Perhaps you've seen this commercial. A pretty lady wearing an obviously new black shirt talks about how horrible it is when you wash your darks and they get all faded. Then she propounds the benefits of Woolite Dark Laundry detergent. Ie. If you wash your darks with this product, they will not fade.
To prove it, they show a black shirt washed 20 times in their product and one washed 20 times in the National Leading Detergent. Quelle surprise! The NLD makes the black shirt fade terribly.
What I noticed for the first time today, after seeing this obnoxious commercial innumerable times, is that right below the subtitling "National Leading Detergent" are written in very small text the words "Plus Bleach".
Well ya don't say? A detergent PLUS bleach fades clothes more than another detergent WITHOUT bleach. As Thomas the Train would say, bust my buffers.
Turns out CBC Street Cents compared this "miracle" product to the Cheer Dark Laundry, and Cheer mopped the house. Way to go Street Cents.
Anyways, it seems like a small annoyance but it goes back to my general distaste of the misleading tactics advertisers use to sell their clients products. This distaste is particularly strong for direct-to-consumer pharmaceutical advertisements, given the potential consequences of taking action based on information advertised, but sometimes it seems like caveat emptor isn't quite enough when the other side employs such dirty tactics.
Maybe if we wash them all with the national leading detergent, they'll clean up their act.
Do you have any examples of misleading ads you can't stand?
Wednesday, January 30, 2008
Deep freeze
So for the first time in my life I saw a weather warning for what is called a "flash freeze". I now know what it feels like.
Yesterday it was 4 degrees Celsius (46F). Today it is -29 degrees Celsius (-20F). Yes, that is a minus sign. There are winds of 80-100km/h (50-62 mph), complete whiteouts from the blowing snow, and up to 15cm (6 inches) of snow in some places.
The lovely part of the flash freeze is that until about 6am this morning, it was still above freezing and was pouring rain. So the roads have a nice thick later of glare ice on them. The driving is treacherous. Every highway out of the city is closed and most of the businesses in town are shut down for the day. Even the doctors offices are closed.
I, however, am still at work. Crap.
Yesterday it was 4 degrees Celsius (46F). Today it is -29 degrees Celsius (-20F). Yes, that is a minus sign. There are winds of 80-100km/h (50-62 mph), complete whiteouts from the blowing snow, and up to 15cm (6 inches) of snow in some places.
The lovely part of the flash freeze is that until about 6am this morning, it was still above freezing and was pouring rain. So the roads have a nice thick later of glare ice on them. The driving is treacherous. Every highway out of the city is closed and most of the businesses in town are shut down for the day. Even the doctors offices are closed.
I, however, am still at work. Crap.
Friday, January 25, 2008
Is two cups of Joe one too many?
As a thematic partner to my previous post, I thought I would quickly comment on the story in the news about two cups of coffee or more a day in pregnancy increasing the risk of miscarriage. First of all, bravo to CTV.ca for having a link to the full text article. That is a rare light in the dim world of health reporting.
The study has some problems inherent in its design in that you cannot randomly assign some pregnant women to drink lots of coffee and some to drink sugar water and see who has more miscarriages. It's not ethical. So you do what's called a cohort study. You take a bunch of pregnant women, monitor and record their various habits, nutritional and otherwise, and then follow them through pregnancy. You than look at one particular habit, like coffee consumption, and see if those with high reported levels of coffee consumption had higher rates of miscarriage than those with lower rates. The problem is that cohort studies are often plagued by lots of possible confounding factors (see previous post). Luckily this study seemed to account for them nicely.
Overall this study was well done and the press might not have totally blown it. Essentially what it found was that women who drank coffee containing 200mg or more of caffeine a day had double the rates of miscarriage compared to those who drank less than 200mg. (One 6-oz cup of coffee contains roughly 100mg of caffeine). The risk seemed to increase with the amount consumed as well.
