Thursday, May 24, 2018

Industrial payments and publication bias

Academic Influence and Its Relationship to Industry Payments in Orthopaedic Surgery

These authors point out that the Hirsch index (h-index) quantifies research publication productivity for an individual, and has widely been considered a valuable measure of academic influence. The Hirsch index (h-index) mathematically adjusts for the total number of publications and the number of times each publication has been cited. In orthopaedic surgery, higher h-indices have been associated with higher academic rank.
In 2010, the Physician Payments Sunshine Act (PPSA) was introduced as a way to increase transparency regarding U.S. physician-industry relationships. The purpose of this study was to investigate the relationship between industry payments and academic influence as measured by the h-index and number of publications among orthopaedic surgeons for the year 2014. They also examined the relationship of the h-index to National Institutes of Health (NIH) funding.

Of 3,501 surgeons, 78.3% received nonresearch payments, 9.2% received research payments, and 0.9% received NIH support. Nonresearch payments ranged from $6 to $4,538,501, whereas research payments ranged from $16 to $517,007. 

Surgeons receiving NIH or industry research funding had a significantly higher mean h-index and number of publications than those not receiving such funding. Surgeons receiving nonresearch industry payments had a slightly higher mean h-index and number of publications than those not receiving these kinds of payments. Both the h-index and the number of publications had weak positive correlations with industry nonresearch payment amount, industry research payment amount, and total number of industry payments.

Academic surgeons who receive industry research support or NIH funding tend to have higher hindices.

For the overall population of orthopaedic surgery faculty, the h-index correlates poorly with the dollar amount and the total number of industry research payments. Regarding nonresearch industry payments, the h-index also appears to correlate poorly with the number and the dollar amount of payments. 

Comment: While the authors conclude that "These results are encouraging because they suggest that industry bias may play a smaller role in the orthopaedic literature than previously thought," this conclusion is not supported by their data. A high h-index indicates only that the author has a relatively large number of relatively often referenced publications - it does not demonstrate that these publications are unbiased. 

When industry supports research, industry influences what is investigated, how the research is done, and what conclusions of the research are published.  If the results of the research do not satisfy the needs of the supporting company, the company can withdraw funding.  In addition, the powerful effect of non-research funding can be easily imagined when viewing the table above.

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