Tuesday, February 19, 2013

Transparency in Medicine

          Doctor Ben Goldacre, author of "Bad Pharma: how drug companies mislead doctors and harm patients" (4th Estate, London) was interviewed by Anna Maria Tremonti recently on the CBC program, The Current. I found this a fascinating example of the critical importance of informational transparency in modern, information based societies like ours. 

          Dr Goldacre argues that industry sponsored clinical medical trials are flawed and, intentionally or unintentionally, mislead doctors and their patients, sometimes with tragic results. Thus, fully one half of clinical trial results are not published in peer reviewed journals. These are generally those trials which produce negative results. This, says Dr Goldacre, is not good science: all results, postive or negative, are required if researchers and medical practitioners are to make informed choices.

           Dr Goldacre discussed a case he studied in which 3 clinical trials showed that drug X functioned better than a sugar pill placebo. These trials were published. Not published: NINE trials which showed no difference in effect between drug X and placebos! Such a flagrant lack of transparency leads to misprescriptions (with risk of injury or death) or the introduction of new drugs of little or no proven value.

            Dr Goldacre, it should be noted, is a practicing doctor and actually rather sympathetic to the difficulties faced by drug companies. For example, some companies actually support disclosure of clinical trial results. He points out that much red tape is involved in setting up clinical trials, forcing companies to reduce the number of trials, their length or the number of patients in each trial. 

           One point I found particularly interesting. Dr Goldacre questions the value of testing new drugs against placebos instead of testing them against the best available currently used drug. This would seem, to me, a pre-eminently sensible procedure..


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