Recent quotes:

Key opinion leaders — a critical perspective | Nature Reviews Rheumatology

By the mid-1950s, Lazarsfeld’s group had extended their argument into medicine, through a study contracted by Pfizer about the factors that influenced doctors in the USA to adopt a new drug. In this landmark study5, the authors asked the fundamental question that continues to drive every pharmaceutical marketing operation to this day: “What were the social processes that intervened between the initial trials of the drug by a few local innovators and its final use by virtually the whole medical community?” The simple answer: the implementation of a new drug is all about promoting and expanding “the effectiveness of interpersonal relations at each stage of the diffusion process”.

A moratorium on strong recommendations is needed | The BMJ

Medicine is addicted to so-called hopium, an unwarranted confidence in the value of its tests and treatments. Clinicians overestimate their value,1 while experts on guideline panels make strong recommendations about care backed by untrustworthy evidence.2 Rigorous guideline methods can highlight this problem, but they are far from a perfect antidote—it is time for a moratorium on strong recommendations. In a linked paper (doi:10.1136/BMJ-2021-066045),3 Yao and colleagues report that almost half (1246 of 2528) of the recommendations issued by the leading American cardiology and oncology professional societies were strong, “just do it” recommendations.4 About a quarter (354 of these were based on low certainty evidence. Compared to a consensus process, an evidence based guideline process reduced the risk of issuing such inappropriately strong recommendations, but not completely: the evidence based approach produced about a third (105 of 354) of the inappropriately strong recommendations in this study. Most of them simply conveyed the panels’ overconfidence in the benefit of following their recommendation.

Looking to Tackle Prescription Overload - The New York Times

One way is for patients themselves to combat polypharmacy, by regularly asking their doctors to reassess their medications — sometimes bringing every pill bottle, including supplements, to an appointment for a “brown bag review.” A short list of potentially inappropriate drugs, published by the American Geriatrics Society, can help them spot problems. That is essentially what Leslie Hawkins did for her mother, Dr. Nothelle said. “Every time she had a health care interaction, she asked, ‘Do we need this? Can we lower this? Can we stop this?’” Ten months passed before Ms. Harrison could see her geriatrician again, and by then, “she was a completely different person,” Dr. Nothelle said. “She was awake, she answered my questions. It was night and day.” Ms. Harrison’s score on the 30-question cognition test jumped from three to 25. She is starting physical therapy to improve her mobility. And she is taking four drugs — insulin, a blood pressure medication and two anti-depressants — instead of 14.

How Big Pharma Finds Sick Users on Facebook – The Markup

Ads for Latuda, an antipsychotic from the company Sunovion used in the treatment of bipolar depression, were shown to users with an interest in the Depression and Bipolar Support Alliance, a nonprofit support group. We also found it targeted at users interested in therapy and the National Alliance on Mental Illness.

Patient Advocacy Groups Take In Millions From Drugmakers. Is There A Payback? | Kaiser Health News

The financial ties are troubling if they cause even one patient group to act in a way that’s “not fully representing the interest of its constituents,” said Matthew McCoy, a medical ethics professor at the University of Pennsylvania who co-authored a 2017 study about patient advocacy groups’ influence and transparency. Notably, such groups have been silent or slow to complain about high or escalating prices, a prime concern of patients. This story also ran on The Daily Beast. This story can be republished for free (details). “When so many patient organizations are being influenced in this way, it can shift our whole approach to health policy, taking away from the interests of patients and towards the interests of industry,” McCoy said. “That’s not just a problem for the patients and caregivers that particular patient organizations serve; that’s a problem for everyone.”

A Million-Dollar Marketing Juggernaut Pushes 3D Mammograms | Kaiser Health News

On average, 3D screenings may slightly increase cancer detection rates, finding about one extra breast tumor for every 1,000 U.S. women screened, according to a 2018 analysis in the Journal of the National Cancer Institute. Most studies also show that 3D screenings cause fewer “false alarms,” in which women are called back for procedures they don’t need, said Dr. Susan Harvey, a Hologic vice president.

