Murray Edmunds,1 Cassie Partington,2 Tom Pugh,3 Sarah Thomas1 and Jodi Cusack1. 1Watermeadow Medical, Witney, UK; 2InforMed Insight Ltd., ...
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Physicians’ attitudes to industrysponsored review articles Murray Edmunds,1 Cassie Partington,2 Tom Pugh,3 Sarah Thomas1 and Jodi Cusack1 1Watermeadow Medical, Witney, UK; 2InforMed Insight Ltd., Macclesfield, UK; 3All Global, London, UK
◆ We
Abstract Objective This internet survey tested end-readers’ attitudes to the value and integrity of pharmaceutical industrysponsored review articles, covering content and the writing/peer-review process. Research design and methods Responses were obtained from 484 healthcare providers (including 198 primary-care and 229 specialist physicians) in the EU and USA to 12 specific questions comprising opposing negative/positive attitude descriptions. Responses were made on a 0–6 score Likert scale, with mean values converted to %maximum. The proportion of 0–1 (‘sceptical’) and 5–6 (‘enthusiastic’) rankings were also calculated. Responses to an additional open invitation to comment were classed ‘negative’, ‘ambivalent’ or ‘positive’. Comparisons were made (t-test) between specialist and primary carers, and between those who had (n=38) and had not authored such an article themselves. Results Mean %maximum scores for the specific questions were 54–65%, with ranges for sceptical and enthusiastic responses of 7.4–14.7% and 22.3–40.5%, respectively. Confidence was higher regarding the involvement of expert authors and peer-reviewers versus sponsors and professional writers. Specialists tended to give more positive responses than primary carers, as did authors versus non-authors. 22.2% and 27.5% of primary and specialist physicians, respectively, gave enthusiastic scores for a question concerning the likelihood of review articles influencing their prescribing. Overall responses to the open question were: positive 31.1%, ambivalent 33.6% (often recognising value but expressing a need for cautious interpretation), negative 11.6%, no response 23.7%. Conclusions While opinion varies, the overall attitude of readers appears more positive than negative, with many considering these articles an important source of information.
Background ◆ Review
articles published in medical journals that are authored by key opinion leaders (KOLs) and sponsored by pharmaceutical companies can provide succinct summaries of a drug’s pharmacological/clinical profile or a medical issue in which the parties involved have an interest. ◆ Summaries of key relevant data and ideas are potentially valuable to care providers in informing prescribing decisions. On the other hand, the involvement of industry sponsors and professional medical writers can attract criticism that these articles will lack balance. ◆ Reactions to such criticism in recent years have included the development of Good Publication Practice guidelines1 and increased scrutiny by editors and peer reviewers, but many journals refuse to accept unsolicited reviews, requiring that potential authors first discuss their ideas with the editor. ◆ It might therefore be thought that these articles are negatively regarded, but little research has been carried out into readers’ attitudes and, anecdotally, many KOLs remain enthusiastic about authoring them, and they are often widely cited elsewhere.
conducted a survey to test end-readers’ attitudes to the value and integrity of pharmaceutical industry-sponsored review articles.
Research design and methods ◆ Respondents
from a healthcare market research panel were invited to take part in an online survey via email invitation. Primary healthcare providers (PCPs), medical specialists and other healthcare practitioners from the panel in France, Germany, Italy, Spain, UK and USA were invited to complete the survey in their local languages. ◆ Twelve specific paired statements (‘questions’) were constructed that described opposing highly negative and highly positive attitudes to various aspects of sponsored review articles (Figure 1). These aimed to test the extent to which such articles are read, trusted and influence prescribing. ◆ Respondents were asked to locate their personal attitude between the opposing statements using a 0–6 score Likert scale. Mean values were converted to a percentage of the maximum score of 6 (%maximum), rounded to the nearest integer. The proportion of 0–1 (sceptical) and 5–6 (enthusiastic) score rankings were also recorded. ◆ Subjects were invited to respond to an open statement (Figure 2). Responses to this were read and classed as ‘negative’, ‘ambivalent’ or ‘positive’. ◆ Respondents were also asked whether they had themselves authored a sponsored review in the last 5 years. ◆ Comparisons were made (t-test) between specialists and PCPs, and between those who had and had not authored such an article themselves. Figure 2. Subjective classification of responses made to the open invitation to comment. “Please provide any comments on your opinion of the value of industry-sponsored review articles”
Results ◆ In
total, 484 healthcare providers (198 PCPs, 229 specialist physicians and 57 ‘others’ including nurses) responded to the survey. Only 38 had themselves authored a sponsored review. ◆ Mean scores for the specific questions and the proportions of sceptical and enthusiastic responses are shown in Figure 1. Data are shown for specialists (top data blocks) and PCPs (lower data blocks). ◆ Confidence in the objectivity of content appeared higher regarding the involvement of expert authors and peer reviewers versus sponsors and professional writers, with a high percentage of positive scores given for questions 9–11. ◆ 22.2% of PCPs and 27.5% of specialists gave enthusiastic scores for a question (12) concerning the likelihood of review articles influencing their prescribing. ◆ Specialists tended to give more positive responses than PCPs. ◆ Authors gave more positive scores than nonauthors, and were significantly more likely to read other sponsored review articles than nonauthors (question 1). The mean %maximum scores among authors ranged from 56 to 71%. ◆ Categorised responses to the open statement are shown in Figure 2. Qualitative assessment of ambivalent responses suggested many readers recognise the value of sponsored reviews, while expressing a need for cautious interpretation.
