Undue industry influences that distort healthcare research, strategy, expenditure and practice: a review
Undue industry influences that distort healthcare research, strategy, expenditure and practice: a review
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DOI：
10.1111/eci.12074
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发表时间：
2013-05-01
影响因子：
5.5
通讯作者：
Ioannidis, John P. A.
中科院分区：
文献类型：
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作者：
Stamatakis, Emmanuel;Weiler, Richard;Ioannidis, John P. A.
在过去15年中，工业产品（主要是药品和设备）的支出呈螺旋式增长，占医疗保健支出的很大一部分。药物和设备的开发和营销所涉及的巨大经济利益可能给了这些行业过度的权力，以影响医学研究、政策和实践。材料和方法回顾文献并分析该行业直接或间接渗透到更广泛的医疗保健系统的多种途径。我们在以下几个层面对行业影响进行了分析：(i)证据基础的产生，（ii）证据合成，（iii）对安全性和危害问题的理解，（iv）成本效益评估，(v)临床实践指南的制定，（vi）医疗专业教育，（vii）医疗实践，（viii）医疗消费者的决定。结果：我们找到了大量一致的证据，表明该行业已经创造了干预决定医疗保健研究、战略、支出、实践和教育过程的所有步骤的方法。由于这些干扰，药物和其他产品的益处往往被夸大，其潜在危害被淡化，临床指南、医疗实践和医疗保健支出决策存在偏见。为了服务于自身利益，医疗行业巧妙地影响了证据基础的制作、证据的合成、对危害问题的理解、成本效益评估、临床实践指南和医疗保健专业教育，并对专业决策和健康消费者产生直接影响。迫切需要制定法规和采取其他行动，重新定义医学的使命，使其朝着更客观、更有利于患者、人口和社会、不存在利益冲突的方向发展。
Background Expenditure on industry products (mostly drugs and devices) has spiraled over the last 15 years and accounts for substantial part of healthcare expenditure. The enormous financial interests involved in the development and marketing of drugs and devices may have given excessive power to these industries to influence medical research, policy, and practice. Material and methods Review of the literature and analysis of the multiple pathways through which the industry has directly or indirectly infiltrated the broader healthcare systems. We present the analysis of the industry influences at the following levels: (i) evidence base production, (ii) evidence synthesis, (iii) understanding of safety and harms issues, (iv) cost-effectiveness evaluation, (v) clinical practice guidelines formation, (vi) healthcare professional education, (vii) healthcare practice, (viii) healthcare consumer's decisions. Results We located abundance of consistent evidence demonstrating that the industry has created means to intervene in all steps of the processes that determine healthcare research, strategy, expenditure, practice and education. As a result of these interferences, the benefits of drugs and other products are often exaggerated and their potential harms are downplayed, and clinical guidelines, medical practice, and healthcare expenditure decisions are biased. Conclusion To serve its interests, the industry masterfully influences evidence base production, evidence synthesis, understanding of harms issues, cost-effectiveness evaluations, clinical practice guidelines and healthcare professional education and also exerts direct influences on professional decisions and health consumers. There is an urgent need for regulation and other action towards redefining the mission of medicine towards a more objective and patient-, population- and society-benefit direction that is free from conflict of interests.