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To the Editor: Mr Friedberg and colleagues¹ found that studies sponsored by drug companies were less likely to report unfavorable results than studies funded by nonprofit organizations. The authors posited several alternative explanations for their findings, including publication bias, unconscious bias because of relationships between the investigator and the pharmaceutical company, early screening of studies by drug firms, and direct company involvement with the study design.

As noted in the accompanying editorial,² the conflict of interest hypothesis would be strengthened by a study design comparing several economic evaluations, from different funding sources, of a single agent. However, the design of the study by Friedberg et al allows alternative explanations to be considered. First, many pharmaceutical companies conduct internal economic evaluations throughout the development of a drug product. Because reimbursement for a drug product is often dependent on positive economic findings,³ otherwise promising products may be terminated during development by the . . . [Full Text of this Article]

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