Judging the benefits and harms of medicines
BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j3129 (Published 30 June 2017) Cite this as: BMJ 2017;357:j3129
All rapid responses
The further thoughts of Professor Sir John Tooke, Chair of the Academy of Medical Sciences report ‘Enhancing the use of scientific evidence to judge the potential harms and benefits of medicines’ are most welcome (1).
Professor Sir John Tooke does not reassure me that an era of unrealistic medicine and the business of science will change anytime soon. Meantime the NHS is struggling across the United Kingdom and this may be in part due to the promotion of medical interventions whose evidence base lacks the objectivity that we all surely seek. This be considered as unrealistic medicine.
I would suggest that most of us fully understand the "reminder" from the Academy of Medical Sciences that potential conflicts of interest can come in all forms and not just financial. But like the public I share the view that we should start with potential financial conflicts of interest as evidence has determined that that exposure to industry promotional activity can lead to doctors recommending worse treatments for patients (2) Godlee and Freer remind us that we expect this from our elected politicians and in other areas of public life. (3)
The voluntary ABPI Register is not working. Its database is only a little more than half complete (4). This really does challenge the "E" in EBM.
The pharmaceutical Industry has, over the preceding year, increased payments to healthcare workers for "promotional activities from £109 million to £116.5 million. (4) This is a major part of Industry budget. Furthermore, we do not know how much may be being paid by device makers and other forms of industry for promotion of their products.
It is welcome, but somewhat "after the bell has rung", that Professor Sir John Tooke confirms that the Academy of Medical Sciences intends to "review" its approach to public transparency. But one wonders how many "houses" do we need to "get in order" to address this issue effectively? I find myself worrying that it could be like a game of Monopoly that never seems to end.
The most effective and cheapest way to address this matter would be Sunshine legislation. This would avoid multiple, overlapping and generally unsearchable databases of interests.
I would suggest that the reputation of science is at stake as is the balance between benefits and harms for us all
Roy Porter, who sadly died prematurely was considered as one of the United Kingdom's finest historians of science and health. He ends "Madness: A Brief History " with a teasing question: ‘Is folly jingling its bells again?’
References:
(1) http://www.bmj.com/content/357/bmj.j3129/rr-8
(2) http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.10...
(3) http://www.bmj.com/content/357/bmj.j3129
(4)http://www.bmj.com/content/357/bmj.j3195?sso=
(5) Porter, R. Madness: A Brief History. 2003. OUP Oxford
Competing interests: Dr Peter J Gordon raised a petition with the Scottish parliament to consider introducing a Sunshine Act for Scotland: http://www.parliament.scot/GettingInvolved/Petitions/sunshineact
Freer and Godlee (1) consider the serious doubts held by both the public and the profession regarding drug efficacy and safety, and lament the weak recommendations made by the Academy of Medical Sciences to address the fundamental problem of conflicts of interest (CoI) in drug information (2).
Since medical journals play a key role in accessing clinical trial and other evidence regarding medicines, it is essential that they have robust policies with regard to CoI. Unfortunately, progress in this area has been inconsistent, with some prominent journals having recently taken a more ‘flexible’ view regarding conflicted authors (3). The International Society of Drug Bulletins (ISDB) is a worldwide network of journals that operate independently, both financially and intellectually, from the pharmaceutical industry. Founded in 1986 with the support of the WHO Regional Office for Europe, ISDB’s rationale is that drug bulletins without industry funding avoid problems faced by editors of other journals, for example in reporting the results of sponsored drug trials (4).
Financial conflicts are, however, not the whole story, and ISDB has continued to debate its policies regarding CoI (5). At a recent extraordinary general meeting, ISDB members voted overwhelmingly to further strengthen the Society’s policy on CoI, defined as any financial or advisory relationship (paid or unpaid) with the pharmaceutical industry. ISDB decided that its editorial teams, and external authors influencing therapeutic choices, must be completely free from CoI. This policy change reflects the accumulating evidence of bias arising from both financial and advisory links with industry, as well as the recognition that disclosure of CoI is often inadequate and may, under some conditions, even aggravate bias (6). While trust in doctors is largely determined by our perception of their knowledge and experience, credible drug information requires that CoI are not merely managed but effectively excluded.