Really though, it only confirms what experts and physicians have stressed all along: in pregnancy, moderation is everything (except in alcohol consumption, smoking, and recreational drug use; no amount is safe). Of course if you pound back 5 double espressos every day you may not be doing your baby any favors. But it looks like for now a single NORMAL size of coffee a day is no harm (stay away from my mugs though; they carry about 300mg each!)
Fine by me anyways. The less coffee my wife can drink when pregnant, the more for me!
The study has some problems inherent in its design in that you cannot randomly assign some pregnant women to drink lots of coffee and some to drink sugar water and see who has more miscarriages. It's not ethical. So you do what's called a cohort study. You take a bunch of pregnant women, monitor and record their various habits, nutritional and otherwise, and then follow them through pregnancy. You than look at one particular habit, like coffee consumption, and see if those with high reported levels of coffee consumption had higher rates of miscarriage than those with lower rates. The problem is that cohort studies are often plagued by lots of possible confounding factors (see previous post). Luckily this study seemed to account for them nicely.
Overall this study was well done and the press might not have totally blown it. Essentially what it found was that women who drank coffee containing 200mg or more of caffeine a day had double the rates of miscarriage compared to those who drank less than 200mg. (One 6-oz cup of coffee contains roughly 100mg of caffeine). The risk seemed to increase with the amount consumed as well.
Really though, it only confirms what experts and physicians have stressed all along: in pregnancy, moderation is everything (except in alcohol consumption, smoking, and recreational drug use; no amount is safe). Of course if you pound back 5 double espressos every day you may not be doing your baby any favors. But it looks like for now a single NORMAL size of coffee a day is no harm (stay away from my mugs though; they carry about 300mg each!)
Fine by me anyways. The less coffee my wife can drink when pregnant, the more for me!
Night sweats
As if postmenopausal women needed more to keep them awake at night.
Last week a study published in the British Medical Journal grabbed headlines across the nation. For years, the Osteoporosis Society of Canada has told women 50 or older that they should get 1500mg of calcium a day from all sources. Now this study comes out and says that they should no longer strive for this target because doing so can increase the risk of heart attack, stroke, and...dunh, dunhh, dunhhhhh....DEATH!
What is a night sweating middle-aged woman to do? All this time she thought that she was following the rules and taking extra calcium to reduce the risk of osteoporotic fractures. No one likes a broken wrist or fractured hip. But what's this? The pay off for a fracture-free life is DEATH! Say it ain't so?
Pharmadaddy to the rescue. Given that I have advanced education in a health profession and have taken extra courses in analyzing medical literature, I feel it is my responsibility to go to the source and find out whether this study considered newsworthy is YOUworthy. Were there any problems with the study that might bring its conclusions into question? What are the experts saying and has this study changed their recommendations? Most importantly, should YOU change what you do based on this new information?
First of all, this study was a well done study in terms of design. However, it seems that the conclusions drawn from the results and the ensuing conclusions drawn in the lay press are not supported by the data, or at least not until further analysis is done.
When you compare a group that took calcium supplements against a group that took a sugar pill, and you see that those who took the calcium had higher rates of heart attack, stroke, and sudden death you could assume that the cause of those higher rates is the calcium. This assumption would be based on the notion that if the members of these two groups were selected at random, than other characteristics that might increase risk of heart attack, stroke, and death would be randomly distributed amongst the two groups evenly, and therefore not be a factor.
Typically what is done with such studies is to look at possible confounding factors, characteristics that may exist in each group that might affect the rates of cardiovascular disease besides taking calcium or not. For example, having previously had a heart attack would increase ones risk of having another, so if the group taking calcium was shown to have a higher proportion of individuals with a history of heart attacks than those taking placebo, you could argue that the increased risk of the nasties might have been due to that difference in baseline characteristics. Or at the least, because of the existence of this potential confounder, you can state that the conclusion that calcium increases heart attack risk is not supported by the data.
