Dear Simon
I was interested to read your comments re in-built bias.
Coming from the pharmaceutical industry and now specialising in providing
EBM reports to it, I have to take issue.
Unfortunately, you appear to have a presumption that anything emanating
from the pharmaceutical industry must be, by definition, biased at best,
wrong at worst.
In my experience, there is little point in the industry producing
erroneous reports. I say this for a number of reasons.
1. Much of the work that I currently do for industry is to examine the
current quality of treatments. There are a number of reasons for this:
firstly, there is little point in a company trying to develop a drug or
device for which there are already good products/devices available.
Secondly, the cost of developing a new drug and bringing it to market is
now estimated at around $800 million - a big number whoever you are - and
companies have responsibilities to themselves and their stakeholders
(including you and I) to ensure that money spent on research is done so
properly.
2. The 'beauty' of EBM work is that it goes a significant way to reducing
bias. I recognise that there is publication bias, i.e., until there is a
journal of 'negative results' there will always be a bias towards
publication of positive results. However, by allowing meta-analysis we can
go a significant way towards finding the 'truest' results.
3. There is always the problem of trying to review older therapies in the
face of new alternatives and quite honestly, there is no easy way round
this. I think it behoves those seeking to introduce new therapies to
undertake good RCTs to prove their point.
4. Regarding the ethics of RCTs, I would consider the only purpose of RCTs
is to remove 'equipoise', i.e., where one is not able to make a
distinction between treatments on current evidence. This includes studying
new treatments v older modalities. Patients must give clear informed
consent to entry into clinical trials according to the Declaration of
Helsinki
I could go on and challenge each of the points but I am sure others will
jump in!
Dr Richard JM Phillips MBBS FFPM MBA
Principal and Managing Director
The Goffin Consultancy Ltd
Riding House,
Bossingham Road
Stelling Minnis
Canterbury, Kent CT4 6AZ
United Kingdom
Tel: +44 (0)1227 709220
Fax: +44 (0)1227 709721
Email: [log in to unmask]
Web: www.goffin-network.co.uk
|