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Sources of Medication Research Funding May Be Under-Reported
< Oct. 01, 2008 > -- Research published this week finds that the mainstream media often fail to report when pharmaceutical company funding is used for studies of medications. 
Furthermore, there is a tendency among both medical and mainstream reporters to use brand names, rather than generic names, when referring to specific medications.
And both of these factors work to skew public and medical opinion toward commercial interests, according to the review, published in the Journal of the American Medical Association (JAMA).
News articles represent an important source of medical information for many patients, and even some physicians. "An increasingly recognized source of commercial bias in medical research is the funding of studies by companies with a financial interest in the results," the authors write.
Little is known about how frequently news articles report the funding sources of the medical research they report on, or how frequently news articles use brand medication names instead of generic names, which could create commercial bias.
The authors of the new study analyzed 306 news articles about medication research from US newspaper and online sites, and they also asked 100 editors at the most widely circulated newspapers in the country about their reporting practices. The studies were published in five major general medical journals (JAMA, New England Journal of Medicine, Lancet, Archives of Internal Medicine, and the Annals of Internal Medicine).
Forty-two percent of the news articles did not state when medication research had received funding from the pharmaceutical industry. And when they did, it was often buried in the text.
Sixty-seven percent of 277 articles that reported on medications only used the medication's brand name in at least half of the references to the medication. According to the study authors, up to $9 billion is spent each year in the US when doctors prescribe brand name medications although a generic would do just as well.
Yet 88 percent of the responding newspaper editors thought that articles they published often or always mentioned company funding. And 77 percent of the editors thought their stories referred to medications by their generic names.
Three percent of the newspapers had formal written policies regarding disclosure of company funding, and 2 percent had such policies regarding the use of generic names of medications.
"As a doctor, I am increasingly worried in recent years that company-funded research can't be trusted in the same way that other research can be trusted," says study author Dr. Michael Hochman, a resident physician at Cambridge Health Alliance in Cambridge, Mass. "[Also], all of us, doctors, patients, journalists, have gotten into a bad habit of referring to medications by their proprietary brand names. At a philosophical level, I think we need to be referring to them by the generic name. We want to keep commercial interests as much out of the doctor-patient relationship as possible."
"Funding sources should be included in every story where it's relevant," adds Andrew Holtz, past president of the Association of Health Care Journalists, former CNN medical correspondent, and now an independent journalist. But, he also points out, the new study itself may be biased because it only included in its analysis stories of at least 200 words.
"Two hundred words is not a very long story and I didn't see in the study anything about whether there was a correlation between length of article and how thorough the article was in mentioning funding and generic and brand names," Holtz says. Such stories, he adds, may be leaving out other important information as well, including, for instance, the side effects of a particular medication.
Peer-reviewed medical journals earlier engaged in a similar debate and most now require that study authors disclose funding sources.
"News organizations, in my opinion, really should have explicit written policies that they enforce," Dr. Hochman says. "We always need to disclose how a medical study is funded. I'm particularly concerned about commercial studies. We have many examples of how company-led research led us astray."
As for preferring generic medication names - many of which are unpronounceable, even for experts - over brand names, Dr. Hochman concedes that will be an uphill battle.
"It's a problem but we're not going to change it unless we take the hard step of trying to learn generic names," he says.
The study authors conclude: "Our findings raise several concerns. For patients and physicians to evaluate new research findings, it is important that they know how the research was funded so they can assess whether commercial biases may have affected the results. Additionally, the use of generic medication names by the news media is preferable so that physicians and patients learn to refer to medications by their generic names, a practice that is likely to reduce medication errors and may decrease unnecessary health care costs."
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Generic medications are a therapeutic "copy" of brand-name medications.
Every year, consumers save an estimated $8 billion to $10 billion dollars by using generic medications, according to the Congressional Budget Office.
The US Food and Drug Administration (FDA) regulates generic medications. They are allowed on the market only after testing has proved they produce the same effect on the body as their brand-name counterparts.
Not every medication has a generic version. Generally, when brand-name medications are first introduced, a patent protects them for 17 years before a generic alternative can be manufactured. Pharmaceutical companies can apply for extensions of this patent protection period. If the patent period is not extended, other companies can introduce their version of the brand-name product after 17 years.
Prescription medications are one of the fastest-growing areas of US healthcare spending.
One way to reduce the high cost of prescription medications is to switch to generic medication, which are priced 25 percent to 80 percent lower than the equivalent brand-name versions.
One reason generic medications cost less than their brand-name equivalents is that manufacturers of generics spend less money on advertising and product development because the brand-name equivalent already is well-known.
FDA rules state that a generic medication must be "bioequivalent" to the brand-name medication, meaning it must have the same active ingredients, strength, dosage form, safety, quality, purity, stability, and performance. The generic medication also must be absorbed at the same rate.
Pharmaceutical companies must adhere to strict manufacturing requirements to earn approval to sell their products. Keep in mind that generic drugs bought over the Internet from places outside the US are not regulated by the FDA and may not meet the same standards for equivalency or safety as those sold in this country.
Differences between brand-name and generic medications that may make a difference in how compliant a patient is in taking the medication are the size, shape, and coating. These differences do not affect the quality, effectiveness or safety of a drug. Other differences between brand-name and generic medications include taste and inactive ingredients.
Depending on the medications you take and how often you take them, you could save hundreds of dollars every year by taking generics instead of brand-name medications.
When your healthcare provider gives you a prescription for a brand-name medication, ask if he or she can prescribe the generic equivalent instead. You also can ask if you can switch from brand names to generics for medications you already take.
In some cases, providers prefer brand names for medical or technical reasons. If so, your provider should be able to explain why.
Always consult your physician for more information.
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