In an era of evidence-based clinical care, a new study finds that research presented to psychiatrists during their annual meeting is overwhelmingly biased on the positive contributions of new medications.
At the same forum, cognitive-behavioral therapy receives less attention even though emerging evidence suggests “talk therapy” can be as effective as pharmaceutical for illnesses such as depression.
In the study, psychiatrists from the University of Michigan and Yale University, analyzed the presentations given at two recent meetings of the American Psychiatric Association.
Findings from the analysis are published in the Journal of Clinical Psychopharmacology.
In a study of APA annual meetings held in 2009 and 2010, researchers discovered that of the 278 studies comparing at least two medicines against each other, 195 had been supported by industry, and 83 funded by other means.
The authors then evaluated the studies without knowing which kind of support each one had.
Of the industry-supported studies, 97.4 percent reported results that were positive toward the medicine that the study was designed to test, and 2.6 percent reported mixed results. Remarkably, no industry-sponsored studies with negative results were presented.
In contrast, when industry was not the source of funding, 68.7 percent of the presentations were positive, and 24.1 percent contained mixed results, while 7.2 percent contained negative results.
This “presentation bias,” in which mostly good news about medicines gets reported at meetings, echoes the “publication bias” that has been documented in research published in major journals, said Srijan Sen, M.D., Ph.D., an assistant professor of psychiatry at the U-M Medical School who led the study.
Sen and his colleague discovered the annual meeting of the American Psychiatric Association, which typically draws 16,000 participants, is characterized by a large industry presence with emphasis on research involving medicines that were still “on patent” and being actively marketed to both psychiatrists attending the conference.
Sen teamed with Yale psychiatrist Maya Prabhu, M.D., M.Sc., to do the formal review.
“This analysis suggests that the APA meeting might be being used as an opportunity to make drugs seem more effective than they are,” he said. At the same time, research discussing the efficacy of “talk therapy” treatments was found to receive much less attention – probably because this intervention does not receive industry backing.
Researchers believe this slanted presentation of new research may influence clinical practice patterns because the APA meeting is a major source of continuing medical education credit for psychiatrists, and a hub for psychiatry residents just starting out in the field.
Sen noted that the research journals and funding agencies have tried to confront research bias in journal articles by requiring pharmaceutical companies to register the clinical trials they are conducting and include the registration number when publishing the study.
This opens up which trials are being reported in the medical literature, and whether the trial results are interpreted according to the original study design. For instance, if a drug trial is designed to test long-term results from a particular treatment, but a paper is published showing positive results over a much shorter term, that could be an indication of bias.
Research meetings could require a similar practice, Sen said. And the APA could be more selective in accepting poster presentation submissions.
If nothing else, Sen said, attendees at the APA’s meeting – and perhaps other large gatherings of psychiatrists – should be aware of the positive bias of the research they will hear about at the meeting. And non-industry funding for research – especially research to compare older “off patent” drugs that aren’t being marketed by industry – is also important, he says.
The federal government has funded large comparison studies in depression, schizophrenia and bipolar disorder, he said – and these mostly showed that the generic medications that have lost their patent protection are just as effective as newer, patent-protected ones.
Even so, psychiatrists prescribe the generic ones far less often than the brand-name patent-protected ones.
Source: University of Michigan