Cochrane proposes further limits on commercial funding
http://www.100md.com
《英国医生杂志》
Fierce opposition to industry funding of Cochrane reviews has caused the organisation抯 leadership to draft a set of proposals that will, if accepted, further restrict commercial funding. The proposed policy will forbid for-profit companies to fund a Cochrane review if they have a "real or potential vested interest in the findings of the review." It would additionally forbid commercial entities to fund the review groups themselves.
The new proposals do not forbid industry sponsorship of other Cochrane entities, but suggest creating a "firewall" between commercial sources and review groups. Nor do they restrict funding by not-for-profit organisations. This is worrying some researchers as a "third party" strategy—in which industry funds or even creates not-for-profit professional or lay organisations that promote certain medicines—is increasingly being used by drug companies to influence prescribing.
The proposals will be discussed, and a final version will be drawn up at the steering committee meeting in Bergamo, Italy, at the end of this month.
The policy review was triggered after it came to light that some Cochrane centres and reviewers interpreted Cochrane抯 conflict of interest policy to allow drug company funding (BMJ 2003;327:924-6). One widely cited instance was Pfizer抯 funding of the review of two migraine drugs—Pfizer manufactures one of the drugs reviewed.
Former consumer advocate for the Cochrane Collaboration, Hilda Bastian, said some reviewers would say it was acceptable to receive commercial funding as long as it is wasn抰 the only funding they received: "People just said, 慜h, my university is contributing my time, and that was enough to make them not solely industry funded.?
Those in favour of industry funding argue that some reviews might not be produced if industry sponsorship is cut off, whereas those opposed to it cited studies documenting bias in commercially funded research. The Cochrane steering group sent an email to members last year outlining the controversy and inviting commentary. A decision was made at its conference in Barcelona to engage in a "consultation" with members and the public to develop a clearer policy statement (BMJ 2003;327:1068).
Reaction against commercial funding was so intense that the steering group posted a series of proposals on their website that will tighten, rather than loosen, such funding.
Some insiders say that the proposed changes are good—but don抰 go far enough. Currently, potential reviewers can approach the Cochrane Collaboration and ask to write a review. "Cochrane has no priority setting mechanism," says Ms Bastian. "When a Cochrane review says a certain triptan works for migraine, and only two triptans are reviewed—one of which is manufactured by the drug company funding the review—you are not necessarily learning about the triptan that is the best or the cheapest because six of the eight triptans then on the market weren抰 reviewed. If you allow free market forces to set the agenda, you end up with this big invisible bias—and that抯 even bigger than individual bias and individual reviewers."
But when Professor Ian Roberts, of the London School of Hygiene and Tropical Medicine, and coordinating editor of the Cochrane Injuries Group, was asked if Cochrane抯 credibility wasn抰 based on being "disinterested," he replied, "No, it抯 based on methodological rigour. Everyone has interests. The point isn抰 to deny those interests but to make them explicit."
Drummond Rennie, a director of the Cochrane Center in San Francisco and a deputy editor of JAMA, told the BMJ, "It抯 sweetly naive, touchingly naive to think that those who have a financial conflict of interest will not be influenced when they do a review. And it抯 touchingly naive to think that readers, knowing of the financial conflicts of interest, won抰 discount the results. There are avalanches of studies showing that studies and reviews are influenced by financial conflicts of interest, always in the direction that favours the commercial sponsor抯 view. To invoke non-financial conflicts is to bring up a red herring."(New York Jeanne Lenzer)
The new proposals do not forbid industry sponsorship of other Cochrane entities, but suggest creating a "firewall" between commercial sources and review groups. Nor do they restrict funding by not-for-profit organisations. This is worrying some researchers as a "third party" strategy—in which industry funds or even creates not-for-profit professional or lay organisations that promote certain medicines—is increasingly being used by drug companies to influence prescribing.
The proposals will be discussed, and a final version will be drawn up at the steering committee meeting in Bergamo, Italy, at the end of this month.
The policy review was triggered after it came to light that some Cochrane centres and reviewers interpreted Cochrane抯 conflict of interest policy to allow drug company funding (BMJ 2003;327:924-6). One widely cited instance was Pfizer抯 funding of the review of two migraine drugs—Pfizer manufactures one of the drugs reviewed.
Former consumer advocate for the Cochrane Collaboration, Hilda Bastian, said some reviewers would say it was acceptable to receive commercial funding as long as it is wasn抰 the only funding they received: "People just said, 慜h, my university is contributing my time, and that was enough to make them not solely industry funded.?
Those in favour of industry funding argue that some reviews might not be produced if industry sponsorship is cut off, whereas those opposed to it cited studies documenting bias in commercially funded research. The Cochrane steering group sent an email to members last year outlining the controversy and inviting commentary. A decision was made at its conference in Barcelona to engage in a "consultation" with members and the public to develop a clearer policy statement (BMJ 2003;327:1068).
Reaction against commercial funding was so intense that the steering group posted a series of proposals on their website that will tighten, rather than loosen, such funding.
Some insiders say that the proposed changes are good—but don抰 go far enough. Currently, potential reviewers can approach the Cochrane Collaboration and ask to write a review. "Cochrane has no priority setting mechanism," says Ms Bastian. "When a Cochrane review says a certain triptan works for migraine, and only two triptans are reviewed—one of which is manufactured by the drug company funding the review—you are not necessarily learning about the triptan that is the best or the cheapest because six of the eight triptans then on the market weren抰 reviewed. If you allow free market forces to set the agenda, you end up with this big invisible bias—and that抯 even bigger than individual bias and individual reviewers."
But when Professor Ian Roberts, of the London School of Hygiene and Tropical Medicine, and coordinating editor of the Cochrane Injuries Group, was asked if Cochrane抯 credibility wasn抰 based on being "disinterested," he replied, "No, it抯 based on methodological rigour. Everyone has interests. The point isn抰 to deny those interests but to make them explicit."
Drummond Rennie, a director of the Cochrane Center in San Francisco and a deputy editor of JAMA, told the BMJ, "It抯 sweetly naive, touchingly naive to think that those who have a financial conflict of interest will not be influenced when they do a review. And it抯 touchingly naive to think that readers, knowing of the financial conflicts of interest, won抰 discount the results. There are avalanches of studies showing that studies and reviews are influenced by financial conflicts of interest, always in the direction that favours the commercial sponsor抯 view. To invoke non-financial conflicts is to bring up a red herring."(New York Jeanne Lenzer)