{"id":43731,"date":"2014-02-07T11:29:50","date_gmt":"2014-02-07T16:29:50","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=43731"},"modified":"2014-02-07T13:52:29","modified_gmt":"2014-02-07T18:52:29","slug":"a-patch-of-blue-3","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2014\/02\/07\/a-patch-of-blue-3\/","title":{"rendered":"a patch of blue…"},"content":{"rendered":"
"I’m a kind of paranoiac in reverse. I suspect people of plotting to make me happy."<\/em><\/font><\/div>\n
Raise High the Roof Beam, Carpenters [1955], J. D. Salinger<\/font><\/div>\n

The last five years of writing about the misadventures of the pharmaceutical industry and the contingency of cooperating KOLs in academic psychiatry and elsewhere have taken something away from my world view. I’ve more or less lived my life walking on the sunny side of the middle of the street, but the steady diet of jury-rigged, ghost written clinical trials and beyond questionable marketing practices abetted by a subset of physicians who should be my mentors and colleagues has taken its toll. It wouldn’t be fair to say I’m diagnosable as fully paranoid, but the skepticism nuclei on my MRI are bilaterally enlarged and my trust circuits have some early atrophic changes. Thankfully, I’m still capable of hope, and last night, I got a much needed reminder of what that feels like.<\/p>\n

Last Friday, I read the news report<\/a> that Johnson & Johnson had contracted with the Yale University Open Data Access [YODA] Project<\/a> to officiate access to the raw data on their clinical trials, past and present, and flagged it for further study [a placemarker…<\/a>]. It was enthusiastically announced as a game-changer on the AllTrials<\/a><\/font> web site<\/a> as well. Then on Sunday, there was a New York Times Op-Ed piece [Give the Data to the People<\/a>] by Yale’s Dr. Harlan Krumholz of the YODA Project. It was all happy talk, but there was a piece that bothered me. And I’ll admit up front that after sitting through the J&J TMAP Trial in Texas in January 2012 and reading all the trial exhibits, J&J had a big place in my skepticism scanner. The part that bothered me is in my post about it [reassure us…<\/a>]:<\/div>\n
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The pharmaceutical companies have insisted on talking about what I call Data Transparency as if it is a synonym for Data Sharing. It’s not. Data Sharing is a magnanimous act on the part of the company to allow other researchers access to the data from their clinical trials for further research for the good of mankind. I’m all in favor of the good of mankind, but that’s not what I’m interested in here. I want us [some us] to be able to check their work independently starting from the same place they do – the instant the blind on a clinical trial is broken – the raw data itself. And the reason I want to do that is the outrageous record they have for cheating in the way they handle that raw data…<\/div>\n<\/blockquote>\n
I wanted reassurance that keeping them honest would be considered a research project. In going over countless clinical trials, the funny business hasn’t been in the trial itself, it has been in what happens once the blind was broken and the raw data was available. The creative license in presenting the data in published articles has been beyond impressive. So I said:<\/div>\n
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We need some recognition that our goal is considered a research topic – namely, "Are they telling the truth in the published paper or are they presenting the data in a way that misleads the reader [like so many have done before]? Are they withholding data to make their drug look more efficacious or safer than it really is [like so many have done before]?" Putting the "re" in research!<\/div>\n<\/blockquote>\n
And I sent my blog post to Dr. Krumholz. The first encouragement was that he answered at all. I’m not used to that. He asked that I clarify my question. So I did ["Would your program consider checking the authors’ analysis based on their submitted protocol an acceptable research question?<\/em>"]. And he answered promptly:<\/div>\n
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They have relinquished control over the data release to us, by contract. So it is up to us to put in place the right process. If you have many questions then you can submit many proposals. I don’t see us rejecting requests that might be about replicating results. JNJ knows that – it was part of our discussion with them – and they still signed the contract. I cannot speak for past actions – but they signed over this authority to us. I think that given this action, JNJ deserves the benefit of the doubt.<\/font><\/strong><\/div>\n<\/blockquote>\n
I couldn’t have hoped for a more direct answer than that. The data itself is to be in the hands of YODA, and they would see replicating results as an acceptable research question. That is<\/u> Data Transparency<\/font>. They reserve the right to insist on a qualified team that agrees to stick to the submitted question. Those are expectable hoops and within their right to request.<\/div>\n

The great fear in the pharmaceutical companies’ offers to come around and relinquish their claim of proprietary ownership of clinical trial data is a Trojan Horse scenario. And that was my fear here. The Trojan Horse was something that looked like a gift, or a concession, but turned out to be a trick. In this case, it would be turning down access because the "research question" wasn’t some new research project, but just to "replicate" results, or in the case of an unpublished study, find out what the results were in the first place. The title of my post was "reassure us," and he did. Of course, the real test will come when the system is in place and someone asks for access to vet a study. All we can do is wait for that day and see what happens. But for the moment, I’m well pleased with Dr. Krumholz’s response. Like Salinger’s Seymour in my opening quote, the universe is plotting to make me happy [or at least, hopeful].<\/p>\n

And Dr. Krumholz has credentials that add credibility to his response:<\/div>\n
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What have we learnt from Vioxx?<\/a><\/div>\n
by Harlan M Krumholz<\/font><\/strong>, Joseph S Ross,  Amos H Presler, and David S Egilman.<\/div>\n
British Medical Journal<\/font><\/strong>. 2007 334:120.<\/div>\n
[full text on-line<\/a>]<\/div>\n

Rofecoxib [Vioxx] was introduced by Merck in 1999 as an effective, safer alternative to non-steroidal anti-inflammatory drugs for the treatment of pain associated with osteoarthritis. It was subsequently found to increase the risk of cardiovascular disease and withdrawn from the worldwide market. Merck now faces legal claims from nearly 30 000 people who had cardiovascular events while taking the drug. The company has stated that it will fight each case, denying liability. Our recent participation in litigation at the request of plaintiffs provided a unique opportunity to thoroughly examine and reflect on much of the accumulated court documents, research, and other evidence. This story offers important lessons about how best to promote constructive collaboration between academic medicine and industry…<\/p>\n

Summary points:<\/div>\n