Why is it so hard to review the Johnson & Johnson vaccine? Data. | MIT Technology Review

Without a national health-care system, there’s no comprehensive way to assess risks and benefits for different groups that have received the vaccine. There is no routine federal capability to connect patient data with vaccine records. Instead, regulators hope clinicians will hear about the pause and proactively report cases they hadn’t previously connected to vaccinations.  “It might stimulate some clinician to say, ‘Oh my God, Mrs. Jones had that three weeks ago,’” says Reingold. In addition, he says, “there’s still quite a few people who have gotten a dose within the last two weeks, and some of them could develop this rare side effect.” The voluntary system may seem archaic, but that is how the six cases under review came to the attention of the authorities. They were reported to the CDC through an online database called the Vaccine Adverse Events Reporting System, or VAERS. It is an open website that medical staff, patients, and caregivers can use to notify the government about potential vaccine side effects.  Because the system is so open, and requires opt-in participation, it’s impossible to calculate exact risks using VAERS data. Epidemiologists generally think of it as a place to look for hypotheses that tie vaccines to side effects, rather than a source that can be used to confirm their suspicions. Related Story The CDC’s $1.75 billion sequencing boom may be throwing money at the wrong problem Experts say trying to stop covid variants without better data is “insanely difficult.” “It’s a messy system. Anyone can report anything, whether it’s biologically plausible that it’s related to the vaccine or not,” says Mark Sawyer, a member of the FDA’s Vaccines and Related Biological Products Advisory Committee, which reviewed the covid-19 vaccines for public use. “Then the job is to sort through and figure out, is there really a signal here?” The next best thing to a national health-care system is the CDC’s Vaccine Safety Datalink, a consortium of American health insurers that provide medical care to patients in-house. The system includes records of about 10 million patients. Unfortunately, only 113,000 Johnson & Johnson vaccines have been captured by that system so far.

How IBM's audacious plan to 'change the face of health care' fell apart

But former employees said IBM’s approach made it all but impossible to answer those questions. It touted multiple studies, for example, that showed the recommendations of Watson for Oncology, its cancer treatment adviser, closely matched those of hospital tumor boards. However, those studies were carried out with IBM clients, not outside and objective researchers, and didn’t prove the tool could actually improve outcomes. That was a far cry from the claim that Watson could help “outthink cancer,” which IBM was suggesting in national advertisements. “It was all made up,” one former employee said of the marketing without robust data behind it. “They were hellbent on putting [advertisements] out on health care. But we didn’t have the clinical proof or evidence to put anything out there that a clinician or oncologist would believe. It was a constant struggle.”

On Randomized Trials and Medicine - Insight

If we had more proper randomization and tracing of these various approaches, we’d have more dexamethasones at hand. The WHO is leading some randomized trials at the moment, but we have little to none going on in the United States.As we learn more about some effective clinical practices, it’s getting harder to do novel ones: ethically, we cannot withhold known best practices from patients. It’s possible that we have found ourselves stuck at a local optimum, but much less than the upside potential we might have had, had we tried proper randomization from the beginning, when we had little to no idea what worked anyway, we could have conducted randomized trials. We should have.. This oversight will go down as yet another major failure of our health infrastructure and response to this pandemic.

On Randomized Trials and Medicine - Insight

Clinical trials for non-pharmaceutical interventions in health are relatively rare because there is little to no money to be made from recommending them. Conversely, drugs which require trials to go on the market are  sponsored heavily by pharmaceutical companies.