As a way of showing readers that confounding variables have been analyzed, study authors show the proportions of baseline characteristics in each group and show the results of a statistical test to determine if the proportions differed significantly between the two groups. Strike one for this study. While they showed the different levels of characteristics between the two groups, they never showed whether these differences were significant or merely based on chance alone. Big no no.
Once you do that first statistical test, if you find any characteristics that differ significantly between the two groups, you can then do what is called a regression analysis. This is a fancy statistical calculation that basically determines whether, in the case of this study, the increased risk of heart attacks would have changed just as much if both groups had the same baseline characteristic. It allows you to see how removing the confounding factor from the equation affects the result. So if the result is significant at first glance, but the regression analysis shows that if you account for differences in history of heart attack and the result disappears, you know that the conclusion was confounded by differences in that baseline characteristic. Strike two for this study: while they did perform a regression analysis on some factors they did not on all possible confounders, which we don't at first know, because they didn't report on them.
What were some potential confounders? The following characteristics differed significantly between the two groups:
1. Total cholesterol level, the calcium group having higher average levels
2. % current smokers, the calcium group having a higher %
3. % former smokers, calcium group having more
4. % with previous high blood pressure
5. % with previous heart disease
6. % with previous high cholesterol
7. % with previous stroke, all of the last four being higher in the calcium group
Therefore, the calcium group already had more potential risk factors than the placebo group, meaning that they probably already had a higher baseline risk of heart attack, stroke, and death. But you don't know if the differences were large enough to erase the effects of the calcium unless you perform a regression analysis.
This study only did so on a few characteristics. They report that previous ischemic heart disease was found to be an independent risk factor for rates of heart attack, stroke, and death. But they neglect to mention that the calcium group had a significantly higher proportion of individuals with previous ischemic heart disease. Hmmm. Also, they never performed regression analysis on % previous stroke, % current smokers or % former smokers, all of which could potentially be independent risk factors for the cardio triad mentioned above.
Finally, when all was said and done, the weakest aspect of this study was that the only significant result found that matters a sniff is the event rate per 1000 person years (this adjusts for people dying off or leaving the study at different times) of CONFIRMED events of heart attack, stroke, or sudden death. Many rates reported in the lay press were from the section about reported events that were never confirmed, only reported by the study subjects. So maybe Mrs. Smith thought she had a heart attack, but it was really a bad panic attack, etc. And even this one significant result is just barely so.
For those who didn't have to suffer through STATS 101, a confidence interval is the range within which the true value of the result is likely to exist 95% of the time. It is a way of quantifying the uncertainty inherent in any scientific result. In medical studies, if the confidence interval for a hazard ratio (ie. a hazard ratio of 2 would roughly mean that those in the treatment group are twice as likely to suffer a nasty event as those in the placebo group) crosses 1, than the result is insignificant, because 1 means both groups have the same risk. Well, the 95% CI for this result was 1.01-2.04. That means that those taking calcium could be anywhere from 1.01X as likely to suffer a heart attack, stroke, or death than those not taking it to 2.04X as likely. Let's just say the bottom end of that CI approaches 1 a little too closely for my comfort.
One last thing to consider is the results of other studies that looked at this question. Many have been inconclusive, but one of the biggest showed no change in cardiovascular event rates due to calcium supplementation. Although this may be due to the different formulations used in each study, it is questionable.
All in all, I was highly disappointed with this study and the media attention that followed. Postmenopausal women have enough to worry about ever since the Women's Health Initiative study was released and the pathetic health reporting that ensued. And as long as Suzanne Somers is alive and spouting the unsubstantiated trash about bioidentical hormone replacement therapy, they will always have plenty more to worry about. So why pile this on top it of it all? Especially when there is no basis for it.
All I can say is that I will not be changing the recommendations I make to my patients regarding calcium supplementation. Until I see this study impact clinical practice guidelines published by the Osteoporosis Society or the Society of Obstetricians and Gynecologists of Canada, I will stand firm, and so should you. Before you ever change any medications or supplements you are taking or not taking, always consult your health care provider.
