title: Undue industry influences that distort healthcare research, strategy, expenditure and practice: a review.
abstract: 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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, UK. e.stamatakis@ucl.ac.uk
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Stamatakis
authors.forename: Richard
authors.initials: R
authors.lastname: Weiler
authors.forename: John P A
authors.initials: JP
authors.lastname: Ioannidis
mesh_terms: D035843:Biomedical Research / Q000379:methods*; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics* / Q000458:organization & administration; D004864:Equipment and Supplies / Q000191:economics*; D005102:Health Expenditures; D006282:Health Personnel / Q000458:organization & administration / Q000523:psychology; D006301:Health Services Needs and Demand / Q000191:economics* / Q000458:organization & administration; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D004364:Pharmaceutical Preparations / Q000191:economics*
chemical_list: D004364:Pharmaceutical Preparations