Department of Epidemiology and Public Health, University College London, London, UK.
Eur J Clin Invest. 2013 May;43(5):469-75. doi: 10.1111/eci.12074. Epub 2013 Mar 25.
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.
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.
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.
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.
在过去的 15 年中，行业产品（主要是药品和医疗器械）的支出呈螺旋式上升，占医疗支出的很大一部分。药品和医疗器械的开发和营销所涉及的巨大经济利益可能赋予了这些行业过大的权力，使其能够影响医学研究、政策和实践。
回顾文献并分析行业通过多种途径直接或间接地渗透到更广泛的医疗保健系统中。我们分析了行业在以下层面的影响：（i）证据基础的产生，（ii）证据综合，（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）医疗保健专业人员的教育，（vii）医疗保健实践，（viii）医疗保健消费者的决策。
我们找到了大量一致的证据，证明该行业已经创造了干预决定医疗保健研究、策略、支出、实践和教育的各个步骤的手段。由于这些干扰，药品和其他产品的收益往往被夸大，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也存在偏见。
为了自身利益，该行业巧妙地影响了证据基础的产生、证据综合、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人员的教育，并且对专业决策和医疗保健消费者直接产生影响。迫切需要监管和其他行动来重新定义医学的使命，使其朝着更加客观、以患者、人群和社会利益为导向的方向发展，摆脱利益冲突。
