A note I posted last night on the e-patient blog
Marcia Angell MD is a well-known, respected physician, long-time editor of NEJM. So it was a bit of a shock today when Amy Romano, blogger for Lamaze International, sent me this quote:
It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.From Drug Companies & Doctors: A Story of Corruption in The New York Review of Books, around New Year's.
Dana Blankenhorn of the ZDNet health blog called it "a bombshell." I couldn't agree more. And I must say, with all the smart people in this community, why on earth haven't we heard more about this??
And how on earth are we supposed to be empowered participatory patients if we can't trust the world's leading journal?
For one thing, we can have our eyes wide open about the evidence we're supposed to trust. Get educated. Learn how to read health news reporting – including the journals. Wise up.
Think critically. It's a fundamental part of being an empowered patient.
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That's what I posted last night. Then, this morning this happened:
Next week at the Connected Health conference in Boston, we're launching the new Journal of Participatory Medicine. The editorial and advisory boards include some people who, I'm told, have seriously good reputations in medicine, including Richard Smith, 25 year editor of the prestigious British Medical Journal. Unbeknownst to me, he's got a piece in the first edition that mirrors the above. So today, our person who tweets for the Journal, @JourPM, added these notes:
"R.Smith (BMJ) concurs w/M.Angell (NEJM) in launch of J. Partic Med: 'most of what appears in peer reviewed journals is scientifically weak'"
"Peer review must be job of the many rather than the few. This must, indeed, be part of participatory medicine's philosophy. R. Smith"
The first edition of the Journal will go live (online) next week. Subscribe/register (free, open access) here.
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Related reading:
No *other* conflict of interest, huh? (11/08)
Negative data on Seroquel suppressed by manufacturer (2/09)
Dr. Reuben deeply regrets that this happened (3/09)
I wish I could say I'm surprised by this, but I have to admit I'm not terribly so, although it's certainly shocking to have such a person come right out and say so.
ReplyDeleteFor the past several years, I've steadfastly refused to take newer medications when it's been possible to use ones with which there is more experience, because it became clear to me with the Vioxx fiasco that there is no longer adequate testing of new drugs, nor adequate oversight by the FDA.
Also, just yesterday, my partner mentioned a study in this week's Science News discussing a study that showed that there's a huge bias in journal publications towards studies with some kind of positive outcome vs those with neutral or negative outcomes which was also quite appalling.
The other day I was sort of berating a cousin who is a chiropractor for that profession not making the results of their studies available online as easily as we can access western medical studies on Medline. I was thinking, when she replied that money is an issue for getting their information disseminated, that what they need to do is self-publish on the web. I mean, honestly, in this day and age, why couldn't anyone who does a legitimate study do exactly that? Clearly that would go for allopathic medicine as well.
Hello Dave,
ReplyDeleteMay I ask you for your e-mail address? I would like to get your advise on an idea of "non-profit" drug or "repurposing" of generic drug (used against alcoholism) for cancer therapy.
Please, see following link:
http://www.cancer.gov/search/ViewClinicalTrials.aspx?cdrid=614004&version=HealthProfessional&protocolsearchid=6900494
Thanks :-)
Boris
More about me (including my e-mail address):
http://network.nature.com/people/disulfiram/profile
Well, I was wrong, there is my e-mail address:
ReplyDeletecvekb(at)seznam.cz
Dr. Angell is a bit radical, so one sometimes must keep that in mind when reading her. However, I must say that it was only when I retired and lifted my nose out of pathology into reading more about general medicine (including the NEJM and many health care blogs run by docs), that it became clear to me how completely and insidiously the big health care companies (pharma, medical device co's, etc.) have infiltrated medicine. This, of course, has to do with funding and with the "publish or perish" edict at all academic centers. Also, as always, with $$$, or should I say $$$$$$$$$$$, as "paid consultants". Such as orthopedic surgeons and particular hip implant manufacturers, etc.
ReplyDeleteOur society's worship of the almightly dollar has completely distorted this industry as well as many other industries in our country. Should we REALLY be surprised? Many physicians are not only no "better" than anyone else but often, because of the personality characteristics which ensure survival in medical training, worse.
nonlocal
ps Dave;
ReplyDeleteRegarding your comment about recommending you to my medical society, I have moved to an adjacent state and, retired, have no current contact with them. However, may I suggest you also consider speaking at hospitals' grand rounds. You would still be speaking to docs, but I feel like some hospital administrators may be receptive to this idea more than some docs would! It depends on the doctor, but I have seen many who are basically scared of their patients and don't welcome empowered ones; but the administrators have to deal with all the complaints from family members, so they might be interested in educating the docs, who get a free meal at grand rounds, haha! Just a thought.
nonlocal
Boris, write to me at the address in my profile.
ReplyDeleteNonlocal, yes - Dr. Sands and I are doing Grand Rounds at Beth Israel Deaconess on December 3. We're telling our basic "Illness in the Age of E" story, about how I used the internet during my illness. Hadn't thought of taking it on the road, nor expanding the message - good idea! We'd have to just work our way through a network of contacts, yes?
Grand Rounds is normally led by a physician, isn't it? Any advice on how to get a "yes" on such requests?
There's usually a hospital committee (mostly docs) that runs it and picks the speakers. To get a "yes", I'd try to look at it from the docs' point of view, like how to deal with patients like you, haha! What I mean is picture yourself as the doc when all your patients come in with stuff from the internet and you have to take time to deal with it, how would you deal with the patient, etc.
ReplyDeleteThen come up with a catchy title and you've got something!
Many docs have become scared of their patients because of stuff like this and some education on what patients are really after, how they can help the doc, etc., may be really well received.
Just my thoughts, of course! Asking your own docs will help too, although in the academic setting they may be more used to looking at the literature, etc.
I'm sure your local docs could help you with contacts in Boston and the Cape, etc. and then if it went well, you'd be in demand elsewhere!
Now as for getting paid, Grand Rounds speakers do get paid but I'd have to leave that part up to you; I was never on one of those committees.
nonlocal
Thanks, nonlocal - good advised, well timed, appreciated.
ReplyDelete