1. Freer J, Godlee F. Judging the benefits and harms of medicines. BMJ. 2017;357:j3129.
2. Academy of Medical Sciences. Enhancing the use of scientific evidence to judge the potential
benefits and harms of medicines. 2017. https://acmedsci.ac.uk/file-download/44970096.
3. Godlee F. Conflict of interest: forward not backward. BMJ. 2015;350:h3176.
4. Lexchin J, Bero LA, Djulbegovic B, Clark O. Pharmaceutical industry sponsorship and research
outcome and quality: systematic review. BMJ. 2003;326:1167-76.
5. Menkes DB. Conflicts of interest and drug information. BMJ. 2011;343:d5617.
6. Loewenstein G, Sah S, Cain DM. The unintended consequences of conflict of interest disclosure.
JAMA. 2012;307:669-70.
Competing interests: Dick Bijl is physician-epidemiologist (Utrecht, the Netherlands) and President of ISDB.
I was pleased to see the BMJ highlighting our latest Academy report ‘Enhancing the use of scientific evidence to judge the potential harms and benefits of medicines’1 in your news section2 and recent editorial3. We welcome the many synergies between the Academy of Medical Sciences’ work in this area and the Evidence Based Manifesto proposed by the BMJ4.
It is essential that the research community gets its house in order for the fullest benefits of research to be translated into the greatest good for society. We believe widespread adoption of our recommendations will help to achieve this aim.
To this end, our report calls for significant changes to the REF system to recognise efforts that support reproducibility, ‘intelligent openness’ initiatives and better research communication(s). Making these changes to the next iteration of the REF has the potential to galvanise the culture shift that is needed in universities and research institutions.
It is time for all organisations involved in research, including the Academy, to look closely at the processes governing our work. For the Academy this will include reviewing the way we declare interests – though it is essential to note an interest does not inherently present a conflict, as this will be context-dependent, and conflicts of interest are not limited solely to industry links.
On such important issues, it is understandable that we all have our own views on ways to move this agenda forward. Yet we are brought together by a common motivation to ensure the robustness and trustworthiness of scientific research so that society reaps the maximum benefit. We suggest that is more likely to happen if the whole research community, including patient representatives, funders, researchers, universities, journals, policy makers and communicators, align their respective efforts and work collectively.
Last week the Academy hosted an implementation meeting to take our recommendations forward, and we were pleased that Fiona Godlee and representatives from across the research community were able to attend. The need for a collective, aligned and coordinated response to the recommendations was reinforced. One key role for the Academy will be to convene partners to ensure progress and optimisation of effort.
We look forward to working with the community to achieve a new era of accountability in the way we generate and communicate trustworthy scientific evidence on the potential benefits and harms of medicines.
Professor Sir John Tooke, Chair of the Academy of Medical Sciences report ‘Enhancing the use of scientific evidence to judge the potential harms and benefits of medicines’
Yours sincerely,
Professor Sir John Tooke FMedSci
1. http://acmedsci.ac.uk/policy/how-can-we-all-best-use-evidence
2. http://www.bmj.com/content/357/bmj.j2974
3. http://www.bmj.com/content/357/bmj.j3129
4. http://www.bmj.com/content/357/bmj.j2973
Competing interests: No competing interests
Dear Madam,
I compliment you, and your patient group, on the efforts for informing about SSRIs harms, and urge you to lobby against SSRI over-prescriptions.
Suicides and self-harm traumatisms are the sixth leading cause of death, but GPs could not reduce them [1], probably because recent evidence reveals that administered antidepressants actually increase suicide risks by 2-5 times. [2][3][4][5][6]
A recent meta-analysis, level I evidence, clearly demonstrated that SSRIs double the risk of suicide and violence in adults. [4]
All pharmaceutical Companies must be obbliged to incude this warning in every antidepressant preparation sold.
Another meta-analysis published in the British Journal of Psychiatry has found that even patients with the most severe depression can expect to get as much benefit from cognitive behavioural therapy (CBT) as those with less severe symptoms. [7]
Even Behavioural Activation effectively decreases depressive symptoms. [8]
References
[1] http://www.bmj.com/content/355/bmj.i6761
[2] http://journals.sagepub.com/doi/pdf/10.1177/0141076816666805
[3] http://www.bmj.com/content/348/bmj.g3510
[4] http://www.bmj.com/content/352/bmj.i65
[5] http://nordic.cochrane.org/sites/nordic.cochrane.org/files/public/upload...
