{"id":4021,"date":"2013-11-04T21:43:59","date_gmt":"2013-11-04T20:43:59","guid":{"rendered":"http:\/\/emilkirkegaard.dk\/en\/?p=4021"},"modified":"2014-10-09T18:50:17","modified_gmt":"2014-10-09T17:50:17","slug":"review-bad-pharma","status":"publish","type":"post","link":"https:\/\/emilkirkegaard.dk\/en\/2013\/11\/review-bad-pharma\/","title":{"rendered":"Review: Bad Pharma"},"content":{"rendered":"

https:\/\/www.goodreads.com\/book\/similar\/19171192-bad-pharma-how-drug-companies-mislead-doctors-and-harm-patients<\/p>\n

http:\/\/lib.free-college.org\/view.php?id=864114<\/p>\n

 <\/p>\n

Having already read Peter G\u00f8tzsche’s D\u00f8delig medicin og organiseret kriminalitet: Hvordan medicinalindustrien har korrumperet sundhedsv\u00e6senet<\/em>. Art People, 2013, this book did not bring so much new. However, it did present things better than G\u00f8tzsche did. To be fair, he focused mostly on proving that the farma industry are organized criminals. I agree, but the science is more interesting than reading about 100 different cases of farma companies cheating and getting fines.<\/p>\n

 <\/p>\n

—<\/p>\n

 <\/p>\n

 <\/p>\n

If you\u2019re a nerd, you might think: these files are electronic; <\/span><\/p>\n

they\u2019re PDFs, a type o f file specifically designed to make sharing <\/span><\/p>\n

electronic documents convenient. Any nerd will know that if <\/span><\/p>\n

you want to find something in an electronic document, it\u2019s easy: <\/span><\/p>\n

you just use the \u2018find\u2019 command: type in, say, \u2018peripheral <\/span><\/p>\n

neuropathy\u2019, and your computer will find the phrase straight <\/span><\/p>\n

off. But no: unlike almost any other serious government docu\u00ad<\/span><\/p>\n

ment in the world, the PDFs from the FDA are a series of photo\u00ad<\/span><\/p>\n

graphs of pages of text, rather than the text itself. This means <\/span><\/p>\n

you cannot search for a phrase. Instead, you have to go through <\/span><\/p>\n

it, searching for that phrase, laboriously, by eye.<\/span><\/p>\n

 <\/p>\n

Easily solved by OCR software.<\/p>\n

http:\/\/en.wikipedia.org\/wiki\/Optical_character_recognition<\/a><\/p>\n

 <\/p>\n

–<\/p>\n

 <\/p>\n

Sharing data of individual patients\u2019 outcomes in clinical <\/span><\/p>\n

trials, rather than just the final summary result, has several <\/span><\/p>\n

significant advantages. First, it\u2019s a safeguard against dubious <\/span><\/p>\n

analytic practices. In the VIGOR trial on the painkiller Vioxx, <\/span><\/p>\n

for example, a bizarre reporting decision was made.83 The aim <\/span><\/p>\n

of the study was to compare Vioxx against an older, cheaper <\/span><\/p>\n

painkiller, to see if it was any less likely to cause stomach prob\u00ad<\/span><\/p>\n

lems (this was the hope for Vioxx), and also if it caused more <\/span><\/p>\n

heart attacks (this was the fear). But the date cut-off for mea\u00ad<\/span><\/p>\n

suring heart attacks was much earlier than that for measuring <\/span><\/p>\n

stomach problems. This had the result of making the risks look <\/span><\/p>\n

less significant, relative to the benefits, but it was not declared <\/span><\/p>\n

clearly in the paper, resulting in a giant scandal when it was <\/span><\/p>\n

eventually noticed. If the raw data on patients was shared, <\/span><\/p>\n

games like these would be far easier to spot, and people might <\/span><\/p>\n

be less likely to play them in the first place.<\/span><\/p>\n

 <\/p>\n

Occasionally – with vanishing rarity – researchers are able to <\/span><\/p>\n

obtain raw data, and re-analyse studies that have already been <\/span><\/p>\n

conducted and published. Daniel Coyne, Professor of Medicine <\/span><\/p>\n

at Washington University, was lucky enough to get the data on a <\/span><\/p>\n

key trial for epoetin, a drug given to patients on kidney dialysis, <\/span><\/p>\n

after a four-year-long fight.84 The original academic publication <\/span><\/p>\n

on this study, ten years earlier, had switched the primary <\/span><\/p>\n

outcomes described in the protocol (we will see later how this <\/span><\/p>\n

exaggerates the benefits of treatments), and changed the main <\/span><\/p>\n

statistical analysis strategy (again, a huge source of bias). Coyne <\/span><\/p>\n

was able to analyse the study as the researchers had initially <\/span><\/p>\n

stated they were planning to in their protocol; and when he did, <\/span><\/p>\n

he found that they had dramatically overstated the benefits of <\/span><\/p>\n

the drug. It was a peculiar outcome, as he himself acknowl\u00ad<\/span><\/p>\n

edges: \u2018As strange as it seems, I am now the sole author of the <\/span><\/p>\n

publication on the predefined primary and secondary results of <\/span><\/p>\n

the largest outcomes trial of epoetin in dialysis patients, and I <\/span><\/p>\n

didn\u2019t even participate in the trial.\u2019 There is room, in my view,<\/span><\/p>\n

for a small army o f people doing the very same thing, re- <\/span><\/p>\n

analysing all the trials that were incorrectly analysed, in ways <\/span><\/p>\n

that deviated misleadingly from their original protocols.<\/span><\/p>\n

 <\/p>\n

This is the kind of second-order scientist that was described in the paper:<\/p>\n

Nosek, Brian A., and Yoav Bar-Anan. “Scientific utopia: I. Opening scientific communication.” Psychological Inquiry<\/em> 23.3 (2012): 217-243.<\/p>\n

 <\/p>\n

This paper is extremely interesting by the way. Read it. Yes, seriously!<\/p>\n","protected":false},"excerpt":{"rendered":"

https:\/\/www.goodreads.com\/book\/similar\/19171192-bad-pharma-how-drug-companies-mislead-doctors-and-harm-patients http:\/\/lib.free-college.org\/view.php?id=864114   Having already read Peter G\u00f8tzsche’s D\u00f8delig medicin og organiseret kriminalitet: Hvordan medicinalindustrien har korrumperet sundhedsv\u00e6senet. Art People, 2013, this book did not bring so much new. However, it did present things better than G\u00f8tzsche did. To be fair, he focused mostly on proving that the farma industry are organized criminals. I agree, […]<\/p>\n","protected":false},"author":17,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1727,1935],"tags":[1918,1924,1067],"class_list":["post-4021","post","type-post","status-publish","format-standard","hentry","category-medicine","category-science-politik","tag-innovation","tag-patents","tag-review","entry"],"_links":{"self":[{"href":"https:\/\/emilkirkegaard.dk\/en\/wp-json\/wp\/v2\/posts\/4021","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/emilkirkegaard.dk\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/emilkirkegaard.dk\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/emilkirkegaard.dk\/en\/wp-json\/wp\/v2\/users\/17"}],"replies":[{"embeddable":true,"href":"https:\/\/emilkirkegaard.dk\/en\/wp-json\/wp\/v2\/comments?post=4021"}],"version-history":[{"count":2,"href":"https:\/\/emilkirkegaard.dk\/en\/wp-json\/wp\/v2\/posts\/4021\/revisions"}],"predecessor-version":[{"id":4373,"href":"https:\/\/emilkirkegaard.dk\/en\/wp-json\/wp\/v2\/posts\/4021\/revisions\/4373"}],"wp:attachment":[{"href":"https:\/\/emilkirkegaard.dk\/en\/wp-json\/wp\/v2\/media?parent=4021"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/emilkirkegaard.dk\/en\/wp-json\/wp\/v2\/categories?post=4021"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/emilkirkegaard.dk\/en\/wp-json\/wp\/v2\/tags?post=4021"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}