Conclusions ◆ Opinion
varies, but the overall attitude of readers appears more positive than negative towards industry-sponsored reviews, with enthusiastic/positive responses to the questions/open statement generally outnumbering sceptical/negative responses by more than 2:1.
◆ Many
PCP and specialist respondents consider these review articles an important source of information.
Positive comments Ambivalent comments Negative comments No response
◆ Specialists
tend to have a more positive attitude than PCPs do, with those who have themselves authored a sponsored review being the most positive.
◆ Given
the positive reception that reviews continue to have with many readers, their future seems assured. However, given frequent expressions of ‘the need to interpret with caution’, it is important that those involved in the writing and publication planning of reviews continue to strive for balance to avoid eroding reader confidence.
23.7% 31.1%
11.6%
33.6%
Reference 1. Graf C, Battisti WP, Bridges D, et al; International Society for Medical Publication Professionals. Research methods & reporting. Good publication practice for communicating company sponsored medical research: the GPP2 guidelines. BMJ 2009;339:b4330.
Figure 1. The 12 specific statements surveyed, showing responses stratified by specialists and PCPs. Proportion of 0–1, 2–4 and 5–6 Likert scores
Negative perception Question 1
I regularly read these articles when published in journals I subscribe to
Question 2
I would never read such an article even if it was provided to me as a reprint
I will certainly read these articles when they are provided to me as reprints
Question 3
Such articles tend to provide biased and potentially misleading accounts of a drug’s clinical profile
Such articles can provide a useful summary of a drug’s clinical profile that can be helpful to the reader
65
Question 4
When such articles focus on a clinical issue, they tend to exaggerate problems or potential solutions according to the interests of the sponsor
Such articles can provide a useful summary of a clinical issue that can be helpful to the reader
58
Question 5
Such articles tend to bias the level of coverage given to certain clinical issues in the medical literature
Such articles can ensure that important clinical issues are adequately highlighted in the medical literature
57
I place more value on articles that deal with medical issues than individual products
I consider articles that summarise a product’s clinical profile to be at least as helpful as articles dealing with a medical issue
63
Question 7
I have no confidence in the industry sponsors to be mindful of the need for balance and integrity in the content
I have confidence that the industry sponsors are mindful of the need for balance and integrity in the content
56
Question 8
I have no confidence that the involvement of professional medical writing services will help to ensure balance and integrity in the content
I have confidence that the involvement of professional medical writing services helps to ensure balance and integrity in the content
56
Question 9
I have no confidence that the involvement of expert authors ensures balance and integrity in the content
I have confidence that the involvement of expert * authors ensures balance and integrity in the content
61
Question 10
I have no confidence that the peer-review process ensures balance and integrity in the content
I have confidence that the peer-review process * ensures balance and integrity in the content
63
Question 11
I pay little attention to the views and opinions of my peers/experts in the field, when they are * given in such articles
I am generally interested in the views and opinions of my peers/experts in the field, as expressed in such articles
66
Such articles seldom challenge my thinking or influence my clinical decision making
Such articles can often challenge my thinking and influence my clinical decision making
Are reviews trusted?
Question 6
Are reviews influential?
Mean % score
I generally ignore these articles when published in journals I subscribe to
Are reviews read?
Is the writing and peer-review process trusted?
Positive perception
Question 12
Sceptical response 0–1
*
*
Intermediate response
Enthusiastic response 5–6
63 *
57 59
*
53
60 *
54
54
56 *
51
54
57
60 *
62 59 56
Top bars/data: specialists, Lower bars/data: PCPs *significant difference between specialist and PCP response (p
