The Publication Bias Bomb
Under The Carpet, Jenkins!
Imagine this scenario. You’re a researcher involved in a series of studies at a company, call it Random Inc. What the experiments are on is irrelevant but for the sake of setting the scene, let’s say that you’re investigating the effects of a new type of milk powder on the growth of children. As your boss, I’m pleased with the general outcome of the studies but am a bit concerned that we had a few of our studies report that our product is no different to what else is on the market.
I look at you dead in the eye and tell you that it’s not good enough. Luckily for you, I have a tried and tested solution that everyone is doing. Best of all, it’s not illegal in the slightest! I ask you to…
….just ignore the studies that didn’t show a positive result in favour of our product!
That’s right, even the negative studies! We can’t go wrong! With that, I walk away back to drive my Lamborghini back to my mansion, you publish only the studies that will paint us in a good light and everybody wins.
Except…do they really?
Ignorance Is A Profitable Bliss…For Some…
I recall sitting in a lecture once, with a professor talking to us about studies and results. In particular, he wanted to talk to us about our final year research projects (except I didn’t do one as I was a media student, though it would’ve been cool!). As he spoke, we hung onto every word. Why not? He is an amazing lecturer and science communicator, after all. But one thing he said has always stuck with me since that fateful day roughly three years ago.
“Don’t be disheartened if you don’t get a significant result! That can tell you just as much, if not more, about what you set out to find than a significant result. Want a non-significant result? Just ask me, I’ve got a drawer full of them!”
It was something I had never thought of before. Since that seemingly innocent day, I had run into this issue time and time again. I say issue, I really mean an ugly behemoth of epic proportions. Whilst I do not claim that this issue is not present in probably every field of science, there is a skewed bias. After all, bias follows that sweet, nefarious smell of money…and there is definitely one field where it is not only rife, but it can cost lives.
The pharmaceutical and drugs industry!
An incredibly lucrative industry, the pharma industry is teeming with companies who are required to conduct plenty of clinical trials to test the effect of their drugs. The only thing is…they have the power, legally, to actually withhold data…notably, negative/non-significant data. I’m not sure if anybody else sees the massive gaping abyss of a problem here but it’s staring us all in the face.
Time + Emotions + Selective Product Studies = PROFIT!
I often marvel that the medical/pharmaceutical industry is just so profitable and my desired field of ecology/environment has to really scrape the barrel at even the best of times to make up the funds for the projects. Maybe one explanation is that medicine/pharmaceuticals are actually more useful and beneficial for humans. After all, everyone needs medicines, right? I can buy into that one: given the choice of saving an endangered animal or supporting research of a novel drug that shows promise against a horrible disease, I’d imagine most people would choose the latter.
But I honestly don’t think that’s the entire reason. Sadly, I am slowly being won over to the fact that a lot of the pharmaceutical industry, notably big pharma, is actually corrupt. Not corrupted, but corrupt. Do I say this out of spite? Of course not. I value the role of medicine and pharmaceuticals in our daily lives. These crucial fields save lives. Yet I think that has led to part of its corruption across all rungs of the pharmaceutical ladder. It’s incredibly easy to bring in the big dollars and pounds by playing on consumer/patient emotions: this new drug could save your loved one, could prevent this debilitating illness.
Oh, and it’s made a LOT easier by the fact that pharmaceutical companies can hide the effects of their studies. Check and mate!
These Are Not The Studies You Are Looking For…
Of course, the corruption doesn’t just end there. According to a 2010 fact sheet, published by the World Health Organisation (WHO), bribery and falsification of evidence (to name a couple of corrupt practices) can occur along each link in the pharmaceutical chain. The more ‘middlemen’ there are between drug conception and the end users (the patients), the higher the chance for corrupt practices. The fact sheet released by the WHO goes onto detail just how deeply ingrained the corruption is. Drugs can be made via counterfeit methods, trials on these drugs can be conducted without regulatory approval and, just as worrying, the inspection of these drugs can be incredibly shoddy, meaning some products get a government seal of approval. What does that all mean? Potentially and realistically, expensive drugs that may, at best, actually do very little and, at worst, cause serious harm to the patients that have been misled into their use. As well as this, the doctors that prescribe these drugs can only go on what studies are available to read about them…
…studies that are selectively released by the companies producing these drugs. Another check and mate!
The result of all this widespread corruption is that most cases of corruption go unreported and people generally feel powerless to actually stop this happening in their countries. As the WHO report details, countries without proper legislation, regulation and laws put in place to control these medicines are most at risk of being targets of this insidious corruption. Without transparency about what drugs patients are consuming, which the drug companies are pretty much hesitant to provide for obvious reasons, patients – you and I – have no idea how effective the drugs we put in our bodies are.
Disregarding everything else, I think this may just mean that placebo is actually the most effective drug out there!
I Can See For Miles And Miles And Miles
Actually, at the moment I can’t. It’s pretty shocking that, were I to have to weigh up evidence between, for example, two drugs, I’d actually have no idea which one was better for me. And I’m not even a doctor! I wonder how patients would feel if they’re being cheated regarding the drugs that they themselves take, through no fault of the doctors themselves (I hope not, anyway). There really is no question: regulation and laws surrounding medicines need to really take into clamp down in order to stem this corruption. It isn’t much of a big ask for drugs companies to publish every study on their drug. After all, if one buys some mincemeat from the supermarket, we want to be sure we know all about it. Wouldn’t it be a big shock if it contained, say, horsemeat instead of just beef? ……….
…alright, maybe that’s a bit too political for this topic.
But the point still stands: transparency is key. The amount of drugs being prescribed and taken by patients worldwide is staggering…but how much do these patients know about what they’re taking? How much do their doctors know? Can ignorance really be called bliss when it involves the lives and health of patients?
Full access to studies, relevant and important information on novel and existing drugs and boycotting corrupt practices. Because the pharmaceutical industry doesn’t seem to be doing that. In the past decade or so, at least three Big Pharma companies, the ones who reap an incredibly disproportionate amount of pharma-driven wealth, were fined for illegal practices. In 2003, Bayer Healthcare paid $257 million in fines for a drug fraud scheme which sought to overcharge for the antibiotic, Cipro. In 2009, Pfizer was fined $2.3 billion for promoting four drugs for uses that were not yet approved by medical regulators. Finally, in 2012, GlaxoSmithKline (GSK) were fined a hefty $3 billion in what was deemed as ‘the biggest healthcare fraud in history’, after they paid off US medics to prescribe potentially dangerous medicine to adults and children.
These are meant to be the companies that are ‘golden standard’ of the pharmaceutical industry.
Misinformation may make a nice profit to line the already bulging pockets of the pharmaceutical industry but it costs lives.
And all it’d take to deal a heft blow to the corrupt industry is greater transparency.
I really got the idea for this post after watching Ben Goldacre give a TED talk on the matter. It really rang out to me and I encourage anybody interested in this burning issue to take a look at it. He is funny, inspiring, poignant and, above all else, incredibly relevant:
His blog, Bad Science, can be found here: