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When reading scientific studies, a couple things should be kept in mind:
"Peer review" depends on who is doing the reviewing-- a reviewer solidly entrenched in the "consensus" is having his reputation invalidated if he allows a paper to be published that goes against the consensus. How altruistic do you expect him to be?
It's not bad that drug companies pay for research and then publish the studies that help them out. The problem comes when they don't publish a study that doesn't support their product.
Beware of papers that report "Relative Risk "-- that's a way of cheating to make a single digit result look like a double digit (more impressive) result. Check the Absolute Risk Reduction....NEJM just reported a study that made the headlines about risk of breast cancer in those using BCP. They reported a "38%" increase in risk. It turns out that they found 58 Ca cases for every 100,000 woman-yrs of BCP compared to only 55/100,000 for non-users. BFD. There's a difference between statistical significance and clinical (ie- practical) significance.
Caveat lector.
If you torture the numbers long enough, you can get them to confess to anything.
Except that's not how "peer review" works....
Peer reviewers, for the most part are anonymous....
I serve as a peer reviewer for several journals. I don't worry about my "reputation being invalidated" whatever that word salad is meant to indicate...
As a "peer reviewer" it isn't up to me decide if a paper is going to be published or not regardless, THAT decision lies with the editorial staff of the journal...I am asked for recommendations on whether or not to publish but I don't withhold that recommendation if I think the authors have met the standard of the journal regardless of my "reputation"
Your interpretation of Absolute Risk Reduction vs Relative Risk Reduction is similarly misguided and erroneous.
ARR and RR BOTH give meaningful but DIFFERENT information related to how one interprets results of studies, they are apples and oranges and are not meant to convey the SAME information
Well I got down to the section discussing ibuprofen and aspirin and Celebrex and Vioxx...my eyes were getting buggy so I have to stop there.
Seeing the many drug pushers that come and go from a doctors office (dressed in their fine clothes and expensive suitcases) has always really bothered me.
I've always felt that giving perks to docs that buy and push your products (usually drugs) was very wrong.
All scientists who write papers on which drug or treatment works best should absolutely have to disclose any conflict of interest. I'd want to know if they were making money off the product, and especially if they held interests in the drug company. That to me would make any papers they write suspect.
I don't think things will ever change though as soooo many of us think doctors know all...that they could never put their financial interests over the safety and betterment of their patients.
It's of utmost importance that we (as patients) research and decide what WE think is best for us...we have to be our own best advocates.
Seeing the many drug pushers that come and go from a doctors office (dressed in their fine clothes and expensive suitcases) has always really bothered me.
I've always felt that giving perks to docs that buy and push your products (usually drugs) was very wrong.
All scientists who write papers on which drug or treatment works best should absolutely have to disclose any conflict of interest. I'd want to know if they were making money off the product, and especially if they held interests in the drug company. That to me would make any papers they write suspect.
I don't think things will ever change though as soooo many of us think doctors know all...that they could never put their financial interests over the safety and betterment of their patients.
It's of utmost importance that we (as patients) research and decide what WE think is best for us...we have to be our own best advocates.
True I've seen this reps in their fine wears and suitcases full of samples and all when I've gone to conventional MD's offices. Not in the integrative MD's offices that I go to.
Sadly, pathetically it's come to Profits before People all since this huge medical explosion of the 70's on.
Never was this the case in my folks' lives...doctors were there for their patients as best they could be and money was not their big focus. No one is in business to the fun of it, it's work and they need to be paid, BUT...
I know life has changed and I don't go thru life with rose colored glasses on.
Seeing the many drug pushers that come and go from a doctors office (dressed in their fine clothes and expensive suitcases) has always really bothered me. I've always felt that giving perks to docs that buy and push your products (usually drugs) was very wrong.
All scientists who write papers on which drug or treatment works best should absolutely have to disclose any conflict of interest. I'd want to know if they were making money off the product, and especially if they held interests in the drug company. That to me would make any papers they write suspect.
I don't think things will ever change though as soooo many of us think doctors know all...that they could never put their financial interests over the safety and betterment of their patients.