Last week a study published in the British Medical Journal grabbed headlines across the nation. For years, the Osteoporosis Society of Canada has told women 50 or older that they should get 1500mg of calcium a day from all sources. Now this study comes out and says that they should no longer strive for this target because doing so can increase the risk of heart attack, stroke, and...dunh, dunhh, dunhhhhh....DEATH!
What is a night sweating middle-aged woman to do? All this time she thought that she was following the rules and taking extra calcium to reduce the risk of osteoporotic fractures. No one likes a broken wrist or fractured hip. But what's this? The pay off for a fracture-free life is DEATH! Say it ain't so?
Pharmadaddy to the rescue. Given that I have advanced education in a health profession and have taken extra courses in analyzing medical literature, I feel it is my responsibility to go to the source and find out whether this study considered newsworthy is YOUworthy. Were there any problems with the study that might bring its conclusions into question? What are the experts saying and has this study changed their recommendations? Most importantly, should YOU change what you do based on this new information?
First of all, this study was a well done study in terms of design. However, it seems that the conclusions drawn from the results and the ensuing conclusions drawn in the lay press are not supported by the data, or at least not until further analysis is done.
When you compare a group that took calcium supplements against a group that took a sugar pill, and you see that those who took the calcium had higher rates of heart attack, stroke, and sudden death you could assume that the cause of those higher rates is the calcium. This assumption would be based on the notion that if the members of these two groups were selected at random, than other characteristics that might increase risk of heart attack, stroke, and death would be randomly distributed amongst the two groups evenly, and therefore not be a factor.
Typically what is done with such studies is to look at possible confounding factors, characteristics that may exist in each group that might affect the rates of cardiovascular disease besides taking calcium or not. For example, having previously had a heart attack would increase ones risk of having another, so if the group taking calcium was shown to have a higher proportion of individuals with a history of heart attacks than those taking placebo, you could argue that the increased risk of the nasties might have been due to that difference in baseline characteristics. Or at the least, because of the existence of this potential confounder, you can state that the conclusion that calcium increases heart attack risk is not supported by the data.
As a way of showing readers that confounding variables have been analyzed, study authors show the proportions of baseline characteristics in each group and show the results of a statistical test to determine if the proportions differed significantly between the two groups. Strike one for this study. While they showed the different levels of characteristics between the two groups, they never showed whether these differences were significant or merely based on chance alone. Big no no.
Once you do that first statistical test, if you find any characteristics that differ significantly between the two groups, you can then do what is called a regression analysis. This is a fancy statistical calculation that basically determines whether, in the case of this study, the increased risk of heart attacks would have changed just as much if both groups had the same baseline characteristic. It allows you to see how removing the confounding factor from the equation affects the result. So if the result is significant at first glance, but the regression analysis shows that if you account for differences in history of heart attack and the result disappears, you know that the conclusion was confounded by differences in that baseline characteristic. Strike two for this study: while they did perform a regression analysis on some factors they did not on all possible confounders, which we don't at first know, because they didn't report on them.
What were some potential confounders? The following characteristics differed significantly between the two groups:
1. Total cholesterol level, the calcium group having higher average levels
2. % current smokers, the calcium group having a higher %
3. % former smokers, calcium group having more
4. % with previous high blood pressure
5. % with previous heart disease
6. % with previous high cholesterol
7. % with previous stroke, all of the last four being higher in the calcium group
Therefore, the calcium group already had more potential risk factors than the placebo group, meaning that they probably already had a higher baseline risk of heart attack, stroke, and death. But you don't know if the differences were large enough to erase the effects of the calcium unless you perform a regression analysis.
This study only did so on a few characteristics. They report that previous ischemic heart disease was found to be an independent risk factor for rates of heart attack, stroke, and death. But they neglect to mention that the calcium group had a significantly higher proportion of individuals with previous ischemic heart disease. Hmmm. Also, they never performed regression analysis on % previous stroke, % current smokers or % former smokers, all of which could potentially be independent risk factors for the cardio triad mentioned above.
