Gates Foundation and Peter Pan

The COI jihadist went as far as insinuating that the Gates foundation needed extra scrutiny as it was working with industry in finding better treatments for malariaand the like. This was based on a PLoS paper suggesting extra scrutiny. When will these people stop? There should be only respect for the foundation! The root of all of their evil doing is an irrational belief that economic principles don't matter and can be circumvented. Just like Peter Pan circumvents gravity!

JAMA should take lessons in avoiding bullying

There is no doubt that the last paper in JAMA by Rothman and Chimonas (two sociologists and not physicians) represents the latest of a series of initimidation and bullying attempts at separating physicians from industry partners. It remains a puzzle why not more physicians are outraged by a McCarthysm article like this, and why JAMA allows for this to be publsihed. The problem is now greater given this is more than opinion, it is a thinly veiled threat! Read and get angry!

JAMA. 2010;304(20):2294-2295. doi: 10.1001/jama.2010.1714




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Conflct of interest and literature spin and JAMA

A recent article by Boutron and Altman in JAMA (2010, 303:2058) addressed the issue of spin in the medical literature. They stated a positive association between industry funding and a positive outcome of a publication. This is highly relevant since previous studies have shown a correlation, but no one has shown wrong doing. In fact its has been logically argued that given the massive investment of money needed for development that the private sector has to be more careful in designing trials that will allow purported benefits of new drugs or devices to be uncovered. This being imponderable the discussion can go on forever and become a chest beating exercise. However something very interesting has happened...

In the article by Boutron, they lacked a formal statistical analysis supporting their statement, and a letter to the editor by Allison and Cope (2010, 304:965) requested an analysis of "spin" and source of funding (primary methodology of their study was spin determination). They report that spin was not associated with source of funding (p value 0.6). I could spin this the Pharmascold way and say there may be a trend or spin it my way and say it not significant. We are better off just looking at the data and conclude there is no evidence that funding changes the RPMs (i.e. SPIN)!!

Conflicts of interest: Finally a formula that solves it!

It is now difficult to know what to do with the information provided in the disclosure section of journal articles.  I am puzzled as to how are we supposed to train residents and fellows into how to incorporate this information into the decision making process.  After all, we want the readers to formulate impressions about disclosures so that they attain objectivity about content.  And objectivity is about measurement.  So how is one supposed to do so?  Until now no one knew for sure.

As background I would suggest we needed a simplified statistical system for an audience who is known on occasions to struggle with stats.  For example many very smart colleagues still struggle with the significance of the p value.  Less than 0.05 Biblical!  Anything else discard immediately...  Let alone understanding a Bonferroni correction.

So to try to solve this problem I tackled a recent paper in the NEJM where C1 inhibitor deficiency is successfully treated by a new intervention (one of 3 papers in the same issue).  (Zuraw et al N Engl J Med 2010; 363:513-522August 5, 2010).  By the way congratulations to the authors on such important study.  (This comment is about the irony of disclosures not the value of their paper, which is truly outstanding).  The methods did not tell me how to account for the disclosures (Top figure).  So if you look at the results section there were 1006 words.  The disclosure text was almost as long (798 words).  There must be a way!  After many hours I took it upon myself to calculate the significance of disclosures and suggest the following formula for correction.

For the sake of providing due credit I thought about the "CANDAB correction" which is an acronym with the first letter of some of the most intense pharmascolds. (HINT:  Solving this is much simpler than my formula).  So here it is finally! Do this for every author.  X stands for the age of the author, y is the net compensation received in the last 12 months and n is the number of times they have participated in CME or consulting.  You add it all and move the p value as many decimal points as the result shows to know the truth. 

 Late breaking news: I heard JAMA will include automatic computation in their website.

Insel gets cold feet...

Trying to “back-pedal” on his support to Dr. Nemeroff, Dr. Insel, Head of The National Institute of Mental Health in Bethesda, has gone to extremes but without considering carefully the facts. A 2010 Research America poll shows that 88% of respondents favor physicians’ collaboration with industry! Yet he goes on to say that “… public’s disapproval of the physician-industry relationship is precisely why disclosure laws are so important.” (cited from Nature Biotechnology 28: 661, 2010) 

  What is the evidence for such disapproval?