Undue industry influences that distort healthcare research, strategy, expenditure and practice: a review

Authors

  • Emmanuel Stamatakis,

    Corresponding author
    1. Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, NSW, Australia
    • Department of Epidemiology and Public Health, University College London, London, UK
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  • Richard Weiler,

    1. University College London Hospitals NHS Foundation Trust, London, UK
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  • John P.A. Ioannidis

    1. Stanford Prevention Research Center, Department of Medicine and Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA
    2. Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, USA
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Correspondence to: Emmanuel Stamatakis, University College London, Department of Epidemiology and Public Health, 1-19 Torrington Place, London, WC1E 6BT, UK. Tel.: +44 (0) 20 76791721; fax: +44 (0) 20 78130242; e-mail: e.stamatakis@ucl.ac.uk

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.

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