Finally, when all was said and done, the weakest aspect of this study was that the only significant result found that matters a sniff is the event rate per 1000 person years (this adjusts for people dying off or leaving the study at different times) of CONFIRMED events of heart attack, stroke, or sudden death. Many rates reported in the lay press were from the section about reported events that were never confirmed, only reported by the study subjects. So maybe Mrs. Smith thought she had a heart attack, but it was really a bad panic attack, etc. And even this one significant result is just barely so.
For those who didn't have to suffer through STATS 101, a confidence interval is the range within which the true value of the result is likely to exist 95% of the time. It is a way of quantifying the uncertainty inherent in any scientific result. In medical studies, if the confidence interval for a hazard ratio (ie. a hazard ratio of 2 would roughly mean that those in the treatment group are twice as likely to suffer a nasty event as those in the placebo group) crosses 1, than the result is insignificant, because 1 means both groups have the same risk. Well, the 95% CI for this result was 1.01-2.04. That means that those taking calcium could be anywhere from 1.01X as likely to suffer a heart attack, stroke, or death than those not taking it to 2.04X as likely. Let's just say the bottom end of that CI approaches 1 a little too closely for my comfort.
One last thing to consider is the results of other studies that looked at this question. Many have been inconclusive, but one of the biggest showed no change in cardiovascular event rates due to calcium supplementation. Although this may be due to the different formulations used in each study, it is questionable.
All in all, I was highly disappointed with this study and the media attention that followed. Postmenopausal women have enough to worry about ever since the Women's Health Initiative study was released and the pathetic health reporting that ensued. And as long as Suzanne Somers is alive and spouting the unsubstantiated trash about bioidentical hormone replacement therapy, they will always have plenty more to worry about. So why pile this on top it of it all? Especially when there is no basis for it.
All I can say is that I will not be changing the recommendations I make to my patients regarding calcium supplementation. Until I see this study impact clinical practice guidelines published by the Osteoporosis Society or the Society of Obstetricians and Gynecologists of Canada, I will stand firm, and so should you. Before you ever change any medications or supplements you are taking or not taking, always consult your health care provider.
Wednesday, January 23, 2008
His first cold
Today marked the emergence of our little guy's first bad cold. He has had some sniffles and runny nose before, but nothing like this. He woke up this morning, very upset and coughing. Poor little guy was just hacking up a storm and really didn't like how it felt. We walked around a bit, but he was just so snuggly and not his playful little self. I thought a hot bath might help so we got in. He snuggled up and fell asleep on my chest for half an hour. Then he was better for a bit.
But for the rest of the day he was pretty unhappy. He really does not like the way coughing feels. Poor kid. I finally know what it's like to have a sick child, and he just has a little cold. My heart goes out to all my patients and all others out there who have children with chronic diseases or other serious illnesses. I cannot even imagine the heartache.
As for my little guy, any tips for dealing with a nasty cold in a 17-month old?
But for the rest of the day he was pretty unhappy. He really does not like the way coughing feels. Poor kid. I finally know what it's like to have a sick child, and he just has a little cold. My heart goes out to all my patients and all others out there who have children with chronic diseases or other serious illnesses. I cannot even imagine the heartache.
As for my little guy, any tips for dealing with a nasty cold in a 17-month old?
Monday, January 21, 2008
Daddiness is next to godliness
Our son is at the stage where he makes connections between things he reads in books and things that exist in our house. He can't talk yet, but when he sees an animal in a book for example, he points off in the distance and grunts, signaling to us that such an animal exists somewhere else in our abode. He will not stop grunting and pointing until we have verbally stated that to which he is referring. It proves difficult for us sometimes. "Where did I see a penguin in the house?" Or the first time he insisted there was a bunny in the house, contrary to parental knowledge. He sure showed his mommy.