[6] http://www.bmj.com/content/355/bmj.i6103
[7] http://bjp.rcpsych.org/content/210/3/190.long
[8] http://www.bmj.com/content/356/bmj.j914
Competing interests: No competing interests
Routinely in PILs the withdrawal and dependency inducing qualities of psycho-active drugs are understated. The long term effects of antidepressants are unknown. There is no research on the horizon, yet these drugs are probably some of the most over-prescribed in medicine and are routinely used for far longer than the 12 weeks of human trials.
Compounding this situation, medicine is failing patients by denying that withdrawal symptoms can be serious or that they can last longer than the three/four months which is optimistically used as a time frame for symptoms. Seizures, systemic disorders, movement disorders, akathisia and suicidality to name but a few of the most serious effects are reported by patients in withdrawal, and often these symptoms follow withdrawal advice that medicine gives out which is too fast.
To achieve a slower speed of taper and get off these medicines safely, patients are forced to take drastic measures. In the absence of liquid versions of drugs, they grind up tablets to make solutions and open capsules to count out beads as they cannot manage to withdraw over the medically advised time frames without nasty and often dangerous symptoms. They need to follow micro-tapers but medicine advises standard doses. This article in The New Scientist explains: https://www.newscientist.com/article/2140106-people-are-hacking-antidepr...
Specific protocols which recognise these potential harms and support safe withdrawal are long overdue and appropriate tapering doses are required.
Patient support groups currently offer superior advice to medicine precisely because they are not in denial about the potential harms. Yet doctors routinely discourage online help assuming theirs is better. In truth,patients are choosing this advice because yours is failing them. The standard statement, “seek medical advice” is pointless to hand out. Referring people to their doctors for advice meets with protocols which induce symptoms or harms and once harmed by medicine and an ill-advised withdrawal medicine turns it’s back. What should support groups and patients do?
For sure, something needs to be done here. Patient safety is in jeopardy and anger is mounting. As this report highlights medicine is in crisis when it comes to confidence in research and yet still widely in denial. Whose advice are doctors adopting and who needs to be challenged? Pharma, the NHS, Government Ministers and advisors, the Royal Colleges, the medical defence unions or the lot? Patients and the reputation of medicine is suffering and this level of denial is unsafe and frankly insulting.
Competing interests: No competing interests
Fiona French's rapid response (1) to 'Judging the benefits and harms of medicines' makes for sobering reading.
Is the real 'E' evidence of the harms of very commonly prescribed neurotoxic medicines (in Fiona's case long-term benzodiazepines and antidepressants) being conveniently and systematically hidden in plain sight?
There is a recent debate article in BMC Family Practice entitled ' "Medically unexplained" symptoms and symptom disorders in primary care: prognosis-based recognition and classification' (2). This article makes for deeply troubling reading. It includes this telling quote :
"Taking a prognostic approach, while remaining agnostic about aetiology, is likely to be acceptable to both doctors and patients".
That is an astonishing statement.
The same article goes to describe major disabling neurological 'symptoms' including Bodily Distress Syndrome (BDS): 'central sensitisation', 'arousal'/'exhaustion') in the following systems: cardiopulmonary/ANS, gastrointenstinal, musculoskeletal, and 'general' (everything else).
Is being 'AGNOSTIC ABOUT AETIOLOGY' of such alarming (and ever growing) evidence - of harm being experienced and reported by patients - trustworthy, honest or even scientific?
(1) http://www.bmj.com/content/357/bmj.j3129/rr-3
(2) https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-017-0592-6
Competing interests: No competing interests
As a patient who has sustained a brain injury after withdrawing from nitrazepam after 40 years’ consumption, I would like to suggest that doctors should listen to the experience of patients who have been thus harmed. I spend every day online communicating with other such patients. Having been sedated for four decades by a prescription drug, I have now “ woken up” to the realisation that I cannot trust the drug companies, the regulatory body, the medical literature or the medical profession itself. I now know why I have been unable to function normally for 40 years. Sadly, I am physically and cognitively disabled due to withdrawal and have a poor quality of life. Having consulted a variety of doctors I am dismayed that after four years I still have no accurate diagnosis of prescription drug damage. If such damage is not acknowledged or recorded, how can it be quantified or acted upon? Perhaps it is more convenient to keep such harm hidden. I now fully realise that my brain and body have gradually been poisoned over the past 40 years, I wonder why this was never mentioned by any of my many doctors during that time. I would have appreciated an opportunity to decide for myself if I wanted to risk the gradual destruction of my health and my life. No doubt my doctors imagine they did their best for me. They are sadly deluded. I now realise that there was never any informed consent on my part and I feel hugely betrayed as do most patients I meet online who are in a similar situation.
