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In addition, published studies often interpret the data as more favorable toward the drug than it actually is. "Not only were positive results more likely to be published, but studies that were not positive, in our opinion, were often published in a way that conveyed a positive outcome," the researchers wrote. Although the FDA requires that pharmaceutical companies provide the results of all studies conducted on a new drug before it receives approval, there is no requirement that those studies be published where doctors, health researchers and the public can read them. A team of researchers from institutions including the Oregon Health and Science University, the Portland Veterans Affairs Medical Center, Kent State University and the University of California at Riverside compared the results of studies reported in the FDA database with whether and how those studies were reported in published literature. "It tells you where they placed their bets before they saw the data," lead researcher Erick Turner said. The researchers examined 74 studies conducted on 12 antidepressants between 1981 and 2004, involving a total of 12,564 patients. Only 38 of these studies (51 percent) produced favorable results for the drugs being tested. All but one of those studies - or 94 percent - were published. In contrast, 22 of the 36 studies that failed to show favorable results (61 percent) went unpublished. Of the 14 studies published, only three interpreted the data unfavorably. The other 11 studies, in contrast with FDA interpretations of the same data, cast the drugs as more effective than they actually were. For example, of the three studies conducted on Glaxo SmithKline's Wellbutrin, only the one showing positive results was published. Of five studies conducted on Pfizer's Zoloft, the one showing positive results was published; the one with questionable results was spun as if the drug were effective, and the three with unfavorable results were never published. According to the researchers, the publication bias inflated the reported effectiveness of the anti-depressant drugs by an average of 32 percent. The actual amount varied from a low of 11 percent for Glaxo SmithKline's Paxil to a high of 69 percent for Bristol-Myers-Squibb's Serzone. Turner said that this exaggeration of a drug's effectiveness can lead doctors to prescribe it in borderline cases where it might not be appropriate. "Selective publication can lead doctors to make inappropriate prescribing decisions that may not be in the best interest of their patients and, thus, the public health," the researchers wrote. The researchers said that the publication bias did not necessarily arise from drug companies actively concealing data. One explanation might be that researchers find negative results uninteresting, and do not go to the effort of writing them up. "There's an expectation that if you get a positive result, that's what you're supposed to do, and if you get a negative result you have failed," Turner said. "The first impulse is to say, 'I was wrong. Maybe I should move on to something more interesting.'" The bias could just as easily come from medical journals being more interested in studies with positive results, Turner said, and not from the researchers at all.
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