1 Boring Old Man

Why I Shouldn’t Read Non-Systematic Review Articles:
Special Pleadings and Undercover Authors
Healthcare Renewal
by Dr. Roy Poses
12/16/2010

… it is time for a reexamination of the clinical evidence for the use of β blockers in hypertension, recognizing that there are patients for whom β blockers, particularly those with vasodilatory actions, are an appropriate treatment option.

Dr. Poses then looked at the logic of the article. First, it references studies that compare β-blockers [often combined with diurectics] against other anti-hypertensives that raised questions of metabolic consequences with the β-blockers. Then, it looks at studies comparing  vasodilating β-blockers [not included in the first group of studies] to placebo that do not report metabolic consequences. Ergo vasodilating β-blockers are better[?]. Poses points out the logical fallacy – Special Pleading [see Nizkor: Logical Fallacies].

II. SUSPICIOUS LOGIC: In this case, apples are compared to oranges – and the conclusion that oranges are better does not follow from the specific comparison

I would like to thank Tamalette Loh, ProEd Communications, Inc. [Beachwood, Ohio], for her editorial assistance and literature validation in the preparation of this report.

Editorial assistance, specifically revisions to the final draft, was provided by Tamalette Loh, PhD, at ProEd Communications, Inc.®, whose services were also funded by GlaxoSmithKline. Dr Loh’s revisions were reviewed and approved by Dr McGill.

Dr Ram is in the speakers’ bureau pool of Cogenix, ProCom, and Genesis, which manage medical education programs for Bristol-Myers Squibb, GlaxoSmithKline, and Novartis.

The series of articles above demonstrated a phenomenon I have not seen explored before. All articles were written with some sort of assistance from an employee of a MECC, perhaps partly funded by a company which marketed a drug which was the subject of all the articles. The assistance was openly acknowledged.  The three articles had some remarkable similarities not explained by an overlap among their listed authors.  This suggested that the ostensible editorial assistant they had in common was substantively involved in the content of the papers, that is, was truly an author. Her presence was not ghost-like. However, the substance of her contribution may have been downplayed.  So let’s call her an "undercover author"  [If someone has a better term, please leave a comment to that effect]…

So the reasons I rarely read narrative review articles except to make teaching points about health care dysfunction are:
•They often are based on idiosyncratic, if not biased selections of data
•They may employ logical fallacies to make their points
•They may be written by people with conflicts of interest, that is, with financial arrangements with companies seeking to market products, particularly drugs and devices.

^{Shortcut: Dr. Ram is listed as being paid $55,300.00 by GSK this year in Propublica‘s database. Dr. Poses comes up clean. No surprises there…}

Poses suggests that we just don’t read narrative reviews because they’re likely to be industry driven. Unfortunately, the "we" that his writings might reach isn’t the "we" that matters – those busy doctors conscientious enough to want to keep up but too busy to take the time to parse articles with this kind of thoroughness and/or read the primary studies. Seems to me that a better approach would be to hound the Journals to stop publishing tainted literature like this. Tamalette Loh of ProEd Communications obviously specializes in anti-hypertensive drugs. Maybe her argument is even right, who knows? But she could publish under her own name in the GSK handouts – then we could evaluate her argument fairly.

So let’s call her an "undercover author"  [If someone has a better term, please leave a comment to that effect]…