Last night we reached a new level of object transference. While reading one of his many wonderful Zonderkidz books, we came across a picture of Jesus. As per usual we stated the name of the person/thing at which he was pointing in first French, then English. Customarily this is followed by him pointing into the distance, usually in reference to the crucifix in our basement. Not this time. This time he burrowed his pointer finger deep into my chest, as it was very obvious to him that I am Jesus. His youthful innocence diminishing any blasphemy inherent in such an assertion, we tried very hard not to burst out in laughter and assured him that daddy was not Jesus, just daddy. He insisted further. We decided to compromise and told him that both daddy and Jesus were men (myself not being in the past tense; at least not until after the third kid). He was satisfied with this explanation.
I'm not sure where he obtained the notion that I was Jesus. I don't even have facial hair beyond weekend stubble. But it sure makes me feel like I've got some big shoes to fill!
Last night we reached a new level of object transference. While reading one of his many wonderful Zonderkidz books, we came across a picture of Jesus. As per usual we stated the name of the person/thing at which he was pointing in first French, then English. Customarily this is followed by him pointing into the distance, usually in reference to the crucifix in our basement. Not this time. This time he burrowed his pointer finger deep into my chest, as it was very obvious to him that I am Jesus. His youthful innocence diminishing any blasphemy inherent in such an assertion, we tried very hard not to burst out in laughter and assured him that daddy was not Jesus, just daddy. He insisted further. We decided to compromise and told him that both daddy and Jesus were men (myself not being in the past tense; at least not until after the third kid). He was satisfied with this explanation.
I'm not sure where he obtained the notion that I was Jesus. I don't even have facial hair beyond weekend stubble. But it sure makes me feel like I've got some big shoes to fill!
Wednesday, January 16, 2008
A bad day for pharma
Last week I came across an interesting article published in Public Library of Science Medicine, an open-access, peer-reviewed medical journal that has produced some excellent literature since its inception. The article evaluated market information and came to the conclusion that big pharmaceutical companies spend roughly twice as much on marketing as they do on research and development. This came as no surprise to me given that of 1147 new patented products released on the Canadian market between 1990 and 2003, only 12% of them could be considered to be novel drug products. The rest are essentially "me too" drugs which are efforts by drug companies to grab a chunk of a large market or to prevent an emerging generic product from eroding market share. So it stands to reason that if they spend so little on research and development that the drug companies would start to get a little sloppy.
The New York Times recently reported some naughty business by Merck and Schering-Plough, makers of Zocor and Zetia (Ezetrol in Canada). The two pharma behemoths, with combined annual revenues of $33 billion, co-market Vytorin, a combination of Zocor and Zetia. You've seen the commercials: some of your cholesterol comes from your diet, which Zetia blocks, and some comes from Grandpa Joe, which Zocor blocks (not Grandpa Joe, the cholesterol). They spent more than $200 million advertising this new drug and planned on sharing the profits.
However, they had a hard time justifying the combination given that there was little evidence for any benefit over existing therapies. So they started the ENHANCE trial. This trial attempted to show that Vytorin would reduce arterial plaque buildup better than Zocor alone. (I will reserve comment for later on the fallacy of this approach, given that this does not necessarily prove that the drug reduces heart attack or stroke risk.) A short time ago, the results were due to be released. Let us just say the companies were not very forthcoming with information.
Finally the powers that be forced the companies to release the information after multiple rounds of stalling. Turns out they had a good reason to not have the data go public. While Vytorin reduced cholesterol better than Zocor alone, turns out it actually caused plaques to buildup in the arteries more, almost twice as fast as Zocor alone. Vytorin patients were also more likely to DIE and suffer HEART COMPLICATIONS, although I must stress this was not statistically significant so may be due to chance alone. That's called a negative result. Drug companies don't like to publish negative results.