Competing interests: No competing interests
It is good to see that the first recommendation of the Academy of Medical Sciences is to involve patients, carers, and the public in research as a means of tackling concerns about the erosion of public trust, overmedication and conflicts of interest (1). It is important however, to note that patient and public involvement is already an imperative for much publicly funded UK health research and has been so for some time. Also, to note that the field of involvement is not outside of or immune to conflicts of interest or the erosion of trust; especially given that such involvement is often reduced to time consuming and tokenistic box ticking exercises (2).
Following O’Neill (3), the aim should be for more trust in the trustworthy and less in the untrustworthy, not for more trust across the board. This requires building, and in some cases rebuilding, trustworthiness in health research and its processes and practices of involvement. It is unhelpful that discussions on the placement and refusal of trust in health research continue to be infused with a pervasive 'deficit model' which implies that all public and professional scepticism of science is unfounded and that there is a need for corrective communication by experts, rather than a need to encourage broader debate that attends to those concerns (4).
1) http://www.bmj.com/content/357/bmj.j3129
2) http://journal.frontiersin.org/article/10.3389/fsoc.2017.00007/full
3) https://www.ted.com/talks/onora_o_neill_what_we_don_t_understand_about_t...
4) http://rsnr.royalsocietypublishing.org/content/early/2016/09/12/rsnr.201...
Competing interests: No competing interests
We could not agree more with Dr Tom Robinson in that we can only gain the trust of the public if we listen to them (1). One of us (Dr Peter J Gordon) raised a petition with the Scottish Parliament to consider a Sunshine Act for Scotland, and as part of this a consultation was undertaken with the Scottish public (2). The majority of those consulted agreed that it should be mandatory for all financial conflicts of interest to be declared on a public register. The Academy of Medical Sciences has gone no further than recommending the development of "frameworks for declaring and managing interests" (3). We would suggest that this will do nothing to restore the public's trust.
References:
(1) http://www.bmj.com/content/357/bmj.j3129/rr
(2) http://www.scottishhealthcouncil.org/publications/gathering_public_views...
(3) http://www.bmj.com/content/357/bmj.j3129/rr
Competing interests: Dr Peter J Gordon raised a petition with the Scottish parliament to consider introducing a Sunshine Act for Scotland: http://www.parliament.scot/GettingInvolved/Petitions/sunshineact
MEDICINES AND VACCINES HARMS: Could International Fraud Unearthed In Ghana Be Happening Elsewhere?
MEDICINES AND VACCINES HARMS: COULD INTERNATIONAL FRAUD UNEARTHED IN GHANA BE HAPPENING ELSEWHERE?
Re: Judging the benefits and harms of medicines doi.org/10.1136/bmj.j3129
I congratulate Joe Freer, Fiona Godlee [1] and Kamran Abbasi [2] for encouraging discussion on medicines and vaccines side-effects. Could the unmasked international fraud that caused untold harm in Ghana [3] not be occurring worldwide?
DEFINITION OF FRAUD
“Crime of obtaining money or some other benefit by deliberate deception” [4]. It is by this definition that this [3] and other events need to be assessed. An Italian, a Lebanese, and a Ghanaian arranged to supply Ampicillin to Ghana’s Ministry of Health. The Italian flew in tens of thousands of empty red/black capsules labelled 500 mg. The two expatriates used the Ghanaian’s factory to put just 10 mg of the antibiotic in each capsule, adding enough chalk and kokonte (cassava powder) to fill it up. How I discovered the names of the culprits, how the Lebanese promised to build me 2 houses in Accra if I kept quiet, how I reported them to the then Commissioner for Health, how when he began to investigate he was moved to the Ministry of Agriculture - all described in BMJ http://oW.ly/Dq8g30dSHe0 [3]. Ward rounds made me distrust Ministry of Health antibiotics. Front-page splash in GHANAIAN TIMES Friday March 16 1984 read “POWDERED MAIZE IN AMPICILLIN CAPSULES: Five arrested in Kumasi and Accra”. [5]
Fraud details in countries differ. Dr J K Anand made the correct diagnosis: “A fraud has been perpetuated by one or more individuals …” [6] looking at the “Missing data at a cost of $2 bn” [2 7]. What happened in Ghana was “crude fraud” [3] but what BMJ Editors highlight is “smooth fraud” whose global effect exceeds my country’s monstrosity by far. This CORRUPTION stinks Tafracher! [8].
