How a marriage with big pharma ended in divorce
BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f6062 (Published 08 October 2013) Cite this as: BMJ 2013;347:f6062All rapid responses
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The name of one of the researchers who obtained details from government organisations about how they decided to endorse the ESHLSG guidance documents is Beth Hall, not Beth Evans as reported here.
Competing interests: No competing interests
Doctors may not able to live comfortably with the pharmaceutical industry because of shortcomings in evidence-based medicine (EBM). If we ask for evidence to support a treatment indication criterion to avoid over or under treatment we will get blank looks. NICE, licencing organisations and peer reviewers are not asking such searching questions and current EBM methods do not address the issue. Instead we treat everyone beyond some theoretical non-evidence-based cut-off point (and some patients not beyond it too just in case they miss out). Because of the absence of sensible conventions of evidence for specifying which patients with different degrees of illness benefit, pharmaceutical companies turn to ‘marketing’ methods.
I put this to a pharmaceutical company many years ago and was provided with data from a trial to try to solve the problem. I was able to show how measurements used to select patients in a trial could be ‘stratified’ to improve diagnostic validity and the prediction of treatment response [1]. I described this approach recently in the ‘Preventing over-diagnosis’ conference supported by the BMJ in Dartmouth College [2] and will be explaining it to students and young doctors in the forthcoming 3rd edition of the Oxford Handbook of Clinical Diagnosis [3]. Medical schools, guideline writers, licencing organisations, researchers of ‘stratified medicine’, journal editors, the pharmaceutical industry and the EMB community should now move forward with such new ideas to reduce harm to patients and further professional embarrassment.
References
1. Llewelyn D E H, Garcia-Puig, J. How different urinary albumin excretion rates can predict progression to nephropathy and the effect of treatment in hypertensive diabetics. JRAAS 2004, 5; 141-5. http://jra.sagepub.com/content/5/3/141.full.pdf+html
2. Llewelyn H. Analysis of clinical trial data by using evidence based triage reduces over-diagnosis. Preventing over-diagnosis conference, Dartmouth College, New Hampshire, 2013 –abstract #11. http://preventingoverdiagnosis.net/documents/POD-Abstracts.docx
3. Llewelyn H, Ang AH, Lewis K, Abdullah A. The Oxford Handbook of Clinical Diagnosis, 3rd edition. Oxford University Press, Oxford, 2014 (in press).
Competing interests: No competing interests
ABPI president says that they ".... couldn’t mandate a single member to say ‘you must do A, B, or C.’”
True, but this would seem to imply that they cannot ensure full compliance with their proposed Principles for Transparency.
Competing interests: No competing interests
Re: How a marriage with big pharma ended in divorce
Relationships are paradoxical. They often end badly, but the bad endings always surprise us. Sadly, this happens with marriage, family, friends, and business. So what are we to think? Perhaps we're so prone to idealized fantasies, that our relationships can't quite stand the light of day. Like dreams, our relationships abruptly end when we wake up, and then the nightmare of breaking up begins.
Competing interests: I have a self-published e-book called "Peace Poetry & The LOVE Diet", which promotes peace, simplifies health, and demystifies addiction.