Suggest read S. Goodman's editorial proposal to use confidence interval. CI saves us from seeing the results as black or white. (Nature 6 Dec. 2018 Vol 564 p.7.
I hope all of us will someday become Baysesians!
Dr. Donald E. Stanley
Associates in Pathology
500 West Neck Road
Nobleboro, ME.04555
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207-563-1560
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From: Evidence based health (EBH) [[log in to unmask]] on behalf of Djulbegovic, Benjamin [[log in to unmask]]
Sent: Thursday, December 13, 2018 5:18 PM
To: [log in to unmask]
Subject: Re: Evidence in everyday and legal senses
This message originated outside of MaineHealth. Use caution when opening attachments, clicking links or responding to requests for information.
My views are to look at the COI (industry- or otherwise) as a technical issue and try to figure out where in design, conduct and the analyses bias had crept in i.e., to identify the mechanism of bias. To date, I believe, data shows that industry does better job (at least in reporting) of the issues such as sample size as well as randomization methods, allocation concealment, drop outs, blinding (all ingredients of the Cochrane Risk of Bias tool). Industry does worse job in the choice of comparator and interpretation of the study results (spin). This has been known for a while now, and lends itself to better to evidence-based, or risk-adopted approach to the management COI. Instead, we still have these black and white rules, to the point that people worry about appearances more than about truth.
ben
From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of McCormack, James
Sent: Thursday, December 13, 2018 1:38 PM
To: [log in to unmask]
Subject: Re: Evidence in everyday and legal senses
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Hi Rod and Jeremy - I would like to suggest the debate about whether or not to include evidence produced by industry or to have reviews funded by industry is an ideological debate not a scientific debate.
I think this because the ultimate answer can’t be found by discussing the science or doing more studies - the debate can be informed by science - but ultimately it comes down to an ideological decision or position
I personally haven’t taken money from industry in 30 years - the annual primary care course course I run in Vancouver is sponsorship free (some of our speakers do have some industry ties on occasion and this is declared) and my Best Science Medicine podcast is also unsponsored - but they are sponsorship free not because of science but purely because I don’t want to have that appearance of conflict of interest associated with what I do - my decision was ultimately ideological not scientific.
I am definitely familiar with the evidence around industry sponsorship bias https://www.cochrane.org/MR000033/METHOD_industry-sponsorship-and-research-outcome<https://urldefense.proofpoint.com/v2/url?u=https-3A__www.cochrane.org_MR000033_METHOD-5Findustry-2Dsponsorship-2Dand-2Dresearch-2Doutcome&d=DwMGaQ&c=ST5Jxgx_zZ9nYuPWkSm01Luus8kzn0TCuX9tmQgnWms&r=rjsxb-GTyTNow3RMYbEzyQ&m=aZl67OIcpHfoCkQ0PF0FdvO2h_Kbtyfl-hZZS_52K_I&s=hyuajwDP7ao3WTplEKBRbdVIFh3IqK0pcM_VZK4MH74&e=> but I think that review also showed that industry trials were at a similar risk of bias to non industry studies and in some cases at a lower risk of bias than non-industry trials.
I also have seen Peter’s "style and approach” and while he is sometimes more in your face than others I see this a lot in a number of people/academics with industry concerns. One person (not Peter) expressed to me he felt he was “in a war with the drug industry”. IMHO if you feel like you are in a war you very possibly might do things that people will do in wars (many not appropriate) because you feel so passionately about your cause.
I have seen a number of people who would be considered anti-industry make statements about industry - especially verbal comments - that are not uncommonly grossly exaggerated but patently false. Weirdly or maybe sadly, their approach is sometimes no different than how the industry not uncommonly puts spin on their research and marketing. I understand that when you have spent your entire career either in industry or against industry you cannot help but develop a number of biases.
Now none of the above should be interpreted to suggest that I don’t think there is an important problem with the way evidence is done and presented by industry. But there is also a problem with how non-industry research is done and presented.
There is no excuse for brashness and bad behaviour when it comes to scientific debate (although I bet we have all had our moments) but I can appreciate that sometimes enough is enough - maybe that is where the board was on this. I think passion is important but unbridled passion can not only be annoying but also destructive and counter productive.
My approach is “I truly don’t care what the results are, I just care to know what the results are” - hope that makes sense.
Would love the opinions or ideas of others on this issue.
And if they are different than mine I will just be brash and difficult and tell you why you are completely wrong - JUST KIDDING!!!!
