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A global team of influential researchers, clinicians, regulators, and citizen advocates suggest how we can start to build an evidence base for healthcare that is free of commercial influences

Scientific research funding is allocated largely through a system of soliciting and ranking competitive grant proposals. In these competitions, the proposals themselves are not the deliverables that the funder seeks, but instead are used by the funder to screen for the most promising research ideas. Consequently, some of the funding program's impact on science is squandered because applying researchers must spend time writing proposals instead of doing science. To what extent does the community's aggregate investment in proposal preparation negate the scientific impact of the funding program? Are there alternative mechanisms for awarding funds that advance science more efficiently? We use the economic theory of contests to analyze how efficiently grant proposal competitions advance science, and compare them with recently proposed, partially randomized alternatives such as lotteries. We find that the effort researchers waste in writing proposals may be comparable to the total scientific value of the research that the funding supports, especially when only a few proposals can be funded. Moreover, when professional pressures motivate investigators to seek funding for reasons that extend beyond the value of the proposed science (e.g., promotion, prestige), the entire program can actually hamper scientific progress when the number of awards is small. We suggest that lost efficiency may be restored either by partial lotteries for funding or by funding researchers based on past scientific success instead of proposals for future work.

To map the current status of head-to-head comparative randomized evidence and to assess whether funding may impact on trial design and results. From a 50% random sample of the randomized controlled trials (RCTs) published in journals indexed in PubMed during 2011, we selected the trials with ≥100 participants, evaluating the efficacy and safety of drugs, biologics, and medical devices through a head-to-head comparison. We analyzed 319 trials. Overall, 238,386 of the 289,718 randomized subjects (82.3%) were included in the 182 trials funded by companies. Of the 182 industry-sponsored trials, only 23 had two industry sponsors and only three involved truly antagonistic comparisons. Industry-sponsored trials were larger, more commonly registered, used more frequently noninferiority/equivalence designs, had higher citation impact, and were more likely to have “favorable” results (superiority or noninferiority/equivalence for the experimental treatment) than nonindustry-sponsored trials. Industry funding [odds ratio (OR) 2.8; 95% confidence interval (CI): 1.6, 4.7] and noninferiority/equivalence designs (OR 3.2; 95% CI: 1.5, 6.6), but not sample size, were strongly associated with “favorable” findings. Fifty-five of the 57 (96.5%) industry-funded noninferiority/equivalence trials got desirable “favorable” results. The literature of head-to-head RCTs is dominated by the industry. Industry-sponsored comparative assessments systematically yield favorable results for the sponsors, even more so when noninferiority designs are involved.

Granting bodies need more data on how much they are spending on work that transcends disciplines, and to what end, explains Rick Rylance.

Advocates ask the US biomedical agency to rethink the design of its RECOVER initiative, citing possible harm and funding waste. Advocates ask the US biomedical agency to rethink the design of its RECOVER initiative, citing possible harm and funding waste. Credit: University of the Pacific Todd Davenport and Mark Van Ness in a lab testing the fitness of a study participant with breathing apparatus

Providing guidance to publicly funded authors on how to publish their work in open access journals is likely to reduce the waste of public money, say David Moher and colleagues

Organizing and accessing biomedical big data will require quite different business models, say Philip E. Bourne, Jon R. Lorsch and Eric D. Green.

Despite the effort of researchers, editors and peer reviewers, the quality of health-research reporting in journal articles is unsatisfactory.1-6 Guidelines that specify a minimum set of items for reporting can improve the accuracy and transparency of publications, thus facilitating easier and more reliable appraisal of quality and relevance. In the future, the website will also host other resources for authors of research articles, editors, peer-reviewers, and developers of guidelines, including a comprehensive digital library for health-research reporting, guidance for the development of robust reporting guidelines, tools to facilitate their use, and educational materials.

Current funding models have high risks and low accountability. Public–private partnerships offer a better way. Current funding models have high risks and low accountability. Public–private partnerships offer a better way. Credit: Michael Hill Michael Hill

The United Kingdom will be part of the world’s largest research funding scheme once more. And it’s not a moment too soon. The United Kingdom will be part of the world’s largest research funding scheme once more. And it’s not a moment too soon.