Scientists find neurochemicals have unexpectedly profound roles in the human brain: Dopamine, serotonin involved in sub-second perception, cognition -- ScienceDaily

"An enormous number of people throughout the world are taking pharmaceutical compounds to perturb the dopamine and serotonin transmitter systems to change their behavior and mental health," said P. Read Montague, senior author of the study and a professor and director of the Center for Human Neuroscience Research and the Human Neuroimaging Laboratory at the Fralin Biomedical Research Institute at Virginia Tech Carilion. "For the first time, moment-to-moment activity in these systems has been measured and determined to be involved in perception and cognitive capacities. These neurotransmitters are simultaneously acting and integrating activity across vastly different time and space scales than anyone expected." Better understanding of the underlying actions of dopamine and serotonin during perception and decision-making could deliver important insight into psychiatric and neurological disorders, the researchers said. "Every choice that someone executes involves taking in information, interpreting that information, and making decisions about what they perceived," said Kenneth Kishida, a corresponding author of the study and an assistant professor of physiology and pharmacology, and neurosurgery, at Wake Forest School of Medicine. "There's a whole host of psychiatric conditions and neurological disorders where that process is altered in the patients, and dopamine and serotonin are prime suspects."

INHN: Daniel Kanofsky’s comment on Edward Tobe’s comment

"The emphasis on prescribing drugs as the major psychiatric contributor to treatment without knowing the patient has become an unfortunate consequence of insurance industry control of medical care initially through the formation of HMOs. Today, psychiatrists perform a 'med check' that may range from 10 minutes to 30 minutes during which a patient, often not in remission, is psychiatrically evaluated to determine medical and psychological changes and current mental status, response to pharmaceuticals, changes in their life, compliance, and ability to function vocationally and avocationally. The psychiatrist writes prescriptions for drugs with minimal knowledge of the patient. Drug sales benefit."

The Corruption of Evidence Based Medicine — Killing for Profit | by Dr. Jason Fung | Medium

“The medical profession is being bought by the pharmaceutical industry, not only in terms of the practice of medicine, but also in terms of teaching and research. The academic institutions of this country are allowing themselves to be the paid agents of the pharmaceutical industry. I think it’s disgraceful”

Coca-Cola’s work with academics was a “low point in history of public health” | The BMJ

An analysis of thousands of emails has shown the extent to which Coca-Cola sought to obscure its relationship with scientists, minimise perception of its role, and use researchers to promote industry friendly messaging. The findings represented a “low point in the history of public health,” said one of the authors. Academics the UK and Italy worked with US Right to Know, an investigative public health and consumer group, to obtain and analyse more than 18 000 pages of email correspondence between the Coca-Cola Company, West Virginia University, and the University of Colorado.1 Both universities were part of a “front group” funded by Coca-Cola called the Global Energy Balance Network (GEBN), a global network of scientists1 said to have been created by Coke to downplay links between obesity and sugary drinks.2

Covid-19 Vaccines With ‘Minor Side Effects’ Could Still Be Pretty Bad | WIRED

The press release for Monday’s publication of results from the Oxford vaccine trials described an increased frequency of “minor side effects” among participants. A look at the actual paper, though, reveals this to be a marketing spin that has since been parroted in media reports. (The phrases “minor side effects” or “only minor side effects” appeared in writeups from The New York Times, The Wall Street Journal and Reuters, among other outlets.) Yes, mild reactions were far more common than worse ones. But moderate or severe harms—defined as being bad enough to interfere with daily life or needing medical care—were common too. Around one-third of people vaccinated with the Covid-19 vaccine without acetaminophen experienced moderate or severe chills, fatigue, headache, malaise, and/or feverishness. Close to 10 percent had a fever of at least 100.4 degrees, and just over one-fourth developed moderate or severe muscle aches. That’s a lot, in a young and healthy group of people—and the acetaminophen didn’t help much for most of those problems.

Screening + Drug Treatment = Increase in Veteran Suicides - Mad In America

There is clear evidence that SSRIs and SNRI antidepressants can provoke suicidal impulses and acts in some users, and the reason is well known. SSRIs and other antidepressants can stir extreme restlessness, agitation, insomnia, severe anxiety, mania and psychotic episodes. The agitation and anxiety, which is clinically described as akathisia, may reach “unbearable” levels, and akathisia is known to be associated with suicide and acts of violence, including homicide.

