October 04, 2010
Deception in research means that you lie
(or fail to tell the whole truth) to a specific participant or
audience about important parts of the research.
A recent study in the Journal of the
American Medical Association found over 40 percent of the best
designed, peer-reviewed scientific papers published in the world's
top medical journals misrepresented the actual findings of the
The "spin doctors" writing the papers found a way to show treatments
worked, when in fact, they didn't.
Doctors and health care consumers rely on published scientific
studies to guide their decisions about which treatments work and
which don't. We expect academic medical researchers to determine
what needs to be studied, and to objectively report their data. We
rely on government regulators to prevent harmful medications from
being approved, or to quickly remove harmful medications or
treatments from the market.
What most physicians and consumers don't recognize is that science
is now for sale; published data often misrepresents the truth,
academic medical research has become corrupted by pharmaceutical
money and special interests, and government regulators more often
protect industry than the public. Increasingly, academic medical
researchers are for hire, and research, once a pure activity of
inquiry, is now a tool for promoting products.
Science has always been considered an objective endeavor that
removes bias and is inherently true and reliable.
While we may acknowledge that some
science is inferior in design or execution, and that there are a few
corrupt scientists, we mostly believe what is published in the
world's top medical journals such as the,
...can be counted on to guide
our medical decisions.
We still have trust in the scientific
That trust may be misguided.
The problem is, deception by omission occurs in all research to some
extent because many details about studies are frequently withheld
from participants in the study and the many of the researchers
For example, most hypotheses are not
described in research studies nor are the aspects of research
Ethicists argue that deception is unacceptable, whereas researchers
regard it as a necessary part of (certain kinds of) research. This
impasse could be resolved by establishing the specific conditions
under which deception in research can be tolerated.
However, the increased frequency of bias
and consequential misinformation throughout evidence-based research
is leading many researchers to abandon deceptive designs in all
forms of research.
The Danger of
Evidence-based medicine is considered the highest standard of care
and is advocated as the basis for all decision making in medical
schools and academic centers.
The idea is that we must make decisions
based on sound medical evidence. That sounds good in theory, but it
only works if that evidence can be trusted; if the evidence at hand
has been generated independently, without bias and with the sole
desire to find the best treatments - pharmaceutical or otherwise.
This model fails to work if the underlying motive is profit.
In a recent report in the Journal of the American Medical
Association, French scientists reviewed over 600 studies
published in the top medical journals during an entire year, and
analyzed in detail 72 of those they considered to be of the
In their analysis they only included
studies with the most respected and reliable design - the randomized
controlled trial. The authors of this report did not just read the
abstracts and conclusions of the studies they reviewed, but
independently analyzed the raw data.
Their findings call into question the
reliability of the very scientific papers that doctors use to make
decisions regarding treatment and that the press counts on to
communicate the latest medical findings.
They found that 40 percent of the articles misrepresented
the data in the abstract or in the main text of the study.
Furthermore they uncovered that in cases
where studies had negative outcomes - in other words, the treatment
studied DID NOT work - the scientists authoring the studies created
a "spin" on the data that showed the treatments DID work.
Here is their conclusion:
"In this representative sample of
RCT's (randomized controlled trials) published in 2006 with
statistically non-significant primary outcomes, the reporting
and interpretation of findings was frequently inconsistent with
In plain language, 40 percent of the
studies we count on to make medical decisions are authored by
scientists who act as "spin
doctors" distorting medical research to suit personal
needs or corporate economic interests.
"Spin" can be defined as specific
reporting that could distort the interpretation of results and
mislead readers. If the conclusions in 40 percent of the papers
published in medical journals are being spun toward independent
interests, how can we consider the medicine we are practicing
Consider the example of the recent large and
widely quoted JUPITER trial
Crestor (a statin or
cholesterol-lowering drug) could prevent heart attacks in people
with normal or low cholesterol.
In this trial researchers twisted the
data to suit the commercial sponsor of the study. An independent
review of the JUPITER trial published in the Archives of Internal
Medicine showed that it was deeply flawed and the actual data did
NOT show any benefit for the prevention of
If this were an isolated incident, we
could overlook it. Unfortunately, it's a consistent pattern.
