Doctoring Data: How to Sort Out Medical Advice From Medical Nonsense by Malcolm Kendrick

Author:Malcolm Kendrick [Kendrick, Malcolm]
Language: eng
Format: epub
Amazon: B00TCG3X4S
Publisher: Columbus Publishing Ltd
Published: 2015-02-06T23:00:00+00:00

CHAPTER SEVEN

Games are played and the players are…

Despite what I have just written about ‘experts’ being wedded to their ‘expert’ views, I do not think that there can be any doubt that the single most important reason why medical research is corrupted is money. Money acts like a great tsunami, driving everything before it in one direction, and one direction only, in favour of the pharmaceutical company, which dishes out the moolah.

There are many different ways in which money distorts the world of medical research. We’re going to call them “games”, although they are anything but fun.

Game 1 – Fund the studies

The first step in the process is that pharmaceutical companies fund and run most of the major clinical studies on drugs, and other interventions.

This is where bias starts, although it is often impossible to spot it. How can you know which important end-points were not included in a clinical trial, and why? Why was comparator drug x chosen and not drug y? Why did they choose statistical test z? Why did they exclude patients with heart failure, or diabetes, or decide on combined end-points? There are a myriad ways to bend the results to your will, long before a trial starts.

Here is a ‘tip of the iceberg’ list published in the Public Library of Science, from a talk by Richard Smith (ex-editor of the BMJ):[79]

“Examples of Methods for Pharmaceutical Companies to Get the Results They Want from Clinical Trials:

Conduct a trial of your drug against a treatment known to be inferior;

Trial your drugs against too low a dose of a competitor drug;

Conduct a trial of your drug against too high a dose of a competitor drug (making your drug seem less toxic);

Conduct trials that are too small to show differences from competitor drugs;

Use multiple endpoints in the trial and select for publication those that give favourable results;

Do multicentre trials and select for publication, results from centres that are favourable;

Conduct subgroup analyses and select for publication those that are favourable;

Present results that are most likely to impress – for example, reduction in relative rather than absolute risk.”

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