Daanish Bassi, Grade 11

In the scientific community, millions of academic papers are published each year detailing the research completed by the vast number of scientists all over the globe. As this tremendous amount of research grows even further, it must be objective and free of bias to ensure that it is trustworthy and accurate (1). Realistically, however, the true essence of objective research may be infiltrated by hidden agendas and implicit biases that silently encroach upon the scientific landscape. Bias can occur at any point during the research process and comes in multiple forms, having the potential to cause false and misleading conclusions, creating serious ethical and moral dilemmas (1,2).|
One of the primary sources of bias in research is industry sponsorship- the act of commercial organizations funding research. While cooperation between academia and industry can be beneficial and generate valuable knowledge, corporations that sponsor research often have interests they desire to promote by influencing research outcomes (3). These corporate interests can drive researchers away from the most beneficial questions and lead them to form inaccurate or misleading conclusions that benefit the corporation (3). The tobacco industry exemplifies these ideas through its funding of research that investigated the harmful effects of smoking. By the early 1950s, there was increasing evidence that there was a link between smoking and the incidence of lung cancer and other major health concerns- a disaster of catastrophic proportions for the tobacco industry (4). In response to this crisis, the tobacco industry attempted to disprove these scientific findings by funding flawed research of their own and suppressing research that went against their interests. The sponsored research often involved scientists with ties to the tobacco industry, many of whom were smokers themselves (4). Additionally, studies funded by the tobacco industry were often purposely designed to produce favorable findings for tobacco companies by using a variety of tactics like framing the scientific question in certain ways and changing the research standards (5). Moreover, the tobacco industry was also involved in the manipulation of data on secondhand smoke by misclassifying participants in terms of exposure in an effort to prove it possessed little danger (6). Ultimately, industry sponsored research creates a myriad of conflicts of interest that can significantly harm the validity of research, potentially even harming human life as seen in the case of the tobacco industry (4).
In addition to industry sponsorship, an individual or society’s social biases can also reduce the objectivity of research subsequently reducing its validity. Social bias, the discrimination or prejudice against an individual, group, or set of beliefs, often involves stereotyping others in ways that disadvantage one group/individual or unfairly advantages another, having the potential to be extremely detrimental in fields like medicine (7). A prime example of social bias present in academic research is the medical estimation of kidney function based on blood creatine levels known as estimated glomerular filtration rate (eGFR) which plays an exceedingly important role in the diagnosis of chronic kidney disease (CKD) and transplant evaluation (8). One of the eGFR equations known as “Modification in Diet of Renal Disease” was developed in 1999 using data from 1628 individuals of which only 197 were black (9). This research contained an incidental finding that black individuals had higher creatinine excretion rates than white individuals justified by the baseless assumption that black people have a greater average muscle mass (8,9). Because of these flawed findings, black ethnicity was determined to be an independent predictor of a greater GFR (black individuals are artificially estimated to have greater kidney function) proving to have devastating effects for black people suffering from CKD (8,9). For example, medical professionals often fail to diagnose the beginning stages of CKD in the black population, so secondary prevention is delayed (8). Furthermore, some black patients with late stages of CKD are not eligible for a kidney transplant despite its need due to the artificial increase of their eGFR (8).
Similar to the estimation of kidney function, cardiovascular research is significantly affected by social biases. Historically, most cardiac research has suffered from a tremendous gender imbalance with the primary focus being males (10). For example, the study that linked aspirin to the prevention of heart attack was conducted among 22,071 male physicians- not a single woman was included (11). The structural gender bias in cardiac research has led to significantly worse cardiac care for women, costing the lives of many as guidelines for heart disease in women are extrapolated from research primarily completed with men despite significant differences (10). Additionally, models for the estimation of cardiovascular risk are primarily based on male risk factors and ignore female risk factors like preeclampsia and gestational diabetes, creating significant estimation errors (12). Even today, women are considerably underrepresented in clinical trials for congestive heart failure and coronary artery disease (10,13).
Ultimately, it is impossible for scientific research to be completely objective and void of all biases as it is exposed to human nature which is inherently subjective; however, there are steps that can be taken to minimize bias and increase trustworthiness. For instance, the continued disclosure of industry funding and other conflicting affiliations is essential to maximize transparency in research where corporate interests may be influencing outcomes. Furthermore, public confidence in scientists is declining due to a variety of factors like the COVID-19 pandemic, social media, and greater social and political divisions, all of which are fueling the spread of misinformation (14). It is crucial that science is defended in the face of this increasing distrust and skepticism through increased awareness of topics like industry sponsorship and bias. If scientists fail to take steps that make their work more objective and transparent, academic research will be less trustworthy and accurate, further reducing public trust, the consequences of which are clearly dire.

Citations:
1. AM. Šimundić, Bias in research. Biochemia Medica 23, 12-15 (2013). doi: 10.11613/BM.2013.003

2. C.J. Panucci and E.G. Wilkins, Identifying and avoiding bias in research. Plastic Reconstructive Surgery 126, 619-625 (2011). doi: 10.1097/PRS.0b013e3181de24bc

3. A. Fabbri, et al. The Influence of Industry Sponsorship on the Research Agenda: A Scoping Review. American Journal of Public Health 108, e9-e16 (2018). doi: 10.2105/AJPH.2018.304677

4. A.M. Brandt, Inventing conflicts of interest: a history of tobacco industry tactics. American Journal of Public Health 102, 63-71 (2012). doi: 10.2105/AJPH.2011.300292

5. L.A. Bero, Tobacco industry manipulation of research. Public Health Reports 120, 200-208 (2005). doi: 10.1177/003335490512000215

6. E.K. Tong and S.A. Glantz, Tobacco industry efforts undermining evidence linking secondhand smoke with cardiovascular disease. Circulation 166, 1845-1854 (2007). doi: 10.1161/CIRCULATIONAHA.107.715888

7. C.S. Webster, et al. Social bias, discrimination and inequity in healthcare: mechanisms, implications and recommendations. BJA Education 22, 131-137 (2022). doi: 10.1016/j.bjae.2021.11.011

8. P. Uppal, et al. The Case Against Race-Based GFR. Delaware Journal of Public Health 8, 86-89 (2022). doi: 10.32481/djph.2022.08.014

9. A.S. Levey, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Annals of Internal Medicine 130, 461-470 (1999). doi: 10.7326/0003-4819-130-6-199903160-00002

10. Cardiology’s problem women. The Lancet 393, 959 (2019). doi: 10.1016/S0140-6736(19)30510-0

11. N.R. Cook, et al. Self-Selected Posttrial Aspirin Use and Subsequent Cardiovascular Disease and Mortality in the Physicians’ Health Study. Archives of Internal Medicine 160, 921-928 (2000). doi: 10.1001/archinte.160.7.921

12. N.R. Aggarwal, et al. Sex Differences in Ischemic Heart Disease: Advances, Obstacles, and Next Steps. Circulation: Cardiovascular Quality and Outcomes 11, e004437 (2018). doi: 10.1161/CIRCOUTCOMES.117.004437

13. N. Reza, et al. Representation of women in heart failure clinical trials: Barriers to enrollment and strategies to close the gap. American Heart Journal Plus 13, 100093 (2022). doi: 10.1016/j.ahjo.2022.100093

14. P. Boyle, Why do so many American distrust science? Association of American Medical Colleges (2022). Link: https://www.aamc.org/news/why-do-so-many-americans-distrust-science