Failure to discount for conflict of interest when evaluating medical literature: a randomised trial of physicians
- Gabriel K Silverman1,2,
- George F Loewenstein3,
- Britta L Anderson4,5,
- Peter A Ubel6,7,8,
- Stanley Zinberg9,
- Jay Schulkin4
- 1Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
- 2University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- 3Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
- 4Department of Research, The American College of Obstetricians and Gynecologists, Washington, DC, USA
- 5Department of Psychology, American University, Washington, DC, USA
- 6Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- 7Center for Behavioral and Decision Sciences in Medicine, Division of General Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- 8VA Health Services Research & Development Center of Excellence, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- 9Division of Practice Activities, The American College of Obstetricians and Gynecologists, Washington, DC, USA
- Correspondence to Ms Britta L Anderson, American College of Obstetricians and Gynecologists, 409 12th St, SW, Washington, DC 20024, USA;
- Received 18 November 2009
- Revised 7 January 2010
- Accepted 8 January 2010
Context Physicians are regularly confronted with research that is funded or presented by industry.
Objective To assess whether physicians discount for conflicts of interest when weighing evidence for prescribing a new drug.
Design and setting Participants were presented with an abstract from a single clinical trial finding positive results for a fictitious new drug. Physicians were randomly assigned one version of a hypothetical scenario, which varied on conflict of interest: ‘presenter conflict’, ‘researcher conflict’ and ‘no conflict’.
Participants 515 randomly selected Fellows in the American College of Obstetricians and Gynecologists' Collaborative Ambulatory Research Network; 253 surveys (49%) were returned.
Main object measures The self-reported likelihood that physicians would prescribe the new drug as a first-line therapy.
Results Physicians do not significantly discount for conflicts of interest in their self-reported likelihood of prescribing the new drug after reading the single abstract and scenario. However, when asked explicitly to compare conflict and no conflict, 69% report that they would discount for researcher conflict and 57% report that they would discount for presenter conflict. When asked to guess how favourable the results of this study were towards the new drug, compared with the other trials published so far, their perceptions were not significantly influenced by conflict of interest information.
Conclusion While physicians believe that they should discount the value of information from conflicted sources, they did not do so in the absence of a direct comparison between two studies. This brings into question the effectiveness of merely disclosing the funding sources of published studies.
Funding This study was supported in part by the Centers for Disease Control and Prevention and grant no R60 MC 05674 from the Maternal and Child Health Bureau, Health Resources and Services Administration, Department of Health and Human Services.
Competing interests None.
Ethics approval This study was conducted with the approval of the Carnegie Mellon University Institutional Review Board.
Provenance and peer review Not commissioned; externally peer reviewed.