{"id":28983,"date":"2012-10-15T22:55:15","date_gmt":"2012-10-16T02:55:15","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=28983"},"modified":"2012-10-15T23:59:01","modified_gmt":"2012-10-16T03:59:01","slug":"crisis-of-confidence","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2012\/10\/15\/crisis-of-confidence\/","title":{"rendered":"crisis of confidence&#8230;"},"content":{"rendered":"\n<ul>\n<div><strong><font color=\"#990000\">New England Journal of Medicine<\/font><\/strong><\/div>\n<li>\n<div><sup>September 20, 2012:<\/sup><\/div>\n<div><a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMsa1202397\" target=\"_blank\"><u><strong><font color=\"#200020\">A Randomized Study of How Physicians Interpret Research Funding Disclosures<\/font><\/strong><\/u><\/a><\/div>\n<\/li>\n<li>\n<div><sup>September 20, 2012:<\/sup><\/div>\n<div><a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMe1207121\" target=\"_self\"><u><strong><font color=\"#200020\">Believe the Data<\/font><\/strong><\/u><\/a><\/div>\n<\/li>\n<p>    <\/p>\n<div><strong><font color=\"#339966\">Hooked: Ethics, Medicine, and Pharma<\/font><\/strong><\/div>\n<li>\n<div><sup>September 27, 2012:<\/sup><\/div>\n<div><a href=\"http:\/\/brodyhooked.blogspot.com\/2012\/09\/nejm-overly-defensive-or-just-naive.html\"><u><strong><font color=\"#200020\">NEJM: Overly Defensive, or Just Naive?<\/font><\/strong><\/u><\/a><\/div>\n<\/li>\n<li>\n<div align=\"justify\"><sup>October 12, 2012:<\/sup><\/div>\n<div align=\"justify\"><a href=\"http:\/\/brodyhooked.blogspot.com\/2012\/10\/more-on-sponsorship-of-studies-in.html\"><u><strong><font color=\"#200020\">More on Sponsorship of Studies in Medical Journals<\/font><\/strong><\/u><\/a><\/div>\n<\/li>\n<\/ul>\n<div align=\"justify\">Like many of us, Dr. Brodie jumped on the recent study in the New England Journal of Medicine that Internists were very suspicious of industry sponsored studies and tended not to prescribe the recommended drugs. And Dr. Brodie thought very little of the editor&#8217;s comments that we should &quot;Believe the Data.&quot;   <\/div>\n<blockquote>\n<div align=\"justify\"><strong><sup>&#8230;the ones that I&#8217;ve shown basically tell the following story:<\/sup><\/strong><\/div>\n<ul><strong><sup>    <\/p>\n<li>\n<div align=\"justify\">Research studies paid for by industry commonly distort findings so as to favor their products.<\/div>\n<\/li>\n<li>\n<div align=\"justify\">As a rule, the journal reader cannot tell how the results have been  distorted. (As the latest entry showed, to find out what was misleading  about a study that occupies&nbsp;7 pages in a journal might require wading  through 8500 pages of data.)<\/div>\n<\/li>\n<li>\n<div align=\"justify\">These distortions occur in all medical journals and if anything are  even more prevalent in the top-tier journals. (Probably not because  these journals are badly edited, but because it&#8217;s so much more of a coup  if the company can land their research findings in those top journals.)<\/div>\n<\/li>\n<p>    <\/sup><\/strong><\/ul>\n<div align=\"justify\"><sup><strong>Bottom line &#8211; <\/strong><em><strong><font color=\"#200020\">if the reader is automatically more skeptical  of a study because it&#8217;s industry sponsored, there is good reason for  that skepticism. <\/font><\/strong><\/em><\/sup><\/div>\n<\/blockquote>\n<div align=\"justify\">But it&#8217;s Brodie&#8217;s follow-up blog post I wanted to comment on. I feel like I&#8217;ve gotten reasonably good at spotting the distortions in the industry financed articles. But I&#8217;m an old retired guy who spends periods during the day looking them over. It&#8217;s what I do these days. Sort of a hobby. When I was in practice, it&#8217;s inconceivable that I would have the time or inclination to do that. Then, I scanned the table of contents. Picked things of interest and scanned the abstracts. I only really dug in chasing a particular interest or looking for details, rather than looking for lies. I expect that&#8217;s what most doctors do. I used to just trust the literature. I read critically, but I wasn&#8217;t paranoid like I am now:<\/div>\n<blockquote>\n<div align=\"center\"><a href=\"http:\/\/brodyhooked.blogspot.com\/2012\/10\/more-on-sponsorship-of-studies-in.html\"><u><strong><font color=\"#200020\">More on Sponsorship of Studies in Medical Journals<\/font><\/strong><\/u><\/a><br \/><strong><font color=\"#339966\">Hooked: Ethics, Medicine, and Pharma<\/font><\/strong><br \/>by Howard Brodie MD PhD<br \/> October 12, 2012<\/div>\n<p><\/p>\n<div align=\"justify\"><sup><strong>Again tipping my hat to Rick Bukata and Jerry Hoffman&#8217;s Primary Care  Medical Abstracts, I come across a <a