Hi Roy and list.
You have only given the reason for physicians to be well versed in the
principles underlying EBM. They must be able to recognize bogus
evidence when it is presented to them. THe best way to do this is with
a firm grounding in basic principles of probablistic thinking and
statistical logic (sorry if that sounded too pompous).
If we are to convince patients that there is a problem with the
superficial reading of the evidence, we must be able to critically
analyze the science and logic underlying the studies.
Dan
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Dan Mayer, MD
Professor of Emergency Medicine
Albany Medical College
47 New Scotland Ave.
Albany, NY, 12208
Ph; 518-262-6180
FAX; 518-262-5029
E-mail; [log in to unmask]
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>>> Roy Poses <[log in to unmask]> 08/11/05 4:01 PM >>>
Evidence-based health wrote:
>Thanks for your kind clarifications.
>
>I used to believe in EBM. No longer. After reading publications by 3
>former editors of major journals and by others (such as Jeanne Lenzer),
I
>feel overwhelmed by the challenge of finding unbiased evidence. I
>strongly recommend to any clinician, any medical student, any teacher
of
>EBM, to read:
>
>Jerome Kassirer's book "On the take. How Medicine's complicity with
big
>business can endanger your health" (Oxford Univ Press 2005)
>Marcia Angell's book "The Truth About the Drug Companies: How They
Deceive
>Us and What to Do About It" (Random House, 2004)
>John Abramson's book "Overdosed America: The Broken Promise Of American
>Medicine" (HarperCollins, 2004)
>Richard Smith's recent article: Medical Journals Are an Extension of
the
>Marketing Arm of Pharmaceutical Companies (PDF attached)
>
>At least, we should begin to realize the monstrous dimensions of the
problem.
>
>Kassirer explains: "...disclosure can be observed to the letter while
>avoiding the intent" (see attached PDF from the chapter "What can be
done?").
>Disclosures should be far more prominent (and not in a remote, general
>section) and far more explanatory. The risk of bias is so great that
it
>should be told at once, (not expecting the reader to look for it under
a
>generic "Help"), far more often and in far more pedagogic exposure and
>discussion.
>
>As to feedback's from readers, I had in mind a more transparent
process,
>as in the Cochrane library, where you can read uncensored views by
others.
>
We have discussed issues of conflict of interest, and manipulation of
research at length on Health Care Renewal
(http://hcrenewal.blogspot.com/) See the following posts since June:
Conflicts of interest at the NIH
http://hcrenewal.blogspot.com/2005/07/nih-report-revealed-ethical-problems.html
Promoting nesiritide beyond the data:
http://hcrenewal.blogspot.com/2005/07/tune-up-from-nesiritide.html
Bildil
http://hcrenewal.blogspot.com/2005/07/bildil-discrepancies-and.html
Pharma laundering their messages through medical education companies:
http://hcrenewal.blogspot.com/2005/07/pharma-goes-to-laundry.html
Conflicts of interest at university trustee level
http://hcrenewal.blogspot.com/2005/07/boston-university-back-tracked-on.html
NIH fired HIV whistle-blower
http://hcrenewal.blogspot.com/2005/07/report-vindicates-nih-whistle-blower.html
"Don't ask, don't tell" interview with Guidant CEO
http://hcrenewal.blogspot.com/2005/07/dont-ask-dont-tell-health-affairs.html
Pfizer and conflicts of interest in the Kelo case
http://hcrenewal.blogspot.com/2005/07/kelo-case-pfizer-and-conflicts-of.html
Australian survey on research integrity
http://hcrenewal.blogspot.com/2005/06/australian-survey-of-threats-to.html
marketing of Vioxx
http://hcrenewal.blogspot.com/2005/06/waxman-summarizes-marketing-of-vioxx.html
Pfizer's trials of fixed-combination lipid lowering drugs
http://hcrenewal.blogspot.com/2005/06/crying-all-way-to-bank-revisited.html
secrecy and censorship
http://hcrenewal.blogspot.com/2005/06/secrecy-and-censorship.html
dispute at American Hypertension Society over industry role
http://hcrenewal.blogspot.com/2005/06/dispute-at-american-society-of.html
scientists behaving badly
http://hcrenewal.blogspot.com/2005/06/scientists-behaving-badly-and.html
Pfizer dissident unplugged
http://hcrenewal.blogspot.com/2005/06/pfizer-dissident-unplugged.html
Merck alleged to have threatened researchers skeptical about Vioxx
http://hcrenewal.blogspot.com/2005/06/allegations-that-merck-threatened.html
medical whistle-blowers' roundtable
http://hcrenewal.blogspot.com/2005/06/medical-whistleblowers-roundtable.html
Our blog is searchable, and there is considerably more in earlier posts,
including considerable discussion of ghost-writing.....
Roy M. Poses MD
Clinical Associate Professor
Brown University School of Medicine
<[log in to unmask]>
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