Why have so many smart, well-trained doctors stood by as American healthcare descended into a state of profound dysfunction? The answer lies in the gradual, nearly invisible commercial takeover of the medical "knowledge" that doctors are trained to trust. In 1981, President Ronald Reagan slashed government support of university-based medical research. Following the 1980 passage of the University and Small Business Patent Procedures Act, nonprofit institutions and their researchers were allowed to benefit financially from the discoveries made while conducting federally funded research. Over the past few decades, the drug companies have taken over most of our clinical research. In 1991, academic medical centers (AMCs)hospitals that train doctors and conduct medical research"received 80 percent of the money that industry was spending to fund clinical trials. But by 2004, the percentage of commercially funded clinical trials conducted by AMCs had fallen from 80 to just 26 percent. That ... allowed the commercial funder to own, and thus control, the data from jointly conducted research. Unbeknownst to almost all doctors, peer reviewers are not granted access to the underlying data that serves as the basis for the reported findings. The drug companies own that data and keep it confidential. Reviewers must rely on brief data summaries. Peer reviewers at even the most prestigious medical journals cannot possibly attest to the accuracy and completeness of the articles they review.