target=\"_blank\" href=\"http:\/\/www.springerlink.com\/content\/8h66774155415128\/\"><u><strong><font color=\"#200020\">study<\/font><\/strong><\/u><\/a> by Drs. Michael Hochman of UCLA  and Danny McCormick of Harvard:<\/p>\n<p>  These guys looked at several ways of reporting results that overestimate benefits:<br \/>  <\/strong><\/sup><\/div>\n<ul><sup><strong> <\/p>\n<li>\n<div align=\"justify\">Reporting relative vs. absolute risks<\/div>\n<\/li>\n<li>\n<div align=\"justify\">Reporting surrogate endpoints rather than significant changes in health<\/div>\n<\/li>\n<li>\n<div align=\"justify\">Reporting composite endpoints instead of reporting each endpoint of interest separately<\/div>\n<\/li>\n<li>\n<div align=\"justify\">Reporting only disease-specific mortality instead of all-cause mortality<\/div>\n<\/li>\n<p> <\/strong><\/sup><\/ul>\n<div align=\"justify\"><sup><strong>If people write in and request I&#8217;ll explain why each of these overestimates benefit from drugs.<\/p>\n<p>  Drs. Hochman and McCormick then compared how likely it was that a study  would report results in these ways, based on who sponsored the study.  They found significant differences in two categories. Exclusively  industry-sponsored studies were more likely than studies with at least  some non-commercial support to report surrogate endpoints (45% vs. 29%)  and disease-specific mortality (27% vs. 16%).<\/p>\n<p>  Now, if you wanted to defend the <em>NEJM <\/em>editorial position, you  could say that readers of studies can readily see how the data are  reported according to these criteria and can be wary of any study,  regardless who funds it, that reports data in the less desirable way.  But let&#8217;s give the last word to Drs. Hochman and McCormick, in their  final recommendations: <\/strong><strong><em>&quot;These findings highlight the need  for educational efforts to ensure that readers understand the  complexities of these endpoints and of relative risk reporting.&nbsp;&#8230; In  addition, Institutional Scientific Review Committees and regulatory  agencies (e.g. the FDA) must closely examine the endpoints used in  clinical trials and discourage the inappropriate use of surrogate and  composite endpoints, and endpoints involving disease-specific mortality.  Finally, medical journals may consider instituting editorial policies  mandating the reporting of results in absolute numbers.&quot;<\/em><\/strong><\/p>\n<p>  <strong>In other words, rather than asking readers to sift through whether the  results are reported in a useful and valid fashion, medical journals  like <em>NEJM<\/em> could simply refuse to publish papers that don&#8217;t  adhere to the highest standards. Of course, if they did, they might lose  revenue as drug companies would not buy so many expensive reprints of  papers that are really useful for marketing drugs &#8211; which may be one of  the&nbsp;roots of the problem.<\/strong><\/sup><\/div>\n<\/blockquote>\n<div align=\"justify\">I know journals have to support themselves. But I for one would pay more for thinner journals if the editors would act like Dr. Brodie suggests in his last paragraph. One thing that I can see in the last several years of reading these journals more thoroughly. There&#8217;s still a big problem, but  I think they&#8217;re getting better. But Dr. Brodie&#8217;s point should move up to the top of our todo list. Journals that truly vetted their articles &#8211; particularly industry financed articles &#8211; and weren&#8217;t afraid to retract the ones that slip through the cracks would make a huge dent in the current crisis of confidence about our literature. Physicians have the right to a truthful literature and the duty to insist on it&#8230;<\/div>\n","protected":false},"excerpt":{"rendered":"<p>New England Journal of Medicine September 20, 2012: A Randomized Study of How Physicians Interpret Research Funding Disclosures September 20, 2012: Believe the Data Hooked: Ethics, Medicine, and Pharma September 27, 2012: NEJM: Overly Defensive, or Just Naive? October 12, 2012: More on Sponsorship of Studies in Medical Journals Like many of us, Dr. Brodie [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-28983","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/28983","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=28983"}],"version-history":[{"count":21,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/28983\/revisions"}],"predecessor-version":[{"id":29004,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/28983\/revisions\/29004"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=28983"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=28983"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=28983"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}