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Conclusions and Recommendations

from Part III - Case Studies

Published online by Cambridge University Press:  13 March 2025

Karen B. Schmaling  and
Robert M. Kaplan
Karen B. Schmaling
Affiliation:
Washington State University
Robert M. Kaplan
Affiliation:
Stanford University
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Summary

After reviewing a wide range of topics, we conclude that good science requires greater efforts to manage biases and to promote the ethical conduct of research. An important problem is the belief that randomized controlled trials (RCTs) are exempt from systematic bias. Throughout the book, we acknowledge the importance of RCTs, but also emphasize that they are not immune from systematic bias. A second lesson concerns conflict of interest, which must always be taken seriously. Most large RCTs are sponsored by for-profit pharmaceutical companies. We identify leverage points to address these problems. These include cultivating equipoise – the position that research investigators enter a study with the understanding that either a positive, negative, or null result is of value. We return to several other themes prominent throughout this book, including the reporting of research findings and serious problems with our system of peer review. The book concludes with recommendations for reducing conflicts of interest, improving transparency, and reimagining the peer review system.

Keywords

advertisingbiasconflicts of interestequipoisepeer reviewpost-marketing surveillancetransparency
Type
Chapter
Information
Rethinking Clinical Research
Methodology and Ethics
 , pp. 339 - 355
Publisher: Cambridge University Press
Print publication year: 2025

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