The money blind: how to stop industry bias in biomedical science, without violating the First Amendment

Neoliberalism and the Commodification of Mental Health

This article contributes to the existing literature on neoliberalism as an ideological hegemonic project by addressing how the image of social reality it advances normalizes the medicalization of human life. Because success, virtue, and happiness in a neoliberal market society are often associated with material wealth, prestige, and “coming out on top,” it follows that normalcy itself is typically conceived along these reified objectives. Acquiring services and/or products that might aid people to meet these results is thus viewed as benevolent and perhaps even indispensable in the pursuit of a fulfilling and productive life. What this also suggests is that integration, mental health, and human well-being become largely functions of consumerism. We address how an emphasis on medicalization, particularly the use of psychotropic drugs, can be traced to the psychopharmacological revolution of the mid-twentieth century and its obsession with situating illness within the individual. We then address how this obsession with medicalization and the tendency to treat “mental illness” as a problem within the individual continues to be supported within the prevailing neoliberal logic that downplays the social realm, treats individuals as self-contained agents, and pathologizes thoughts and behaviors that deviate from what the market defines as functional, productive, or desirable.

Incomplete medication adherence of chronically ill patients in German primary care

BACKGROUND

Incomplete medication adherence is a major problem in health care worldwide. Patients who adhere to medical treatment have a better prognosis and create fewer costs.

OBJECTIVE

To assess the degree of incomplete adherence of chronically ill routine primary care patients in a German setting and analyze the association between incomplete medication adherence, as well as clinical and sociodemographic patient characteristics.

METHODS

In a cross-sectional survey, chronically ill patients were asked to assess their adherence in primary care retrospectively using the Medication Adherence Report Scale (MARS-D) questionnaire. To investigate the association of incomplete adherence with sociodemographic and clinical data, univariate and multivariate analyses were conducted.

RESULTS

In total, 62.1% of 190 patients were categorized as incompletely adherent. The mean MARS-D score was 23.5 (standard deviation = 2.7). Analyses revealed no statistically significant associations at P < 0.05 between degree of adherence and patient characteristics. The total explained variance amounted to 11.8% (Nagelkerke's R(2) = 0.118) in the multivariate analysis.

CONCLUSION

Previously reported results regarding associations of sociodemographic and clinical data with incomplete medication adherence could not be confirmed for this sample of chronically ill patients. In order to be able to provide guidelines for the reduction of incomplete medication adherence in German primary care, further research is needed.

More mad and more wise

It is clearly important that clinicians have appropriate assessment and management pathways when working in clinical settings where illnesses associated with cognitive impairment may impair both mobility and safety, such as memory clinics and medical services dealing with older people. However, in wider terms, particularly in terms of an understanding of the impact of cognitive function on the whole population of older drivers, it is critical that debate on cognitive function and driving is adequately informed by the sciences of gerontology and public health, embraces a broad definition of cognitive function which recognizes both the gains and losses of ageing, recognizes the barriers and disruptive influences which may skew scientific debate, and frames such a discourse in terms of an appropriate balance between mobility and safety.

A randomized study of how physicians interpret research funding disclosures

BACKGROUND

The effects of clinical-trial funding on the interpretation of trial results are poorly understood. We examined how such support affects physicians' reactions to trials with a high, medium, or low level of methodologic rigor.

METHODS

We presented 503 board-certified internists with abstracts that we designed describing clinical trials of three hypothetical drugs. The trials had high, medium, or low methodologic rigor, and each report included one of three support disclosures: funding from a pharmaceutical company, NIH funding, or none. For both factors studied (rigor and funding), one of the three possible variations was randomly selected for inclusion in the abstracts. Follow-up questions assessed the physicians' impressions of the trials' rigor, their confidence in the results, and their willingness to prescribe the drugs.

RESULTS

The 269 respondents (53.5% response rate) perceived the level of study rigor accurately. Physicians reported that they would be less willing to prescribe drugs tested in low-rigor trials than those tested in medium-rigor trials (odds ratio, 0.64; 95% confidence interval [CI], 0.46 to 0.89; P=0.008) and would be more willing to prescribe drugs tested in high-rigor trials than those tested in medium-rigor trials (odds ratio, 3.07; 95% CI, 2.18 to 4.32; P<0.001). Disclosure of industry funding, as compared with no disclosure of funding, led physicians to downgrade the rigor of a trial (odds ratio, 0.63; 95% CI, 0.46 to 0.87; P=0.006), their confidence in the results (odds ratio, 0.71; 95% CI, 0.51 to 0.98; P=0.04), and their willingness to prescribe the hypothetical drugs (odds ratio, 0.68; 95% CI, 0.49 to 0.94; P=0.02). Physicians were half as willing to prescribe drugs studied in industry-funded trials as they were to prescribe drugs studied in NIH-funded trials (odds ratio, 0.52; 95% CI, 0.37 to 0.71; P<0.001). These effects were consistent across all levels of methodologic rigor.

CONCLUSIONS

Physicians discriminate among trials of varying degrees of rigor, but industry sponsorship negatively influences their perception of methodologic quality and reduces their willingness to believe and act on trial findings, independently of the trial's quality. These effects may influence the translation of clinical research into practice.