Table 1 Interactions between marketing and clinical trials

General influences on the choice and design of industry trials

 • Clinical/commercial product profile, competitor landscape, opportunities and risks

 • Regulatory requirements

 • Cost, time, patient recruitment and logistics

Marketing functions of industry trials

 • Generating commercially useful data

 • Engaging, organizing and retaining key opinion leaders

 • Building relationships with investigators and their institutions, including internationally

 • Seeding — familiarizing clinicians with use of a product such that they continue using it after the trial

 • Generating publicity, interest and prestige for a drug and its manufacturer, for instance, through publications, congresses and material for sales representatives

 • Internal marketing — building company enthusiasm and product understanding

Marketing-related features of industry trials

A. Research question

 • May be meaningful or fatuous; ambitious or conservative; balanced or loaded; appropriately or inappropriately framed

B. Commercial choices and biases in design, conduct and analysis

 • Not all commercial trials are biased, and marketing can be based on unbiased data and reporting

 • Nonetheless, many industry trials involve commercially expedient methodological choices and biases. These may be unconscious or planned

 • Randomized studies — multifarious opportunities for commercially expedient decisions and biases, often closely related to the clinical particularities of the trial

C. Commercial choices and biases in reporting

 • Non-reporting of unhelpful trials and data

 • Delayed, obscure or underreporting: choice of journal, website or congress proceedings

 • Published articles — selective reporting of favourable vs. unfavourable results; inferring greater clinical relevance than the data justify; framing, interpretation, visual spin, rhetoric and conclusions

 • Overreporting of favourable findings in secondary publications

 • Attributional spin, highlighting the role of academics and understating that of manufacturers, is endemic in medical journal articles