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.

Who Checks Facts Anymore?

Over 4 years ago, a New York Times editorial lovingly endorsed an opinion piece published by JAMA (HERE) decrying medical product promotion to physicians working in academic health centers.  The authors of the critical JAMA piece relied on one previously published literature review (HERE) which they alleged had found “overwhelming negative effects on clinical care” resulting from the pharmaceutical industry’s interactions with physicians. Remarkably, the cited review article explicitly stated that none of the studies reviewed had even attempted to measure the impact of interactions on clinical care. This is major misinterpretation of published research. Yet the authors have not corrected their error, nor has the New York Times called for their doing so. 

And the Times has done it again in an editorial entitled “Cleaning up medical advice.” (May 1, 2010). Some of the same authors from the original falsified JAMA article, defined uncritically by the editorial as “experts” (a topic for another post), had published a follow up piece in the same journal (HERE), extending their complaints to medical product industry’s financial support of medial professional organizations.  They recommended markedly reducing and eventually eliminating commercial support of such societies.  The Times provides a megaphone to tout the recommendation of these “experts” based on the theoretical contention that commercial support of medical education results in inappropriately biased information.  This conjecture has been proven false.  Four studies published HERE, HERE, HERE, and HERE in the past year surveying hundreds of thousands of physicians participating in education events reported strikingly low perceptions of bias due to commercial sponsorship. 

And more importantly, the “experts” downplay, and the Times totally ignored, the positive and indeed necessary contribution industry funding makes to the educational activities of professional societies.  They fixate on the false idea that the interests of physicians and of the companies that provide them with powerful tools are not closely aligned – to promote longevity, reduce pain and improve quality of life. 

The Times should not accept as fact, conjectural opinions. The evidence is out there. The Times should check the facts before giving advice to the nation’s medical societies ... maybe it's the Times that needs to “clean up” its advice?