In an incredible article published in the New England Journal of Medicine, study authors looked at FDA-registered studies for 12 antidepressants including over 12 000 patients. Of the 74 studies looked at, 31% were not published. It was shown that whether or not the studies were published was related to whether or not the outcomes were positive, which means that subsequent clinical decisions made on the basis of published research were biased completely toward the positive. Only 1 of the 38 positive studies was not published. Of 36 negative studies, only 3 were published.
The really interesting part comes when they compare the effect size shown for these antidepressants in the published studies versus all the studies, published or not. The effect size of the published data was on average 30% higher than the effect sizes reported in all the data, thereby grossly inflating the efficacy of these agents to those accessing medical literature, namely healthcare professionals relying on it to make informed decisions in treating their patients. In other words, according to published data, 94% of the trials conducted on these 12 agents had positive outcomes. In fact, only 51% had such outcomes.
So to the group of guilty parties that includes Merck and Schering-Plough, you can now add GlaxoSmithKline, Forest, Eli Lilly, Organon, Bristol-Myers Squibb, Pfizer, and Wyeth.
That begs the question: if even I as a healthcare professional cannot necessarily trust what I read in peer-reviewed academic medical journals, how can you, the average consumer trust what you read in the lay press?
--------------------------------------------------------------------------------------------------------------
Verbosen verboten
Prevaricate: to stray from or evade the truth
The New York Times recently reported some naughty business by Merck and Schering-Plough, makers of Zocor and Zetia (Ezetrol in Canada). The two pharma behemoths, with combined annual revenues of $33 billion, co-market Vytorin, a combination of Zocor and Zetia. You've seen the commercials: some of your cholesterol comes from your diet, which Zetia blocks, and some comes from Grandpa Joe, which Zocor blocks (not Grandpa Joe, the cholesterol). They spent more than $200 million advertising this new drug and planned on sharing the profits.
However, they had a hard time justifying the combination given that there was little evidence for any benefit over existing therapies. So they started the ENHANCE trial. This trial attempted to show that Vytorin would reduce arterial plaque buildup better than Zocor alone. (I will reserve comment for later on the fallacy of this approach, given that this does not necessarily prove that the drug reduces heart attack or stroke risk.) A short time ago, the results were due to be released. Let us just say the companies were not very forthcoming with information.
Finally the powers that be forced the companies to release the information after multiple rounds of stalling. Turns out they had a good reason to not have the data go public. While Vytorin reduced cholesterol better than Zocor alone, turns out it actually caused plaques to buildup in the arteries more, almost twice as fast as Zocor alone. Vytorin patients were also more likely to DIE and suffer HEART COMPLICATIONS, although I must stress this was not statistically significant so may be due to chance alone. That's called a negative result. Drug companies don't like to publish negative results.
In an incredible article published in the New England Journal of Medicine, study authors looked at FDA-registered studies for 12 antidepressants including over 12 000 patients. Of the 74 studies looked at, 31% were not published. It was shown that whether or not the studies were published was related to whether or not the outcomes were positive, which means that subsequent clinical decisions made on the basis of published research were biased completely toward the positive. Only 1 of the 38 positive studies was not published. Of 36 negative studies, only 3 were published.
The really interesting part comes when they compare the effect size shown for these antidepressants in the published studies versus all the studies, published or not. The effect size of the published data was on average 30% higher than the effect sizes reported in all the data, thereby grossly inflating the efficacy of these agents to those accessing medical literature, namely healthcare professionals relying on it to make informed decisions in treating their patients. In other words, according to published data, 94% of the trials conducted on these 12 agents had positive outcomes. In fact, only 51% had such outcomes.
So to the group of guilty parties that includes Merck and Schering-Plough, you can now add GlaxoSmithKline, Forest, Eli Lilly, Organon, Bristol-Myers Squibb, Pfizer, and Wyeth.
That begs the question: if even I as a healthcare professional cannot necessarily trust what I read in peer-reviewed academic medical journals, how can you, the average consumer trust what you read in the lay press?
--------------------------------------------------------------------------------------------------------------
Verbosen verboten
Prevaricate: to stray from or evade the truth
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