Positive outcomes in Random Control Trials (RCTs) seem anything but random

Industrial medicine views random control trials (RCTs) as the gold standard for determining the efficacy of medications. The thinking goes: blinding, controls/placebos and regular reporting produce objectively reliable, generalizable results.

Yet critics argue that RCTs, at least the ones that clinicians habitually read in the reprints of medical journal articles shared by drug company reps, are deeply flawed.

Richard Smith, longtime editor of the BMJ, argued that “Medical Journals Are an Extension of the Marketing Arm of Pharmaceutical Companies.”

Up to 75% of published RTC studies are funded by manufacturers, and (surprise!) most studies that aren’t positive for the manufacturer never get published. This “dead pool” is estimated to be roughly half of all studies. (Source.)

Industry funded research focuses on areas where drug companies can make money, rather than areas that maximize public health.

But even in studies affirming a medication’s efficacy often appear to have been rigged. Smith compiled this list of strategies drug companies use to rig RTCs:

* Conduct a trial of your drug against a treatment known to be inferior.

* Trial your drugs against too low a dose of a competitor drug.

* Conduct a trial of your drug against too high a dose of a competitor drug (making your drug seem less toxic).

* Conduct trials that are too small to show differences from competitor drugs.

* Use multiple end points in the trial and select for publication those that give favourable results.

* Do multicentre trials and select for publication results from centres that are favourable.

* Conduct subgroup analyses and select for publication those that are favourable.

* Present results that are most likely to impress – for example, reduction in relative rather than absolute risk.

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