WHY NOT CALL A SPADE A SPADE?
Describe something as “scientific” and probity is assumed. Are we right in that assumption? [9 10 11]. How many of Professor John Tooke’s 12000 Academy of Medical Sciences Fellows [12] have read that remarkable article by Professor Lord S Zuckerman OM FRS MA DSc LLD MD FRCP FRCS, entitled “Pride and Prejudice in Science”? [13] Reading that convinced me scientific liars and lying scientists exist.
BMJ Editor Richard Smith in his book The Trouble with Medical Journals [14] states that medical journals have become "creatures of the drug industry", rife with fraudulent research and packed with articles ghost written by pharmaceutical companies. In a 2014 interview with New Scientist he suggested criminalization of research fraud [15].
BUT TERMINOLOGY COULD HIDE WRONGDOERS
Take the frequent use of phrases like “reputation of science is at stake”, and “poor science”, and “imperfections in the evidence base”, and “inadequate evidence”, and “gaps in vaccine science”. How, O how do I identify from these phrases the kind of fraudulent researcher Lord Zuckerman describes whether regarding Statins, or Thalidomide, or Tamiflu, or Tranquilizers in pregnancy, or Opiates, or Hydroxyurea? Is there no way of identifying researchers who give science a bad name? Must scientists making mistakes take refuge in something called “poor science” that “will correct itself” [16]?
TAIL WAGGING THE DOG PHENOMENON IN MEDICAL PRACTICE
Has minority opinion (the tail) not sometimes worked its way into Global bodies like WHO, UNESCO, WORLD BANK, CDC to prescribe “Official Policy” for the majority (the dog) resulting in disaster? How else do we explain WHO Director-General apologising for Sierra Leone losing 11,000 people to Ebola? [17] Or reversing earlier endorsement of Tamiflu (Oseltamivir)? [7]. Why did experts differ so much that Dr Fiona Godlee demanded “an independent review” on Statins? [18] Front page Daily Telegraph August 1 “Statins ‘needlessly doled out to millions’” [19], and DAILY EXPRESS July 14 2017 “STATINS: NEW HEALTH ALERT – Study says heart pills do you more harm than good” [20].
FRAUD NOT ALWAYS TO BLAME
“The Lancet”, wrote Sarah Knapton, “argued that thousands of people had been misled into stopping their medication after two articles appeared in the BMJ questioning their use and warning of side-effects” [21]. Two editorial giants disagreeing on Statins? There was no suggestion that any editorial palms had been greased. Indeed, one Lancet Editorial “Corruption in health care costs lives” criticised “aggressive marketing strategy by pharmaceutical companies” [22]. We know that equally brilliant experts can look at facts differently, and I gave the example of Dr Jeffrey Sachs and Professor C J Peters whose emphases on tropical public health priorities differ. [3 23. 24].
TRIBAL RUMOURS, CONSPIRACY THEORIES, CONSPIRACY FACTS [25-30]
Threats immediately provoke rumours as when on July 8 2002 one UN Official at the Barcelona AIDS Conference said (BBC’s WORLD AT ONE) that any country’s Leader failing to heed “Official Policy” should be “kicked out” [31], rumours intensified: POPULATION CONTROL is what most “Official Policy” is about - mandatory vaccinations [26], use of Artesunate-Amodiaquine for malaria [32], medicated bed nets (“What’s wrong with present nets? These Imperialists are killing babies with chest problems from medicated nets”), azoospermia in African young men caused by “spermicidal vitamins” [25 26], “Pressure from UK to legislate that men marry men and women marry women is for population control”. When vaccination for HIV was mooted people exclaimed: “Are they going to prick us with needles so we can do what we like?” [26]. Speak Tribal Language to collect grassroots opinion and you will find “Official Policy”-Vaccinology perceived as big business to kill many birds with one spicule-stone for POPULATION CONTROL. [25 26 33-36]
WHAT THEN SHALL WE DO?
