Undue industry influences that distort healthcare research, strategy, expenditure and practice: a review European Journal of Clinical Investigation, Volume 43, Issue 5, pages 469–475, May 2013. Emmanuel Stamatakis1,2,, Richard Weiler3, John P.A. Ioannidis4,5, Article first published online: 25 MAR 2013
Abstract: Background: Expenditure on industry products (mostly drugs and devices) has spiraled over the last 15 years and accounts for substantial part of healthcare expenditure. The enormous financial interests involved in the development and marketing of drugs and devices may have given excessive power to these industries to influence medical research, policy, and practice.
Material and methods: Review of the literature and analysis of the multiple pathways through which the industry has directly or indirectly infiltrated the broader healthcare systems. We present the analysis of the industry influences at the following levels: (i) evidence base production, (ii) evidence synthesis, (iii) understanding of safety and harms issues, (iv) cost-effectiveness evaluation, (v) clinical practice guidelines formation, (vi) healthcare professional education, (vii) healthcare practice, (viii) healthcare consumer’s decisions.
Results: We located abundance of consistent evidence demonstrating that the industry has created means to intervene in all steps of the processes that determine healthcare research, strategy, expenditure, practice and education. As a result of these interferences, the benefits of drugs and other products are often exaggerated and their potential harms are downplayed, and clinical guidelines, medical practice, and healthcare expenditure decisions are biased.
Conclusion: To serve its interests, the industry masterfully influences evidence base production, evidence synthesis, understanding of harms issues, cost-effectiveness evaluations, clinical practice guidelines and healthcare professional education and also exerts direct influences on professional decisions and health consumers. There is an urgent need for regulation and other action towards redefining the mission of medicine towards a more objective and patient-, population- and society-benefit direction that is free from conflict of interests.
Introduction: A universal characteristic of most healthcare systems in developed countries is the heavy focus on pharmacological approaches for treating and preventing chronic disease and the considerable expenditure on high-tech medical equipment, devices and technologies. This focus is often linked to astonishing financial interests, such as the $130 billion a single drug (Lipitor) generated over 14 years , an amount that is higher than the 2010 gross domestic product of 129 of the 184 countries in the world . Besides traditional drugs, biologics and devices can also produce huge revenue. For example, the manufacturers of anti-TNF biological drugs and therapies have created a $10 billion annual market [3, 4] even though these agents are used for indications with rather modest, incremental benefits. The market for drug-eluting stents for coronary artery disease is $4·6 billion per year in the United States alone , even though a large share of the indications for which these stents are used (e.g. stable coronary disease) has no supporting evidence [6-9]. This excessive financial capacity and the associated political and lobbying power allow the industry to dictate the rules of the healthcare game to serve its interests at several levels. The industry’s interests are often at stark contrast to those of the patients and the society. In this article, we try to analyse the multiple complex pathways through which the industry has directly or indirectly infiltrated healthcare systems including strategic direction, expenditure, research, medical education and daily clinical practice. How the industry influences healthcare research, strategy, expenditure and practice:
How the industry influences healthcare research, strategy, expenditure and practice: The industry has created means to intervene in all steps of the processes that influence healthcare research, strategy, expenditure and practice. These include evidence base production, evidence synthesis, understanding of harms issues, cost-effectiveness evaluation, clinical guidelines formation, healthcare professional education and direct influences on healthcare professional decisions (Fig. 1).Address: Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK. (E. Stamatakis); School of Public Health, Prevention Research Collaboration, University of Sydney, Sydney, NSW 2006, Australia (E. Stamatakis); University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BU, UK (R. Weiler); Stanford Prevention Research Center, Department of Medicine and Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA 94305, USA (J. P. A. Ioannidis); Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA 94305, USA (J. P. A. Ioannidis).References:
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