Case in point...our favorite target, Steve Nissen. He is quite transparent --sort of -- about receiving all sorts of money from drug companies. But such transparency does not reveal his true biases. To wit we now see in print what many were telling drugwonks and the media, that his meta-analyses was a cherrypicking expedition designed to generate headlines but not establish a meaningful hypothesis ...
From the the online, early release of the Annals of Internal Medicine:
Uncertain Effects of Rosiglitazone on the Risk for Myocardial Infarction and Cardiovascular Death
George A. Diamond, MD; Leon Bax, MSc; and Sanjay Kaul, MD
"A recent, widely publicized meta-analysis of 42 clinical trials concluded that rosiglitazone was associated with an approximately 43% increased risk for myocardial infarction and an approximately 64% increased risk for cardiovascular death. The sensitivity of these conclusions to several methodological choices was not assessed. The meta-analysis was not based on a comprehensive search for all studies that might yield evidence about rosiglitazone’s cardiovascular effects. Studies were combined on the basis of a lack of statistical heterogeneity, despite substantial variability in study design and outcome assessment. The meta-analytic approach that was used required the exclusion of studies with zero events in the treatment and control groups. Alternative meta-analytic approaches that use continuity corrections show lower odds ratios that are not statistically significant. We conclude that the risk for myocardial infarction and death from cardiovascular disease for diabetic patients taking rosiglitazone is uncertain: Neither increased nor decreased risk is established."
http://www.annals.org/cgi/content/full/0000605-200710160-00182v1
Anyone care to do an analysis of how many times we called out Nissen in our blog as opposed to how many times his meta-analysis was challenged in the literature but NOT reported in the media? We are being chastised by small minds who are picking fights with us to generate page views. But that's another matter.
Now with respect to this idiotic proposal to require doctors to register every mug and pen with some Gift Registry (maybe the federal government can subcontract the work to Bed Bath and Beyond) let's just restate the obvious...there are many sources of money and many sources of bias. So let's require every doctor, every pharmacist, every epidemiologist, every researcher to list every gift, every speaking engagement, every grant, every affiliation, every incentive, every cash bonus, ever expert witness retainer, every consulting agreement with any foundation, non-profit organization, any voluntary or political affiliation that may be a source of or give an appearance of conflict.
So for example, providing consulting services to members of Congress of one political party should be listed. The sames goes if you are providing consulting services or expert witness services to the plaintiff group suing Eli Lilly regarding the weight gain from Zyprexa. That's you Dr. Furberg. If you are on a board or participate in programs that receive money from the trial bar like Jerry Avorn, you should disclose that. And if you receive money from George Soros and sit on the board of the the liberal Commonwealth Fund and work with the Prescription Project which gets it money from suing drug companies if you serve on an IOM panel looking at drug safety like David Blumenthal, you should disclose that too. Oh, and if you are a blowhard like Sid Wolfe you should have no problem at all detailing just how much cash you get from the trial bar, disclosing if you or the state PIRGs receive any money at all for consulting or working with or for other organizations in advancing legislation at the state level to impose this disclosure restrictions on doctors but not yourself ...
From the the online, early release of the Annals of Internal Medicine:
Uncertain Effects of Rosiglitazone on the Risk for Myocardial Infarction and Cardiovascular Death
George A. Diamond, MD; Leon Bax, MSc; and Sanjay Kaul, MD
"A recent, widely publicized meta-analysis of 42 clinical trials concluded that rosiglitazone was associated with an approximately 43% increased risk for myocardial infarction and an approximately 64% increased risk for cardiovascular death. The sensitivity of these conclusions to several methodological choices was not assessed. The meta-analysis was not based on a comprehensive search for all studies that might yield evidence about rosiglitazone’s cardiovascular effects. Studies were combined on the basis of a lack of statistical heterogeneity, despite substantial variability in study design and outcome assessment. The meta-analytic approach that was used required the exclusion of studies with zero events in the treatment and control groups. Alternative meta-analytic approaches that use continuity corrections show lower odds ratios that are not statistically significant. We conclude that the risk for myocardial infarction and death from cardiovascular disease for diabetic patients taking rosiglitazone is uncertain: Neither increased nor decreased risk is established."
http://www.annals.org/cgi/content/full/0000605-200710160-00182v1
Anyone care to do an analysis of how many times we called out Nissen in our blog as opposed to how many times his meta-analysis was challenged in the literature but NOT reported in the media? We are being chastised by small minds who are picking fights with us to generate page views. But that's another matter.
Now with respect to this idiotic proposal to require doctors to register every mug and pen with some Gift Registry (maybe the federal government can subcontract the work to Bed Bath and Beyond) let's just restate the obvious...there are many sources of money and many sources of bias. So let's require every doctor, every pharmacist, every epidemiologist, every researcher to list every gift, every speaking engagement, every grant, every affiliation, every incentive, every cash bonus, ever expert witness retainer, every consulting agreement with any foundation, non-profit organization, any voluntary or political affiliation that may be a source of or give an appearance of conflict.
So for example, providing consulting services to members of Congress of one political party should be listed. The sames goes if you are providing consulting services or expert witness services to the plaintiff group suing Eli Lilly regarding the weight gain from Zyprexa. That's you Dr. Furberg. If you are on a board or participate in programs that receive money from the trial bar like Jerry Avorn, you should disclose that. And if you receive money from George Soros and sit on the board of the the liberal Commonwealth Fund and work with the Prescription Project which gets it money from suing drug companies if you serve on an IOM panel looking at drug safety like David Blumenthal, you should disclose that too. Oh, and if you are a blowhard like Sid Wolfe you should have no problem at all detailing just how much cash you get from the trial bar, disclosing if you or the state PIRGs receive any money at all for consulting or working with or for other organizations in advancing legislation at the state level to impose this disclosure restrictions on doctors but not yourself ...