“Intelligent Openness” [37] does not exist in a post-truth world [38-40]. Deception requires “Intelligent Coverup”. The serious concerns of parents and doctors who have seen damage caused by medicines and vaccines must prevail over “Official Policy” from WHO, NICE, NIH, CDC, EUROPEAN COMMUNITY. Vigilance is required as when Ghana Academy of Arts & Sciences advised Parliament NOT to allow Ebola Virus Vaccine Trials in our Ebola-free country. [41 42]. Protest is mounting against mandatory vaccinations worldwide [43 44]. Why should coercive tails continue to wag docile dogs?
Competing Interests: Self-Appointed Spokesman for Africa on Clinical Epidemiology [45 46], Public Health [47 48], and African Anthropogenetics [49 50 51].
Email: felix@konotey-ahulu.com Twitter@profkonoteayhul www.sicklecell.md
Felix I D Konotey-Ahulu FGA MD(Lond) FRCP(Lond) FRCP(Glasg) DTMH(L’;pool) FGCP
Kwegyir Aggrey Distinguished Professor of Human Genetics, University of Cape Coast, Ghana and Former Consultant Physician Genetic Counsellor in Sickle Cell and Other Haemoglobinopathies, Korle Bu Teaching Hospital, Accra, Ghana and 9 Harley Street London W1G 9AL.
References
1 Freer Joe, Godlee Fiona. Judging the benefits and harms of medicines. BMJ 2017; 357: j3129 https://doi.org/10.1136/bmj.j3129 (30 June 2017)
2 Abbasi Kamran. The missing data that cost $20 bn. BMJ 2014: 358
3 Konotey-Ahulu FID. Who should pharmacovigilate in developing countries? http://oW.ly/Dq8g30d5He0 Rapid Response 14 September 2007 to BMJ Editorial by Pirmohamed M, Atuah KN, Dodoo ANO, Winstanley P. Pharmacovigilance in developing countries. BMJ 2007; 335: 462
4 ENCARTA World English Dictionary. Fraud is the crime of obtaining money or some other benefit by deliberate deception. A BLOOMSBURY REFERENCE BOOK. Bloomsbury Publishing Plc 1999, London page 741.
5 GHANAIAN TIMES. Powdered Maize in Ampicillin Capsules. In Konotey-Ahulu FID What Is AIDS? Tetteh-A’Domeno Company, Watford, England 1989, Figure 5.6, page 75. ISBN: 0 9515442 0 9
6 Anand JK. “A fraud has been perpetuated …” Rapid Response 14 July 2017 to Mark H Ebell’s “deliberately withheld data” in WHO downgrades status of Oseltamivir BMJ 2017: 358: j3266 (12 July 2017) [Reference 7] and Kamran Abbasi’s “Missing billions” [Reference 2].
7 Ebell Mark H. WHO downgrades status of Oseltamivir: Important lessons from the Tamiflu story. https://doi.org/10.1136/bmj.j3266 BMJ 12 July 2017; 358:doi.10.1136/bmj.j3266
8 Konotey-Ahulu FID. Tafracher – http://bit.ly/2bRQ7B1 Invaluable Ghanaian devulgarizing word. BMJ Personal View 1(5953): 329 8 February 1975.
9 Dyer Clare. Journal agrees to retract paper after university found study was never done. BMJ 2013; 347:155 http://dx.doi.org/10.1136/bmj.f5500
September 5 2013
10 Eales L-J, Nye KE, Pinching AJ. Group specific component and AIDS. Erroneous data. Lancet 1988; i: 936
11 Konotey-Ahulu FID. Sickle Cell and Altitude. BMJ 1972; 2: 231-232
“If evidence obtained from my country cannot be scientific it should at least be true”
12 Tooke J. Enhancing the use of scientific evidence to judge the potential harms and benefits of medicines. Academy of Medical Science Report. 2017 http://acmedsci.ac.uk/policy/how-can-we-all-best-use-evidence
13 Zuckerman, S. Pride and Prejudice in Science. Aerospace Medicine 1974; 45: 638-647. [Also republished in Ghana Medical Journal 1975; 14: 52-60]
14 Smith Richard. The Trouble with Medical Journals. Royal Society of Medicine Press, London, 266 pages. ISBN 1-85315-5673-6
15 Smith Richard "It's time to criminalize serious scientific misconduct", in Interview with Nuwer R. New Scientist, 2986: 27 (15 September 2014).