James
On Dec 13, 2018, at 11:39 AM, Jeremy Howick <[log in to unmask]<mailto:[log in to unmask]>> wrote:
Hi Rod,
Thanks for sharing your thoughts. I think there was a scientific debate. Based on Peter’s letter, the scientific debate was the involvement of industry-funded Cochrane reviewers, which led to a debate about the nature of science (reviews):
* Peter cites scientific evidence that there are relevant differences between evidence produced by industry-funded authors of studies, and evidence produced by studies that are not industry funded. See here: https://www.ncbi.nlm.nih.gov/pubmed/28207928<https://urldefense.proofpoint.com/v2/url?u=https-3A__www.ncbi.nlm.nih.gov_pubmed_28207928&d=DwMGaQ&c=ST5Jxgx_zZ9nYuPWkSm01Luus8kzn0TCuX9tmQgnWms&r=rjsxb-GTyTNow3RMYbEzyQ&m=aZl67OIcpHfoCkQ0PF0FdvO2h_Kbtyfl-hZZS_52K_I&s=KhXg_QsKu7npNCE_YPJLSn9nUNjzkiJkYFwclgNmbgs&e=>.
* Some members of the Cochrane board wanted to loosen the ban against industry funded reviews.
* This led to a conflict between Peter’s view about evidence, and that of some of the Cochrane members. This is a scientific debate.
I don’t deny that Peter is brash when confronted with views that oppose his (I have experienced that personally). However it is unscientific to allow his brashness to eclipse his reason for opposing the views of some members of the Cochrane board.
Best wishes,
Jeremy
From: "[log in to unmask]<mailto:[log in to unmask]>" <[log in to unmask]<mailto:[log in to unmask]>> on behalf of Rod Jackson <[log in to unmask]<mailto:[log in to unmask]>>
Reply-To: Rod Jackson <[log in to unmask]<mailto:[log in to unmask]>>
Date: Thursday, 13 December 2018 at 02:25
To: "[log in to unmask]<mailto:[log in to unmask]>" <[log in to unmask]<mailto:[log in to unmask]>>
Subject: Re: Evidence in everyday and legal senses
Hi Susan. Fair point. My ‘evidence’ of bad behaviour is all second hand albeit from multiple sources and related to settings outside Cochrane. However the point of my note to the list was simply to ask that we focus on the specific issues from the scientific evidence at the centre of this issue rather than on whether there was a conspiracy to stifle scientific debate.
When someone on the list has a question or presents a critique of some evidence, we can have a constructive scientific debate. That’s what I have enjoyed about this list. However when someone states that there is a conspiracy to stifle scientific debate, without specifying a specific scientific issue to discuss, there is no issue to debate.
If there is someone on the list who knows about the scientific controversy that led to Peter’s expulsion and would be willing to summarise the key issues for the list, I would be happy to join you and others in a scientific debate.
Cheers Rod
* * * * * * * *
sent from my phone
On 13/12/2018, at 13:47, Bewley, Susan <[log in to unmask]<mailto:[log in to unmask]>> wrote:
Dear Rod
If you are 'not involved in Cochrane in any way', how can you so confidently break your silence to share 'common knowledge' about things you've not witnessed and that might, or might not, be right and fair? Would it not be better to advise your at least 2nd-hand sources to speak up and act within proper structures rather than sharing what is (essentially) gossip about an 'ex-member' you don't even have the courtesy to name on the global EVIDENCE-BASED-HEALTH@JISC LIST?
My reflections have been particularly piqued recently having been caught up short on an issue here in the UK where the 'common knowledge' was: (a) of a serious nature that could destroy individuals, careers and reputations, (b) needed evidencing in ways that will withstand the cross-questioning of barristers, and (c) now that it's being dealt with, the latest rumour that's circulating turns out to be the opposite of action being taken! Our local story hasn't yet reached a conclusion, and continues to unfold through multiple jeopardy disciplinary processes, regulators and courts. Legal processes (which is where conflicts end) take time, attention to detail, and should start with presumptions of innocence.
So, regarding Peter Gotzsche's expulsion, I would be more reassured by hearing about just procedures rather than bad-mouthing and opaque processes. Even from my faraway distance, the die seemed to be cast a long time ago https://www.cochrane.org/news/statement-cochrane<https://urldefense.proofpoint.com/v2/url?u=https-3A__www.cochrane.org_news_statement-2Dcochrane&d=DwMGaQ&c=ST5Jxgx_zZ9nYuPWkSm01Luus8kzn0TCuX9tmQgnWms&r=rjsxb-GTyTNow3RMYbEzyQ&m=aZl67OIcpHfoCkQ0PF0FdvO2h_Kbtyfl-hZZS_52K_I&s=xE-Oyh3MIrCPD597MHgMygdO-rsPT9KZh9SlcY9ne4g&e=> (an entangled scientific and 'behaviour' issue), and I can't be the only person thinking there's a bad smell about it all....
I'll own up that I don't (and can't) know the full story and will just have to wait patiently. Maybe you'd like to join me?
Susan Bewley MA MD FRCOG
Professor (emeritus) of Obstetrics and Women's Health
c/o Department of Women and Children's Health
School of Life Course Sciences
King's College London
10th Floor, North Wing
St. Thomas' Hospital
Westminster Bridge Road
LONDON SE1 7EH
Tel: 020 7188 3639
Mob 07984 907 548
P Please consider the environment before printing this e-mail!