It's of utmost importance that we (as patients) research and decide what WE think is best for us...we have to be our own best advocates.
One of my daughters is in the medical field and works in a retinal surgery practice (she's not an MD). She's been in the med field for years and has worked in several specialty practices.
BUT - she's the first to tell you how the pharma / doctor relationship rolls. One rep will call in ahead of his visit and take a latte order for everyone in the office. This can be as many as 30 employees - all 'gifted' with a hot beverage and a luscious tray of pastries. Another rep caters lunch for the entire office - and not the cheap Safeway sandwich tray. He treats everyone to a hot buffet delivered by a local catering company. Docs within any practice she's worked for receive theater tickets, sports tickets and, for the really 'special' customers, they get invites to conferences in lovely tropical climates as 'guest speakers'.
Ever notice all of those little pharma samples your doctor hands out to you? Why some and not others? Then you go to purchase the product and find out - surprise - it's new on the market. Kick-backs anyone?
And BTW, I've also known (former) pharma reps that verify much of this from their end. Certain docs are their preferred customers and they have been trained to 'work' them royally...
If you torture the numbers long enough, you can get them to confess to anything.
I had never heard that before, and it is brilliant.
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Everyone has their opinions, beliefs etc etc and even in the great religious leaders in the world....billions of sheepole and I was one for the first part of my life and then I had time to start thinking for myself more and more.
Well I got down to the section discussing ibuprofen and aspirin and Celebrex and Vioxx...my eyes were getting buggy so I have to stop there.
Don't have much time--got to leave for work soon--but I got that the basic intent of the article was to point out the financial incentive researchers have to make the products from which they receive the incentive look good in their research (show some kind of "clinical benefit"). The articles publishing the studies don't want to disclose this information because they want the readers to believe that what is being published in their journals is the closest to the absolute truth as you can get. When, however, there is no such thing--because of that ubiquitous thing called bias.
You can't get away from it. It's always there. It's the huge problem I have with doctors who just want to go by the books. Well, you can't do that folks. What the books say is right is not always going to be what works for the patient. It's a good guideline, no doubt. It's a good thing to try first since there's more evidence that points in that direction. But always--ALWAYS--go by what you see in the PATIENT, what he or she tells you, not numbers or what this study showed or that guideline tells you what to do next. It's not always going to work out that way in practice.
Don't have much time--got to leave for work soon--but I got that the basic intent of the article was to point out the financial incentive researchers have to make the products from which they receive the incentive look good in their research (show some kind of "clinical benefit"). The articles publishing the studies don't want to disclose this information because they want the readers to believe that what is being published in their journals is the closest to the absolute truth as you can get. When, however, there is no such thing--because of that ubiquitous thing called bias.
You can't get away from it. It's always there. It's the huge problem I have with doctors who just want to go by the books. Well, you can't do that folks. What the books say is right is not always going to be what works for the patient. It's a good guideline, no doubt. It's a good thing to try first since there's more evidence that points in that direction. But always--ALWAYS--go by what you see in the PATIENT, what he or she tells you, not numbers or what this study showed or that guideline tells you what to do next. It's not always going to work out that way in practice.
Researchers these days must disclose potential conflicts of interest. The reader then must evaluate the content of the publication to see if there is real bias and a real conflict of interest, not just a potential one. If studies by multiple researchers from different institutions support the same conclusions, the only way the conclusion could be biased by a conflict of interest would be the existence of a conspiracy.
The thing is that doctors sometimes do things without evidence showing that what they think works best actually does work best.
That is why there has been a shift to guidelines that can be supported by evidence, and that evidence is never the result of a single study.
Treatment needs to be individualized, but that most often happens because a patient cannot tolerate a drug, say due to allergy or side effects. Unfortunately, sometimes it is due to cost, though many drug companies have patient assistance plans. Also, insurance companies often make treatment decisions by refusing coverage.
None of that invalidates the guidelines. Guidelines are just that. They support treatment goals, but not all patients will be able to reach those goals. Docs do the best they can.
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