Physicians may be biased against research from poor nations

(Reuters Health) - Physicians in England appear to favor research from high-income countries over research from low-income countries, a bias that could lead to reluctance to adopt cost-saving healthcare innovations, a new study suggests.

“High-income research is disproportionately overvalued, and low-income research is undervalued,” said lead author Dr. Matthew Harris, clinical senior lecturer in public health at the Institute of Global Health Innovation, Imperial College London.

“Research from low-income countries is being discounted prematurely and unfairly,” he said in a Skype interview. “That’s a prejudice, a preconceived notion.”

Harris and his team enlisted 347 clinicians in England. The clinicians were told they would be taking a speed-reading survey, but instead of judging them on how fast they read, the researchers examined how participants evaluated the evidence and relevance of four research abstracts.

The abstracts were of similar length and complexity, the research team reports in the journal Health Affairs. Each abstract was labeled as having been written by an unnamed researcher at one of four universities. Two of the universities were in high-income countries – Harvard University in the U.S. and Freiburg University in Germany, and two were in low-income countries – the University of Addis Ababa in Ethiopia and the University of Mzuzu in Malawi.

When the abstracts were labeled as coming from Harvard or Freiburg, clinicians were more likely to rate them as relevant and to consider the study’s evidence as strong. When the same abstract was labeled as coming from the University of Addis Ababa or the University of Mzuzu, clinicians tended to rate it as weaker and less relevant.

The greatest difference in clinician ratings was a 25 percent higher rating for the relevance of a randomized trial of a cholesterol-lowering drug when the abstract was labeled as coming from Harvard or Freiburg as opposed to Addis Ababa or Mzuzu.

Dr. David Kuwayama, a vascular surgeon and professor at the University of Colorado Denver in Aurora who was not involved with the study, said it “clearly illustrates the inherent biases that all of us in academic medicine . . . share when it comes to devaluing research from outside of the U.S. and Europe.”

“If a journal publishes a groundbreaking paper from a low-income country, but we in the Western world are unwilling to value it, then we are depriving both ourselves and our patients of valuable, maybe even life-saving, medical knowledge,” he said in an email.

As a result of prejudices that the study suggests, patients and healthcare systems could be missing out on so-called frugal innovations, Harris said. One example is using a hand drill available in hardware stores in a sterilized bag to perform orthopedic surgery. England’s National Health Service could save an estimated 100 million pounds ($131 million) over five years, if it switched from orthopedic drills to hand drills in sterilized bags, Harris said.

“Many countries that have emerged from poverty are actually developing frugal innovations, doing more with less, increasing value,” he said. “We know that there are some excellent ideas arising from these settings that don’t get the attention they deserve,” he said.

Kuwayama said it would be “dangerously naive to presume that researchers in low-income countries have little to provide us.”

Walter Kukull, epidemiology professor at the University of Washington School of Public Health in Seattle who was not involved with the research, was less concerned about the bias it suggests.

“Part of the effect of the reported study could be due to a reviewer-perceived impression that a project described in the abstract either would not have the resources or recognized expertise in the country to carry out the reported research,” he said by email. “While this is regarded as a ‘bias’ in the paper, it could also go to the element of trust, thus a purposeful judgment.”

The results might have been different, Kukull noted, if study participants had read full papers, which might have reduced perceived bias. Regardless, Kukull was not convinced that the findings showed prejudice.

“As a reviewer of grants, knowing who the investigators are, what they have done and where they are located as well as their scientific environment influences outcomes substantially and probably should,” he said. “I am not as worried as their conclusion implies we should be that great research from low-income countries is being buried or rejected.”

SOURCE: Health Affairs, online November 6, 2017.