Publication Bias: Who is to Blame?

Publication bias occurs when a study’s results influence its probability of publication. This has been acknowledged already in 1959 (1). An article this past week in Newsweek rightfully laments the impact of such publication bias on the public health.

The Newsweek article implicates big bad pharma as the primary culprit in this process. But is it? Logic and human nature would surely suggest that marketing departments inside big corporations, where money is the primary incentive, are unlikely to go out of their way to publicize the negative effects of their pharmaceuticals or medical device. Therefore, I get this argument and I don’t disagree. Meanwhile there are clear cases where a pharmaceutical company threw its considerable weight around to squash negative studies. A case in point being the much-ballyhooed instance that happened in the mid 1990s – Knoll Pharmaceuticals threatened legal action against UCSF when an investigator sought to publish a negative study. But where is the evidence that such behavior by pharma is common? The PLoS article cited by Newsweek only demonstrates that many clinical trials (roughly half) go unpublished. Since big bad pharma is as beholden to academia as academia is to big pharma, I find it more than a little disingenuous to ascribe all of the publication bias to a pharma conspiracy.

Having been personally involved in scientific publishing over almost three decades, and having seen two clinical studies go unpublished, I believe that the primary culprit behind publication bias lies with academia itself. Why? For starters, medical academia controls most scientific journals as well as the incentives for most of the scholarly publishing of clinical trials, hence the interdependence with pharma. Moreover, it is a reality that academic promotion is a primary motivation for publishing journal articles. In this regard, a young academic scores few points in the chase for tenure by publishing negative studies, which just aren’t sexy in the eyes of promotion committees. Meanwhile, negative studies don’t score many points in the impact factor game played by so many big name “luxury” journals whose cachet is highly coveted by academic promotion committees. Given academia’s near stranglehold on both authors and journals, there are no incented physicians left to publish negative studies, hence the publication bias we all decry.

Meanwhile when it comes to publishing any scientific article, medical journals themselves have created ever-burgeoning barriers involving cost, process and time. The reality is that in a world where the rewards are so small, or in truth non-existent, it is just too painful for many physicians to publish any number of societally high-value observations such as negative studies. For example, look at the academic and journalistic bias (including PLoS) against case reports, arguably the only instance of publishing pure truth devoid of underpowered studies, misleading statistics and heterogeneous patient populations. So ultimately I argue that the same powers-to-be that bemoan the lack of more publishing are the very source of the problem, and active steps to mitigate publication bias across the academic literature are needed. Cureus, with its streamlined process for scientific publication, is quite happy to help remedy the challenge of publication bias!

  1. Sterling TD. Publication decision and their possible effects on interference drawn from tests of significance – or vice versa. J Am Stat Assoc 1959;54:30-34.
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