubiquitous for frequently cited randomised controlled trials, and most of these influential trials have no other sources of funding".

"Since 1994, biotechnology and drug companies have provided funding to an increasing proportion of frequently cited studies", and

"Industry funding has become ubiquitous for frequently cited randomised controlled trials, and most of these influential trials have no other sources of funding".

The authors conclude that many important questions in clinical research have no connections with specific products and thus would not be supported by industry. Such questions may never be funded or may not be cited frequently once published. They forsee the scenario of "Academic Inc," with academic medicine evolving into an efficient enterprise that is directed by profit and has strong ties to other profit making corporate structures.

One effect of the huge amount of industry-funded research is that national guidelines may be biased towards the better quality studies.[2]

For example, most of the evidence on which the 2004 NICE (National Institute for Health and Clinical Excellence) guidelines on dyspepsia are based came from randomised controlled trials funded by industry. This created several distortions in the evidence base:

Firstly, evidence from trials of proton pump inhibitors was abundant compared with data for off-patent treatments such as metoclopramide or lifestyle interventions.

Secondly, placebo was chosen as a comparator when "current" treatment would have been better.

Thirdly, in one instance (cisapride in non-ulcer dyspepsia) a large number of poor quality studies funded by industry led to a result that was later discounted as potentially biased.

Another effect of the disparity between research into pharmaceutical drugs and alternative medicine is that doctors now expect that all therapies should be clinically validated, even though much more funding for research is channelled into pharmaceuticals. There has been a backlash against Prince Charles' pro-integrative medicine address to the World Health Assembly in Geneva.[3] Thirteen high-profile doctors wrote an open letter saying that alternative medicine was being promoted within the UK National Health Service despite a lack of evidence.

The UK government had previously stated an intention to commission research focused on improving health and social care.[4] In their goals for research and development over the next five years, the government has made a commitment to "creating a vibrant research environment that contributes to the health and wealth of England". This could well be a way of getting funding for important research, particularly in the light of recent criticism.

Follow up:

References:

1. Patsopoulos NA, Analatos AA, Ioannidis JP.

Origin and funding of the most frequently cited papers in medicine: database analysis.

BMJ. 2006 Mar 17.

PMID: 16547014

2. Delaney B.

Commentary: Is society losing control of the medical research agenda?

BMJ. 2006 Mar 17;

PMID: 1654701

3. BBC News: Doctors attack 'bogus' therapies

4. Department of Health. Best research for best health. London: DOH, 2006. www.dh.gov.uk