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One swallow maketh not summer!
- BM Hegde (1 September 2008)
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BMJ's policy on pharmaceutical funding
- Jane Smith (1 September 2008)
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BM Hegde, Editor in Chief, Journal of the Science of Healing Outcomes. Mangalore-575 004, India
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Dear Editor, If one hears a bird singing it doesn’t mean it's summer. If someone says “I like you” it doesn’t mean that they both will be walking down the aisle the following week, either. Similarly, one Japanese study does not make it safe for children to be unusually obese. There are newer enemies hiding in the dark. Look at monosodium glutamate (MSG), now incorporated in every junk food including cola drinks, which is, possibly, the hidden cause of the recent epidemic of obesity! MSG obesity is early-onset obesity due to MSG-induced lesions in arcuate nucleus of the neonatal mice. All the mice developed severe hyperleptinaemia, more remarkable in females, but NMRI male mice alone showed massive hyperinsulinaemia and an extremely high HOMA index. Could Insulin resistance be due to MSG? Whereas diet induced obesity is late- onset obesity and needs prolonged feeding with diet containing more than 60% calories as fat, MSG obesity, on the other hand, needs very little dietary change and is easy to acquire. (1) Just as the world is trying to delink continued medical education from the drug and devices lobby, which will take decades to be seen on the ground, the food lobby needs to look into their conscience to see if profits mean much more than the lives of the future generation of the human race. The drug lobby connection could empower our “thought leaders” in many ways other than just the wining, dining, and flying round the world in first class comfort for family holidays. They could even get them academic honours from well known organizations as also get them elected to top posts in their associations if they wished etcetera, etcetera. The last is called medical politics. This list is long. The editorial misses one vital link. (2) The “so called” randomised controlled studies, the gold standard in the statistical science of medicine, and the funding thereof, which comes mostly through the CROs (Clinical Trial Organisations), especially in the third world (3) is where the rot starts for generating all our recent knowledge (not wisdom) in the evidence based medicine. This marriage of convenience can not be broken by just the recent attempts to curb lavish wining and dining by the drug lords alone! The “thought leaders” of our profession that “consult” for the drug companies are the “creators” of that knowledge, not, I hope, knowing that the truth lies elsewhere. Seventeen studies of hypertension treatment with drugs compiled together gave the “relative risk reduction” of -21%, which is being sold to doctors, textbooks, and to teachers, boils down to just –0.8% “absolute risk reduction” with hardly any extra “survival benefit.” While SB with drugs was 96.8%, it was just 96% without drugs. Probably, with intensive life style modifications, the survival benefit would have been better without drugs. Mind you, this doesn’t take into consideration the dangerous and, sometimes, fatal ADRS reported with antihypertensive drugs on the long run. To know their gravity please look at another measure- number needed to treat (NNT) analysis. (3) One of the significant studies was the MRC Study of mild to moderate hypertension reported in the BMJ in 1985. (4) This study showed that to save one “probable” stroke in the following five years, 850 apparently healthy individuals had to be drugged for five years. Now sit back and think of the number of ADR events of morbidity and mortality in those five long years. Many such examples could be given of the devious statistical ways to cheat the doctors as detailed by Steven Milloy in his book “Science without Sense”. (5) The tissue plasminogen activator (tpA) study fiasco and the larger than usual “bare feet” of Peter of Oxford study, caught by the BMJ reporter’s camera, which was shown in the editorial by, I think, Richard Smith, entitled “What a Feat?”. This exposed, as if proof were needed, how the thought leaders create industry friendly “scientific” knowledge base for all our teaching and learning. It is really frightening. (6) (7) (8) (9) (10) We need more crusaders like Ray Moynihan to keep fighting for this cause. (11) To stop all such unholy nexuses there needs to be lot of soul searching in our profession. Unethical practices do not stop without our changing ourselves to follow the Hippocratic Oath instead of being hypocrites that most of us become, after swearing by the Oath. Let us, at least, try and convert the non-converts, the new entrants into medical schools all over the world. Let them know these secrets before they get in to know what they are in for. Yours ever, bmhegde References: 1) Matyšková R, Maletínská L, Maixnerová J et. al. Monosodium glutamate and obesity. Physiol. Res. 2007; October 11th. 2) Smith J. Big subjects: education and obesity. BMJ 2008; 337: a 1448 3) Ravneskov. U. Reanalysis…… BMJ 18th June 2002. 4) MRC study-mild moderate hypertension-preliminary results. BMJ 1985; 5) Milloy S. Science without Sense. 1994. Cato Institute Washington DC. 6) Pickering WG. Does medical treatment mean patient benefit? Lancet 1996; 347: 379-80. 7) Seth CL, Shojania KG, and Auerbach AD. Should we use large scale healthcare interventions without clear evidence that benefits outweigh costs and harms? No. BMJ 2008; 336: 1277. 8) Dusen LV. The business called medicine. CMAJ 1997; 157: 1724. 9) Fanu JL. The case of the missing data. BMJ 2002; 325: 1490. 10) Ebrahim S, Smith GD. Systematic review of RCTs of MRFIT. BMJ 1997; 316: 1666 11) Moynihan R. Is the relationship between pharma and medical education on the rocks? BMJ 2008; 337: a925 Competing interests: Humanist |
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Jane Smith, Deputy editor BMJ
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In the group of articles about continuing medical education funded by the pharmaceutical industry (referred to in this Editor's Choice) we should have declared that the BMJ Group itself produces CME material partly funded by the pharmaceutical industry. Our advertising and sponsorship policy is available at Jane Smith
Competing interests:
None declared |
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