The Ethical Nag

It may seem to the casual observer that the U.K.’s Great Oxford Debate (held in September at Oxford University and covered last month in the British Medical Journal) resembled a fight between the fox and the farmer over which one of them should be in charge of the henhouse. In one corner, wearing the red silk shorts, you had physician, activist and Bad Science blogger Dr. Ben Goldacre, who argues that the financial interests of a drug company lead to distorted clinical evidence when they run research trials on their own drugs.  In this corner, in the shiny blue Spandex, you had consultant Vincent Lawton, a veteran of decades in the drug industry, arguing that adequate safeguards already exist to keep a drug company’s research bias nicely  in check.

With the British Medical Journal refereeing the rumble, let’s tune in for Round One, led off by Vincent Lawton:

“The drug industry is sometimes accused of finding it difficult to reconcile the difference between the strict disciplines of ethical science and its responsibility to its shareholders to return a healthy profit. But clinical trials are properly managed by a rigorous system of regulatory scrutiny throughout.”  VL

Sounds convincing to me, but wait!  Dr. Ben fires back with a combination punch to the breadbasket:

“The practice of medicine is based on evidence. We need this evidence base to be complete and of the highest quality, so that we can make the right decisions. But drug companies produce most of the evidence we use. There is no doubt that these companies have a conflict of interest when they conduct drug trials: they want to sell their products, and so naturally they want a positive result from the trials they sponsor. But there is now good evidence from systematic reviews, meta-analyses, and case studies that this conflict of interest results in bad evidence, which distorts medical decision-making and so harms patients.”  BG

Good power punch, Dr. Ben – but Vincent is not yet ready to kiss the canvas:   Read more…

You know that photogenic and charming medical “expert” who is trotted out during your breakfast hour newscasts to explain the latest health buzz?  The medical miracle breakthrough that gets a full page spread in the Sunday paper? The CBS television show 60 Minutes gushing over the Kanzius cancer cure machine?  How can you tell if these news stories are on the level?

The simple answer: you can’t. ”Everytime you think you’ve seen the worst use of media coverage of health topics, something lower pops up”, claims the savvy medical journalism watchdogs over at Health News Review. 

For example, here’s how HNR evaluated a “news” story on ABC’s Good Morning America about an off-label unapproved use of laser treatment for toenail fungus. ”The advantages were unsubstantiated, the harms unstated, and the effectiveness exaggerated. Promotion of an unapproved off-label use of laser treatment that has no published study results available.  Disease mongering at its worst. Millions of us ’suffering in silence’ with toenail fungus? Gag me.”

HNR makes the following assessment of the laser treatment news story:   Read more…

There’s a simple blood test done routinely to screen men for a condition that is rarely serious.  But if your screening test happens to be positive, the resulting treatment and side effects are likely to be devastating to your day to day quality of life, and may include stress incontinence, overflow incontinence, urge incontinence, or continuous incontinence. And impotence, temporary or permanent.

Should you get this blood test done?

That’s the controversial question behind two large, randomized clinical trials this past year studying the relationship between PSA-based screening and prostate cancer mortality: The European Randomized Study of Screening for Prostate Cancer and the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial in the U.S.  According to the European study, which involved over 162,000 men between the ages of 50 and 74 in seven countries, PSA-based screening reduced the already low rate of death from prostate cancer by 20%, but was also associated with a high risk of overdiagnosis and overtreatment.

The American PLCO trial found the rate of death from prostate cancer was very low for both the 38,343 men in the group that received annual PSA-based screening and the 38,350 men in the control group who received “usual care.” The conclusion: “Screening was associated with no reduction in prostate cancer mortality.” 

‘Non-intervention’ is what urologist Dr. Anthony Horan says he was taught when he attended medical school and also during his urology residency at the Columbia Presbyterian Hospital in New York in the mid-1970s. “We didn’t go looking for the incidental cancers that were of no clinical significance,” explains the author of The Big Scare:  The Business of Prostate Cancer.  “And if we found them, we did nothing about them.”  Read more…

Caption translation for this Discovery Channel ad in the Netherlands:

NOT FOR WOMEN’S EYES

Discovery Channel has television men want to watch. Exciting, smart, interesting, adventurous, and most of all real. Watch for yourself.

I know that, as a woman, I hate smart, interesting stuff. It’s just too hard to understand and it makes my brain hurt. I try to watch TV that is stupid, boring, cautious, and totally fake.

Source: Sociological Images