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From: Evidence based health (EBH) <[log in to unmask]<mailto:[log in to unmask]>> on behalf of Rod Jackson <[log in to unmask]<mailto:[log in to unmask]>>
Sent: 07 December 2018 20:15:18
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: -Ioannidis: Cochrane crisis: secrecy, intolerance, and evidence-based values.
Dear Juan. I’m not involved with Cochrane in any way, but it is common knowledge that the ‘bad behaviour’ you acknowledge was real and not a one-off incident, nor limited to the ex-member’s interactions with Cochrane. I don’t believe any team should have to put up with unacceptable behaviour from members. I don’t in the teams I’m involved in.
So I am concerned that you may be confusing the appropriate response by a team to the unacceptable behaviour of a member with ‘silencing science.’
I have remained silent throughout this whole discussion, but after reading your latest communication, I finally decided to respond.
There may be a Cochrane crisis but please can we focus specifically on the science and move on from how Cochrane managed the ‘bad behaviour’ of a member. It seems very unlikely that this was a conspiracy to stifle scientific debate. While critical contrarian voices are essential to scientific debate, ‘extreme voices’ have a tendency to inhibit rather than facilitate debate.
Cheers Rod Jackson
* * * * * * * *
sent from my phone
On 8/12/2018, at 06:52, Juan Gérvas <[log in to unmask]<mailto:[log in to unmask]>> wrote:
-Ioannidis: Cochrane crisis: secrecy, intolerance, and evidence-based values.
-Despite the statement of the Board that what has happened is not about freedom of speech, scientific debate, tolerance, dissent, or criticism, it is precisely these issues that unavoidably surface in this clash, regardless of whether any “bad behavior” is also implicated or not. One may claim that Cochrane needs to protect its reputation for balanced, unbiased, disinterested assessments and that extreme voices harm this reputation. However, one may conversely argue that unbiasedness is indeed a hard-won strength of Cochrane and critical contrarian voices are essential contributors to this legacy. Anyone can and will unavoidably wonder: under its recent CEO leadership, is Cochrane silencing scientists? Is it being subverted by commercialization? Is it paralyzed? Has it been hijacked?
@DaHammerstein @PGtzsche1 @cochranecollab @nogracias_eu
https://onlinelibrary.wiley.com/doi/abs/10.1111/eci.13058<https://urldefense.proofpoint.com/v2/url?u=https-3A__emea01.safelinks.protection.outlook.com_-3Furl-3Dhttps-253A-252F-252Fonlinelibrary.wiley.com-252Fdoi-252Fabs-252F10.1111-252Feci.13058-26data-3D01-257C01-257Csusan.bewley-2540KCL.AC.UK-257C9c572314be424d40277508d65c80d82d-257C8370cf1416f34c16b83c724071654356-257C0-26sdata-3DFQW9lxOhTj54fdgG2J7pSv5M1qu3yUtNcaW9KDr3Hjw-253D-26reserved-3D0&d=DwMGaQ&c=ST5Jxgx_zZ9nYuPWkSm01Luus8kzn0TCuX9tmQgnWms&r=rjsxb-GTyTNow3RMYbEzyQ&m=aZl67OIcpHfoCkQ0PF0FdvO2h_Kbtyfl-hZZS_52K_I&s=mK3xYiRj3ByaQi1MtmVC2HZ23hMOKAyE79IUFkY0vPE&e=>
-just in case, ask me the PDF
Spanish version
La ciencia necesita libertad de pensamiento y de crítica y tolerancia a la discrepancia.
La ciencia busca la verdad, no sirve a creencias personales, prejuicios ni venganzas.
La ciencia debería usar datos, no amargura.” John Ioannidis
http://www.nogracias.eu/2018/12/07/la-crisis-cochrane-secretos-intolerancia-valores-la-medicina-basada-la-evidencia-john-ioannidis/<https://urldefense.proofpoint.com/v2/url?u=https-3A__emea01.safelinks.protection.outlook.com_-3Furl-3Dhttp-253A-252F-252Fwww.nogracias.eu-252F2018-252F12-252F07-252Fla-2Dcrisis-2Dcochrane-2Dsecretos-2Dintolerancia-2Dvalores-2Dla-2Dmedicina-2Dbasada-2Dla-2Devidencia-2Djohn-2Dioannidis-252F-26data-3D01-257C01-257Csusan.bewley-2540KCL.AC.UK-257C9c572314be424d40277508d65c80d82d-257C8370cf1416f34c16b83c724071654356-257C0-26sdata-3Dp4k00BfFd35IzVIatk-252FhrfB9z3cYel2n9eMwF9sCn9k-253D-26reserved-3D0&d=DwMGaQ&c=ST5Jxgx_zZ9nYuPWkSm01Luus8kzn0TCuX9tmQgnWms&r=rjsxb-GTyTNow3RMYbEzyQ&m=aZl67OIcpHfoCkQ0PF0FdvO2h_Kbtyfl-hZZS_52K_I&s=ZJt7g79Zu7ZxWmVYouBP-u4DX8LpFQX9Tvn60bepnLU&e=>
-un saludo juan gérvas @JuanGrvas
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