Donohoe 1

Donohoe MT. Health services research and industry. JAMA 1997;278:896-7 (letter).

To the Editor. ----- The articles by Blumenthal et. al.[1] and Dong et. al.[2] highlight the scope and nature of the problem of scientists withholding data from colleagues and from peer-reviewed journals; Rennie’s editorial [3] touches on the possible sequelae of such limitations on the free exchange of scientific information. These authors concentrate on basic science, pharmaceutical, and biotechnology-related research. I am concerned about similar problems limiting the nature, scope, and dissemination of results in health services research.

With the increasing enrollment of patients in managed care organizations (MCOs), coupled with cuts in government funding of organizations concerned with studying the processes and clinical outcomes of various models of clinical care for different diseases (e.g., The Agency for Health Care Policy and Research), more and more MCO’s are funding internal outcome studies. Ideally, the goals of such research should be to study the effects of different clinical interventions on morbidity, mortality, and quality of life, and to develop protocols for achieving enhanced outcomes at reduced cost. However, these organizations are increasingly for-profit entities which compete for “covered lives.” As a consequence, researchers funded or employed by these institutions may be under written order, or experience pressure from management, to selectively publish only those results which shed a positive light on their organizations, and to suppress information potentially valuable to clinicians nationwide, but which may make their organizations’ quality of health care delivery appear inferior to its competitors.

For instance, an MCO may publish the positive results of a new protocol for disease management, and may directly advertise this information to potential patients and to benefit coordinators of large health care purchasing groups, all the while suppressing negative portions of their data, a form of publication and advertising bias. Given the recent and rapid increase in direct-to-consumer promotion of often-biased and incomplete information by the pharmaceutical industry [4], [5], similar sales pitches from the public relations divisions of MCOs cannot be far behind.

Furthermore, since for-profit MCOs aim to enroll the healthiest and wealthiest members, a shift from publicly-funded to MCO-sponsored outcomes research could shift the research agenda toward diseases more likely to affect the upper and upper-middle classes, rather than those linked to low socioeconomic status, further marginalizing those whose access to care is already limited. My concerns is heightened by the fact that for-profit MCOs are buying academic medical centers and gaining increased control and influence over health service researchers and physicians-in-training.

Our duty as researchers is not primarily to our financial sponsors or our employers, but to the patients we are studying and future patients of all physicians who may benefit from our results. Let us not be like the 17th-century Chamberlen family, who kept secret its invention of the obstetrical forceps for a century and profited handsomely, while much needless maternal suffering and infant death could have been averted. [6]

Secrecy is not conducive to the development of effective and safe practice guidelines, which practicing physicians consult in the care of patients, and which educators employ to train succeeding generations of physicians. In fact, the advancement of civilization through science is based on the open and free exchange of ideas, not the hoarding and selective distribution of important findings for monetary gain.

Martin Donohoe, M.D.

Assistant Professor of Medicine

OregonHealthSciencesUniversity

Division of Internal Medicine

[1] Blumenthal D, Campbell E, Anderson M, Causino N, Louis, K. Withholding research results in academic life science. JAMA 1997;277:1224-1228.

[2] Dong B, Hauck W, Gambertoglio J, et. al. Bioequivalence of generic and brand-name levothyroxine products in the treatment of hypothyroidism. JAMA 1997;277:1205-1213.

[3] Rennie D. Thyroid Storm. JAMA 1997;277:1238.

[4] Borzo G. Consumer drug ads booming; FDA reviews restrictions. American Medical News (February 10, 1997).

[5] Wilkes M, Doblin B, Shapiro M. Pharmaceutical advertisements in leading medical journals: experts’ assessments. Annals of Internal Medicine 1992;116:912-919.

[6] Knut Haeger. The Illustrated History of Surgery (New York, Bell Publishing Company, 1988).

Public Health and Social Justice Website