I think not.
Last week I was very pleased to have been asked to the Glasgow Evidence Based Medicine Society. I going to talk about the problems of medical headlines in the media. I got there a bit early and so went to a session being run by Pfizer on how to critically analyse a paper. It was all quite standard stuff – apart from the wee Pfizer logo on the bottom of every slide – in terms of how to unpick a paper and analyse it’s flaws.
But what was missing, in an enormous, black-hole kind of way, was a discussion about the way in which pharmaceutical companies can choose not to publish clinical trial data. Despite the APBI claiming that criticism levelled at pharma is ‘fashionable’ they have not addressed the fact that actually, people like Sir Iain Chalmers have said as far back as 2004 that non publication of trials kills people. Not so recent a fashion, then. Ben Goldacre’s recent book Bad Pharma offers spades of evidence that despite assurances from Pharma that this kind of dangerous practice would stop, there is copious evidence that it hasn’t. The discussion from Pfizer didn’t mention any of this or the way in which this publication bias distorts what we know about the evidence, leads to overestimation of pharmaceutical benefits, and unnecessary risks and harms for patients. Have a look at this paper which details some of the correspondence to and from managers at Astra Zeneca, and cringe.
And so, by the time it came for me to give my talk, I was ridden with angst. This enormous problem hadn’t been mentioned, and if there is to be any discussion about the need for evidence in clinical practice, it has to be about what we don’t get to know about. If we don’t know about all the clinical trials of a drug, we don’t know as much as we should, and any attempts to critically analyse the evidence will thus fail in making a fair judgement.
And so I apologise if I went on a bit, or was overly harsh, but until we start talking about these problems with evidence based medicine, we will continue to do more harm than we need to. Pfizer, if you want to talk to me, am happy to discuss, at firstname.lastname@example.org .