Millions
of patients may have taken influenza drugs that have little or no benefit
to them, according to an Australian-led study.
The
study found that researchers paid by pharmaceutical companies were more likely
to recommend antiviral drugs for flu and produced different recommendations to
independent researchers conducting the reviews.
The
study analysed 26 systematic reviews, a type of study considered to be the gold
standard of evidence because they assess all existing studies on a topic using
stringent guidelines.
Adam
Dunn, lead author of the study and a health informatics expert at the
University of NSW, said: “Systematic reviews summarise available evidence
following strict protocols, so we expect findings from them to be consistent.
“But
we found reviewers with ties to pharma introduced bias, as we found a
disconnect between what their results showed and what they went on to
recommend.”
The
study, published in the journal Annals of Internal Medicine, concluded that
benefits of the class of drugs, known as neuraminidase inhibitors, may
eventually be found to have been inflated, which could prove highly costly to
governments.
“Global
stockpiling of antivirals was recommended by a panel from the World Health
Organisation in 2002 and in 2009, governments around the world spent $6.9bn
building stockpiles of oseltamivir [Tamiflu], an investment that remains poorly
supported by available clinical evidence,” the study said.
Almost
80% of reviews written by researchers with financial ties were favourable
towards the drugs, while 17% on independent reviews were positive, the study
found.
Ray
Moynihan, a senior research fellow at Bond University who has authored books on
the pharmaceutical industry and overdiagnosis, described the work of Dunn and
his colleagues as “highly valuable, critical work”.
“It’s
incredibly encouraging to see this issue being examined in Australia, and that
our researchers are at the cutting edge of some of the big, international
debates occurring in medical and scientific
evidence,” Moynihan said.
“We
know from very reliable evidence that clinical trials that are sponsored by
pharma tend to favour the sponsor’s drug, but what this paper is showing is
that this bias has crept into what is considered the most reliable form of
medical evidence, the systematic review.”
It
was a worrying finding for patients, he said.
There
needed to be a stronger push for independent research to be conducted without
drug industry funding, he said, adding that public funding available through
bodies like the National Health and Medical Research Council should be used
instead.
“It
is clear we have likely been misled about the benefits and harms of these drugs
because so much of the evidence is tainted by a pro-industry or pro-drug bias,”
Moynihan said.
“This
is a cause for alarm as billions of dollars of public money has been invested
into these drugs.”
Addressing
concerns that harmful movements, like the anti-vaccination campaign, may use
papers like Dunn’s as evidence not to trust doctors and medical advice,
Moynihan said the study reinforced the importance of scientific evidence.
“Far
from making people sceptical about science,
this should reinforce its value in medicine,” Moynihan said.
“What
we have in medicine is unfortunately a lot of marketing disguised as science,
and this paper helps us realise that bring the best of the scientific methods
forward to debate medical evidence can improve our knowledge.”
Much
greater transparency in medical and scientific research and by drug companies
was also needed, he said.
Dr
Florence Bourgeois, a co-author of the paper and emergency medicine specialist
at Boston Children’s Hospital in the US, said it was important that doctors
talk to their patients about the safety and efficacy of the drugs.
But
she acknowledged that could be difficult given the contradictions and
uncertainties around them.
“The
best thing is for patients to have a conversation with their healthcare
provider about whether these drugs are the right choice for them,” she said.
“Clinicians,
in turn, should decide on a case-by-case basis which patients are good
candidates for the drugs, weighing the benefits and harms.”
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