A randomized study of how physicians interpret research funding disclosures.

Kesselheim AS, Robertson CT, Myers JA, Rose SL, Gillet V, Ross KM, Glynn RJ, Joffe S, Avorn J.

Source

Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02120, USA. akesselheim@partners.org

Abstract

BACKGROUND:

The effects of clinical-trial funding on the interpretation of trial results are poorly understood. We examined how such support affects physicians' reactions to trials with a high, medium, or low level of methodologic rigor.

METHODS:

We presented 503 board-certified internists with abstracts that we designed describing clinical trials of three hypothetical drugs. The trials had high, medium, or low methodologic rigor, and each report included one of three support disclosures: funding from a pharmaceutical company, NIH funding, or none. For both factors studied (rigor and funding), one of the three possible variations was randomly selected for inclusion in the abstracts. Follow-up questions assessed the physicians' impressions of the trials' rigor, their confidence in the results, and their willingness to prescribe the drugs.

RESULTS:

The 269 respondents (53.5% response rate) perceived the level of study rigor accurately. Physicians reported that they would be less willing to prescribe drugs tested in low-rigor trials than those tested in medium-rigor trials (odds ratio, 0.64; 95% confidence interval [CI], 0.46 to 0.89; P=0.008) and would be more willing to prescribe drugs tested in high-rigor trials than those tested in medium-rigor trials (odds ratio, 3.07; 95% CI, 2.18 to 4.32; P<0 .001="" 0.37="" 0.46="" 0.49="" 0.51="" 0.52="" 0.63="" 0.68="" 0.71="" 0.87="" 0.94="" 0.98="" 95="" a="" across="" all="" and="" as="" ci="" compared="" confidence="" consistent="" disclosure="" downgrade="" drugs="" effects="" funding="" half="" hypothetical="" in="" industry-funded="" industry="" led="" levels="" methodologic="" nih-funded="" no="" odds="" of="" p="" physicians="" prescribe="" ratio="" results="" rigor.="" rigor="" studied="" the="" their="" these="" they="" to="" trial="" trials="" were="" willing="" willingness="" with="">

CONCLUSIONS:

Physicians discriminate among trials of varying degrees of rigor, but industry sponsorship negatively influences their perception of methodologic quality and reduces their willingness to believe and act on trial findings, independently of the trial's quality. These effects may influence the translation of clinical research into practice.