Sadly, it really is about the money

New York Yankees pitcher David Wells has long been known for his appetite. Now he's known for biting the hand that feeds him.

The 39-year-old lefty, whose Ruthian physique and bacchanalian reputation have endeared him to many a beer-bellied baseball fan, made headlines during an otherwise uneventful spring training period with the publication of his tell-all book Perfect I'm not! Boomer on Beer, Brawls, Backaches and Baseball.

Before the book was even released to the general public, prepublication accounts were raising eyebrows throughout baseball, citing one passage in which Wells claimed to have been "half-drunk" while pitching a perfect game in 1998 and another in which he estimated that up to 40% of baseball players use steroids.

Had the book been published after Wells' retirement, such statements might have been dismissed as typical Boomeresque bluster or a cry for attention. But the fact that Wells chose to publish his book while under contract with the Yankees-who feel that the team's reputation is compromised by association-was enough to make even the skeptics take note.

It isn't easy to accept money from an organization, then turn around and publish information that might not be in that organization's best interests. This, unfortunately, is as true in healthcare as it is in sports. Practitioners have undoubtedly sensed that commercially sponsored studies are more likely to report positive results than nonsponsored studies-and now researchers from the Scripps Clinic in La Jolla have provided some hard numbers to document this trend (see "By the Numbers: Commercial funding of orthopedic research," page 19).

Motivated by recent recalls of hip implants, the researchers analyzed a year's worth of articles in the Journal of Arthroplasty and the Journal of Bone and Joint Surgery, plus 568 presentations from the same year, and confirmed what most of us have suspected all along: commercially sponsored research is almost never published or presented if the findings are anything but positive. When they looked at studies of hip implants specifically, 73% were commercially funded-and 94% of those reported positive results. With so few researchers willing to risk losing a source of funding by publishing negative results, it's no wonder that thousands of faulty acetabular shells or femoral heads had already been implanted before the devices' flaws were acknowledged.

And let's not pretend that this type of bias exists only in hip implant research, or only in orthopedic research. To many device or drug manufacturers, a study that reports negatively on a product can only be bad for business. Never mind that Centerpulse, formerly Sulzer Medica, paid out more than $700 million last fall to settle a class action suit filed by recipients of defective Sulzer hip and knee implants. Talk about bad for business.

The Scripps Clinic researchers, who presented their results in February at the annual meeting of the American Academy of Orthopedic Surgeons, suggested that the academy could play more of a watchdog role in monitoring the commercially funded studies selected for publication or presentation. At the very least, all practitioners should make themselves aware of just who is paying for the research on which they base their clinical decisions.

The Yankees fined David Wells $100,000 for tarnishing the team's image through the publication of his book. Wells, who makes $3 million per year, can afford it. Researchers who depend on manufacturers for funding may not feel that they can afford to risk a punishment of such magnitude. But unfortunately, it seems that risks not taken by researchers are risks that are passed on to patients.