Science for Sale
Marcia Angell, former editor-in-chief of the New England
Journal of Medicine recently
wrote a scathing analysis of the
infiltration of Big Pharma into medical research, education and drug
Aside from the $30 billion a year spent
on marketing pharmaceuticals to physicians (known as "continuing
has turned many academic researchers into hired hands.
Thought leaders from academic medical centers are provided grants to
do research "contracted for" by Pharma, and the research is often
designed, executed and ghostwritten by the funders.
The conflict of interest statements of
authors on research articles now often runs several pages long.
These authors not only receive grants but sit on corporate advisory
boards, receive large speaking fees and enter into patent and
royalty agreements with Pharma.
Experts like these are also relied upon to create practice
These guidelines help physicians
determine what medications to use and how to keep up with "best
practices." Yet the panels that develop these guidelines are full of
scientists and physicians with financial ties to the industry or to
the drugs being evaluated. For example, in a survey of 200 expert
panels, one-third of the panelists had a financial interest in the
drugs they evaluated.
Another example: In 2004, the National Institute of Health's
National Cholesterol Education Program, dramatically lowered the
ideal "bad" or LDL cholesterol level.
This led to guidelines that expanded the
number of Americans who "should" take statin drugs
from 13 million to 36 million.
There was only one problem. Eight of the nine panel members who
established these new guidelines had industry ties. An independent
group of over 30 scientists in a letter to the National Institutes
of Health publicly opposed these recommendations.
Even more recently, 95 of the 170 psychiatrists and contributors to
the new manual for psychiatric illnesses (DSM-V)
were found to have financial ties to companies that make
How did the manufacturer convince scientists and physicians that it
is "safe" to be exposed regularly to low levels of an exceptionally
toxic poison? Answer: Deceptive research and deceptive statements!
Studies have also shown that
practice guidelines from independent groups such as the American
College of Cardiology are based on inadequate or questionable
It would appear that our evidence-based
medicine isn't based on very much evidence.
Science Wrong - Misleading Media Reports
To get beyond this kind of industry deception, doctors and health
care consumers need to be wary and read between the lines. In an era
of sound bites and sensationalism, we do not receive intelligent and
critical analysis, and most importantly a coherent synthesis of
The data in any one study is part of a scientific story of how the
world works, and medical research is the story of biology.
Each study must be evaluated in the
context of what we know, existing data, and what makes sense from a
biological perspective. We won't always be right, but we can stop
the ping-pong game of what's good and what's bad for you that
facilitates the newest, not necessarily the best, treatment, and
provides fodder for journalistic sensationalism that fuels the 24/7
Often headlines are taken from the abstracts or summaries of
Studies show that half the time,
the abstracts don't accurately represent the findings of the
research. Even when the summary is correct, studies show that the
media incorrectly reports the research findings or doesn't place
them in the historical context of other key research on the subject.
No wonder patients and doctors are confused.
Business interests and the incestuous relationship between
scientists and industry have corrupted the landscape of medical
The media doesn't do a good job
of investigative journalism.
But there are things you can to do
change protect yourself.
Ever wonder how the manufacturer of
aspartame convinced scientists and
physicians that it is "safe" to be exposed regularly to low levels
of an exceptionally toxic poison?
Answer: Deceptive research and
How to Protect
Yourself From the Spin Doctors
Follow the money: Be a detective
and look up the articles mentioned in the news. Find the
study, see who wrote it, and determine what financial
conflicts of interest they have. Also check who funded the
Do your homework: Be suspicious
of media reports of scientific findings. Does the
finding make sense in the context of other studies and is it
the best possible approach. Educate yourself by learning to
PUBMED (the National
Library of Medicine) and reviewing different perspectives.
Does it pass the "sniff test":
Is the treatment suggested just a "me too" drug that has not
been proven to be any better than existing treatments? Does
it make sense to you or does something smell rotten? Trust
Advocate for an arm's length
relationship between industry and academia. Write your
Senators and Congressmen to develop new regulations and
legislation that will build a fire-wall to protect us.
Grants are fine, but Pharma should have no participation in
study design and should not be allowed to interpret or
Demand a no revolving door
policy between industry and government regulators. Former
drug company executives should not be on FDA committees or
involved in regulation or legislation.
Advocate for comparative
effectiveness research. Preventing this research allows
Pharma not to play fair.
Campaign for finance reform: If
done effectively, can limit the influence of industry on