Marcia Angell MD is a well-known, respected physician, long-time editor of NEJM. So it was a bit of a shock today when Amy Romano, blogger for Lamaze International, sent me this quote:
It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.
From Drug Companies & Doctors: A Story of Corruption in The New York Review of Books, around New Year’s.
Dana Blankenhorn of the ZDNet health blog called it “a bombshell.” I couldn’t agree more. And I must say, with all the smart people in this community, why on earth haven’t we heard more about this??
And how on earth are we supposed to be empowered participatory patients if we can’t trust the world’s leading journal?
For one thing, we can have our eyes wide open about the evidence we’re supposed to trust. Get educated. Learn how to read health news reporting – including the journals. Wise up.
Think critically. It’s a fundamental part of being an empowered patient.
_____
Related reading:
No *other* conflict of interest, huh? (11/08)
Negative data on Seroquel suppressed by manufacturer (2/09)
Dr. Reuben deeply regrets that this happened (3/09)
Dave,this is where online support groups/communities are so important. The collective minds and experiences so many help analyze the credibility of said articles/research. The Cushing’s community at Cushing’s Help and it’s message boards are amazingly critical of all research (positively and negatively). And since we read so much of it, we can point out where there are contradictions among the research.
I like what one of the comments said recently at my blog:
This is sad but I’m sure we have not heard the end of it yet. I had the opportunity to interview Dr. Erika Schwartz who blew the doors open on Wyeth/Schering with Premarin. It took years but finally the unsealing of the documents about the ghostwriters and what was written and this was just recent.
Everybody remembers the warning that came out about the drug creating breast cancer, and as it was called in history, the greatest experiment on women in history. At the end of WW2 Shering was so corrupt the Roosevelt ordered all their US companies seized and put under government control and then years later to our disappointment, the marketing with ghostwriters.
Dr. Schwartz has spoken at Harvard over this issue and wants numbers and stats run on how many women on Premarin developed breast cancer versus other therapies, and we still can’t get them!
http://ducknetweb.blogspot.com/2009/07/premarinprempro-ghostwriting-judge.html
They just lost another case and the product is still on the market.
http://ducknetweb.blogspot.com/2009/09/wyeth-loses-court-case-prempro-caused.html
So yes it is sad when we can’t rely on the journals and that goodness we have doctors like Dr. Schwartz and others who pursue this and help get the truth out there. Amazing that the documents were sealed for so many years and yet the publications were published for years too.
Wyeth was not alone, Merck and others had their share of ghostwriters too.
A bombshell indeed. I’ve been communicating to birth professionals and parents about research for five years now, and it seems the job just keeps getting harder. When “evidence-based practice” became the dogma, people advocating for better, safer birth practices were elated because we knew research was on our side. But time and again, a deeply flawed, seriously biased study has come along and shaped policies and practices despite the flaws and limitations. What’s more, the prominence of systematic reviews separates the reader from the original study and packages the study together with a bunch of other (often flawed, biased) studies and presents it as the pinnacle of the evidence pyramid and absolute “truth”. And the existence of a systematic review often stops the progress of research in that field, because the case is closed. (The truth has been revealed.)
Even if you *do* have the skills and access to critically analyze a study, it’s quite a task to apply that analysis to the whole body of literature on a topic and/or to determine the methodological rigor of a systematic review. I know because I’ve done it a number of times for my blog and my forthcoming book, and its often a days-long process, something few providers and patients are likely to undertake on their own.
And FWIW, many studies in maternity care are junk even if they’re not drug trials. So it’s not just big pharma that we have to point fingers at.
Of course, there are many studies that are methodologically strong and plenty of reason to keep on reading and writing about research. And there is often as much to learn from a bad study as from a good one, especially if you have the means to critically analyze it (or have a friendly blogger willing to do it on your behalf! :)
One of the things that concerns me about e-patitientism (which I firmly believe in) is that it currently seems to require a level of knowledge and sophistication that the vast majority of the U.S. population lacks because of our abysmal educational system. We e-patients are only the tip of an iceberg — what can we do to help the vast majority of potential e-patients who are under water in terms of health literacy, technology know-how and access, etc.?
Sorry, mis-typed “e-patientism”
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The Twitter account for the new Journal of Participatory Medicine, @JourPM, tweeted these additions today, about Richard Smith’s article in the first edition of the Journal:
“R.Smith (BMJ) concurs w/M.Angell (NEJM) in launch of J. Partic Med: ‘most of what appears in peer reviewed journals is scientifically weak'”
“Peer review must be job of the many rather than the few. This must, indeed, be part of participatory medicine’s philosophy. R. Smith”
(Smith was editor of British Medical Journal for 25 years.)
The first edition of the Journal will go live (online) next week. Subscribe/register (free, open access) here.
I could not agree more.
I entered this field a couple of years ago with, like most people, a blind faith in the scientific probity and wisdom of the medical community. It seems that I am everyday confronted with conclusions based on insufficient evidence, often biased by vested interests, and a resistance to measuring what actually works and what does not. With open communications a consumer backlash is inevitable in my opinion. We had better start measuring things properly and fast.
Drugs are supposed to be safe and effective.
Hi, new member here.
I read through Ms. Angell’s article, but came away with something different. She doesn’t really review the books, but instead summarizes some key points that support the nearly universal idea that Big Pharma is corrupt. Then towards the end she also includes, “physicians, medical schools, and professional organizations…” as all guilty of wrongdoing along with the drug companies. While I don’t dispute any of that, I do see a glaring omission from the list of guilty parties: The medical publishing industry.
Her headline-grabbing quote is that it’s “no longer possible to believe much of the clinical research that is PUBLISHED…”
And there is the key word. Published.
Here’s the way I see it. Research needs to get published to be considered valid. The act of publishing confers validity and authority to the research. Therefore it is the publisher that legitimizes the research. And who makes the decisions about what submitted research gets published? The editors. People just like Ms. Angell.
The medical media are our trusted gatekeepers of medical knowledge. Is it not the medical media’s responsibility to publish accurate information? If they can NOT be trusted to do that, then what is the purpose of their existence? Put another way, how are we, as believers in Participatory Medicine, going to save our lives and the lives of our loved ones, if we cannot believe the articles that these prestigious medical journals deign to publish and legitimize?
Again, I’m new here and in no position to start throwing stones. But I have 20 years experience in the media business (and five years experience managing my wife’s cancer healthcare). Publishing and producing medical information is a very big business, and I’m pretty sure that medical information workers are just as human as other healthcare workers. So head’s up!
The legitimacy of the medical information delivery system is a critical topic that we would be ill-advised to ignore.