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Table 1.  Research Article Funding Sources Included in US Preventive Services Task Force Systematic Reviews, 2014-2016
Research Article Funding Sources Included in US Preventive Services Task Force Systematic Reviews, 2014-2016
Table 2.  Countries of Origin for Research Article Funding Sources Included in US Preventive Services Task Force Systematic Reviews, 2014–2016a
Countries of Origin for Research Article Funding Sources Included in US Preventive Services Task Force Systematic Reviews, 2014–2016a
1.
US Preventive Services Task Force.  About the USPSTF. https://www.uspreventiveservicestaskforce.org/Page/Name/about-the-uspstf. Accessed February 16, 2018.
2.
Krist  AH, Wolff  TA, Jonas  DE,  et al.  Update on the methods of the US Preventive Services Task Force: methods for understanding certainty and net benefit when making recommendations.  Am J Prev Med. 2018;54(1S1):S11-S18. PubMedGoogle ScholarCrossref
3.
US Preventive Services Task Force.  Published recommendations. https://www.uspreventiveservicestaskforce.org/BrowseRec/Index. Accessed February 16, 2018.
4.
Kesselheim  AS, Robertson  CT, Myers  JA,  et al.  A randomized study of how physicians interpret research funding disclosures.  N Engl J Med. 2012;367(12):1119-1127.PubMedGoogle ScholarCrossref
Research Letter
May 22/29, 2018

Sources of Funding for Research in Evidence Reviews That Inform Recommendations of the US Preventive Services Task Force

Author Affiliations
  • 1Office of Disease Prevention, National Institutes of Health, Rockville, Maryland
  • 2Agency for Healthcare Research and Quality, Rockville, Maryland
JAMA. 2018;319(20):2132-2133. doi:10.1001/jama.2018.5404

The US Preventive Services Task Force (USPSTF) is an independent panel of national experts in disease prevention and evidence-based medicine that develops recommendations for the delivery of clinical preventive services including screening tests, preventive medications, and behavioral counseling.1 To develop recommendations, the USPSTF evaluates the quantity, quality, and strength of evidence from systematic reviews of published studies.2

It is important that high-quality research studies on prevention and screening compose the evidence base for the USPSTF, and that funders of these studies are unbiased. However, little is known about the funders of these studies. This study characterizes the sources of funding for the scientific evidence base used by the USPSTF.

Methods

We identified recommendation topics issued by the USPSTF from January 2014 through February 2016.3 We examined the funding sources acknowledged in each research article that met inclusion criteria for the systematic evidence reviews underlying these USPSTF recommendations. We classified each source into 1 of 4 funding categories: government, industry, nonprofit or university, and unknown. Because the research articles often listed multiple sources of funding and we counted each source, totals may sum to greater than 100%. The funding categories were further analyzed to determine which government agencies and organizations were the most frequently mentioned funders. We also categorized each funding source by country of origin. When funding was identified from a multinational organization (eg, a large pharmaceutical company), it was assigned to the country in which the main headquarters was located, unless additional details were provided that noted a different location.

Results

Twenty-five recommendation topics covering a broad range of clinical preventive services were released during the 2-year study period. The systematic reviews for these topics synthesized a total of 1650 research articles (Table 1), with a median of 55 (interquartile range, 58). One or more funding sources were identified for 79% of the research articles. Government agencies provided support for 931 articles (56%). The remaining support came from nonprofits or universities (530 articles, 32%) and industry (282 articles, 17%). The sources of funding varied by recommendation topic; for example, behavioral counseling for sexually transmitted infections had the highest proportion of government funding (91%), whereas screening for chlamydia and gonorrhea had the highest proportion of industry funding (75%). The sources of funding originated from 37 countries with 640 articles (39%) supported by US-based funders (Table 2). The National Institutes of Health (NIH) was the single largest contributor (420 articles, 25%). The next largest funders were the United Kingdom’s Medical Research Council (48 articles, 3%), the US Centers for Disease Control and Prevention (39 articles, 2%), Australia’s National Health and Medical Research Council (37 articles, 2%), the United Kingdom’s National Health Service Research and Development Programme (36 articles, 2%), and the Netherlands Organisation for Health Research and Development (35 articles, 2%).

Discussion

The USPSTF considered scientific evidence supported by a broad range of funders in making recommendations for clinical preventive services. Government agencies worldwide provided funding for most of the research articles, with the NIH being the largest funder. This finding is important because physicians may view certain funders (ie, industry) as less credible than others (ie, NIH).4

Many of the research articles were supported by governments and organizations outside of the United States. Although the preventive services evidence base includes many high-quality studies conducted in the United States, there are well-designed clinical and epidemiologic studies carried out abroad that further enhance it.

Because this study identified funding sources from research articles as opposed to research studies, the results may overestimate the contributions of funders that supported large studies with results reported in more than 1 scientific article included in the systematic reviews. Another limitation is missing data: 21% of the articles reviewed did not identify any funding source, potentially lessening the precision of the estimates of funding support.

Future studies should investigate the sources of funding for the evidence base of other national clinical guidelines.

Section Editor: Jody W. Zylke, MD, Deputy Editor.
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Article Information

Accepted for Publication: April 4, 2018.

Corresponding Author: Jennifer Villani, PhD, MPH, Office of Disease Prevention, National Institutes of Health, 6100 Executive Blvd, Ste 2B03, Rockville, MD 20892 (villani@nih.gov).

Author Contributions: Dr Villani had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Villani, Ngo-Metzger, Vincent.

Drafting of the manuscript: Villani, Ngo-Metzger.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Villani, Vincent.

Administrative, technical, or material support: Vincent.

Supervision: Villani, Klabunde.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. The Agency for Healthcare Research and Quality (AHRQ) supports the US Preventive Services Task Force. No other disclosures were reported.

Disclaimer: The views expressed in this article are solely the opinions of the authors and do not necessarily reflect the official policies of the US Department of Health and Human Services, the National Institutes of Health (NIH), or AHRQ; nor does mention of the department or agency imply endorsement by the US government.

Additional Contributions: We thank the AHRQ and the Evidence-based Practice Centers at Kaiser Permanente, RTI International—University of North Carolina, Pacific Northwest/Oregon Health and Science University, University of Alberta, and Vanderbilt for providing full citations of research articles; Elizabeth Neilson, PhD, MPH, MSN, Kathryn Koczot, and David Tilley, MPH, MS, CPH (all from NIH Office of Disease Prevention), for assistance with study design, data collection and cleaning, and analytic advice, respectively. Their assistance was provided as part of their official duties in the NIH Office of Disease Prevention.

Additional Information: NIH staff led the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References
1.
US Preventive Services Task Force.  About the USPSTF. https://www.uspreventiveservicestaskforce.org/Page/Name/about-the-uspstf. Accessed February 16, 2018.
2.
Krist  AH, Wolff  TA, Jonas  DE,  et al.  Update on the methods of the US Preventive Services Task Force: methods for understanding certainty and net benefit when making recommendations.  Am J Prev Med. 2018;54(1S1):S11-S18. PubMedGoogle ScholarCrossref
3.
US Preventive Services Task Force.  Published recommendations. https://www.uspreventiveservicestaskforce.org/BrowseRec/Index. Accessed February 16, 2018.
4.
Kesselheim  AS, Robertson  CT, Myers  JA,  et al.  A randomized study of how physicians interpret research funding disclosures.  N Engl J Med. 2012;367(12):1119-1127.PubMedGoogle ScholarCrossref
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