16 Krumholz Harlan M. Statins evidence: when answers also raise questions. Sharing data is more likely to settle the debate than another review. BMJ 2016; 354:i1463 (doi:10.1136/bmj.i4963)
17 WHO Apology: Maria Cheng – The Associated Press: “WHO admits it botched early attempt to stop disease. Health Agency says response to recognize potential Ebola’s explosive spread too slow”. October 17 2014.
18 Godlee F. Statins: We need an independent review. BMJ 2016; 354: j4992 http://www.bmj.com/content/354/bmj.j4992
19 Bodkin Henry. Statins “needlessly doled out to millions”. Daily Telegraph Front Page August 1 2017
20 Sheldrick Giles. Statins: New Health Alert. Daily Express Front Page July 14 2007.
21 Knapton Sarah. End statins controversy with government review. Daily Telegraph. Friday September 2015, page 1
22 Lancet Editorial. Corruption in health care costs lives. Lancet 2006, February 11-17, page 447.
23 Sachs JD. A new global effort to control malaria. Science 2002; 298: 112-124.
24 Peters CJ. Hurrying towards disaster? Special Centennial Edition of PAHO, Washington DC, pp 14-20. [1902-2002]
25 Konotey-Ahulu, FID. What is AIDS? Tetteh-A'Domeno Company, Watford, England, 1989, 227 pages ISBN: 0 9515442 Reprinted 1996.
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27 Clinton President W J. Apology on behalf of the American Government to survivors of the Tuskegee Syphilis Experiment victims. Worldwide Radio & Television. May 16 1997.
28 Konotey-Ahulu FID. President Obama apologizes over Guatemala syphilis study: International cooperative research in jeopardy. BMJ Rapid response October 17 2010. www.bmj.com/content/341/bmj.c5494.full/reply#bmj_el_243183
29 Muller-Hill Berno. Murderous Science: Elimination by Scientific Selection of Jews, Gypsies, and Others – Germany 1933-1945 [Translated from German by G R Fraser] Oxford University Press, 1988.
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31 BBC July 8 2002 WORLD AT ONE names UN Official who said any country’s leader who failed to obey “Official Policy” should be “kicked out”.
32 Amofah G. Furore over Artesunate-Amodiaquine. Daily Graphic Accra 2006, Monday May 15, page 23.
33 Konotey-Ahulu FID. AIDS in Africa. Lancet 2002; 360 (9343): 1424 Nov 2. In response to “vaccine development in the developing world” in Weidle PJ, Mastro TD, Alison DG, Nkengasong J, Machara D.HIV/AIDS treatment and HIV vaccines for Africa.
34 Konotey-Ahulu FID. Konotey-Ahulu FID. Averting a malaria disaster. Lancet 1999; 354: 258. July 17.
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36 Lancet Annotations. The Biological Bomb. Lancet 1968 March 20; 1: 465 Lord Ritchie-Calder - “Public health in reverse: While one group of scientists is devoting its energies to prevent diseases, another is devising man-made epidemics”.
37 Tooke J. Judging the benefits and harms of medicines. Rapid Response 14 July 2017 to Joe Freer and Fiona Godlee www.bmj.com/content/357/bmj.j3129
38 Konotey-Ahulu FID. AIDS in Africa: Misinformation and Disinformation. Lancet 1987; 2(8552): 206-208 July 25
39 McCartney Margaret. Evidence in a post-truth world. BMJ 2016: 355: i6363 (Nov 28 2016) https://doi.org/10.1136/bmj.i6363
40 Konotey-Ahulu FID Evidence in a post-truth world: Scientists' Misinformation and Disinformation 19 December 2016 http://bit.ly/2igdDg2
41 Konotey-Ahulu FID. Ebola and Ethics: “Are vaccine trials going on somewhere in Africa?” www.bmj.com/content/350//bmj.h2105/rr-5 BMJ Rapid Response June 2 2015
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Competing interests: Self-Appointed Spokesman for Africa on Clinical Epidemiology [45 46], Public Health [47 48], and African Anthropogenetics [49 50 51].