DEMAND CHEMICAL IMBALANCE RETRACTION: Round One: The Most Absurd "Chemical Imbalance" Quote

There's almost 200 quotes on this page so far. In efforts to find the most preposterous I need your help. Over the next few weeks I'll be wanting you to vote. There will be a cut-off point for each post. I have included the Twitter/Facebook link for each of the individuals. If you want to ask them to join in then please feel free to contact them. This will give them an opportunity to retract their claim or not, as the case may be.

Richard Smith: Psychiatry in crisis? - The BMJ

Dutch psychiatrists, it was explained to me, are feeling vulnerable because there are too many of them. They have two treatments to offer–drugs and psychotherapy. But the Netherlands has many clinical psychologists, and they have taken over the psychotherapy. Psychiatrists are left with drugs and anxiety about their future.

Why cancer screening has never been shown to “save lives”—and what we can do about it | The BMJ

Discrepancies between disease specific and overall mortality were found in direction or magnitude in seven of 12 randomised trials of cancer screening.8 Despite reductions in disease specific mortality in the majority of studies, overall mortality was unchanged or increased. In cases where both mortality rates were reduced the improvement was larger in overall mortality than in disease specific mortality. This suggests an imbalance in non-disease specific deaths, which warrants examination and explanation.

Evolution of systems

Food in New York improves from bankruptcy to bankruptcy, rather than the chefs individual learning curves –compare the food quality in mortal restaurants to that in an immortal governmental cafeteria. And in the absence of the filtering of skin in the game, the mechanisms of evolution fail: if someone else dies in your stead, the built up of asymmetric risks and misfitness will cause the system to eventually blow-up.

A pill to fight alcoholism causes an uproar in France

Among the issues they cited was the ANSM decision to approve baclofen before the second study was publicly available. Even before publication, the academics noted the trial sponsor — the Public Assistance Hospital in Paris — touted results in a press release. The hospital also sold study data to Ethypharm, a small company that sought regulatory approval to market the drug, although this was not disclosed in the paper. Curiously, Ethypharm also performed the analysis that was the basis for the ANSM decision. When the Bacloville study was finally published last December, the group of researchers discovered an unexplained change in the primary outcome, a practice that is frowned upon because it can suggest an attempt to achieve desired results. The researchers contend the change in outcomes made it harder to analyze what, if any, difference baclofen had on patients, leading to a bias in favor of the drug. “Biased trials lead to biased decisions, and biased decisions mean that people get treatment that doesn’t work, possibly don’t get treatment that does work, can be harmed by treatment and it costs the health care system more,” said Joel Lexchin, a professor of family and community medicine at the University of Toronto, and one of the researchers who have criticized the Bacloville study.

Why Doctors Are Bad At Stats — And How That Could Affect Your Health

Gerd and his team have explored whether medical professionals understand the statistics measures actually needed to prove that a cancer screening programme saves lives. This is a classic problem in health statistics. What clinicians need to compare is mortality rates, not 5-year survival rates. The mortality rate tells the number of deaths in a period of time. In contrast, the 5-year survival rate only tells how many people live 5 years after the day they have been diagnosed with cancer. Some screening programmes can diagnose people earlier — which can increase those ‘5-year survival rates’ — without making them live any longer.

A brief history of medical statistics and its impact on reproducibility.

By failing to address the structurally driven deficits in scientific and statistical thinking already apparent decades earlier, and then amplifying them with professional incentives to produce more and more research (grossly mismeasured by papers published), medical research had become a scandal. Altman concluded that “We need less research, better research, and research done for the right reasons.” This is, in my opinion, the most important sentence ever written about medical research, but it fell on deaf ears. How do I know this? A decade or so later, the Lancet published a special issue on research waste, which made the case that medical research costing billions of dollars each year is wasted due to things like poor research questions, flawed study designs, erroneous statistical analyses, and clumsy research reports (15).

Using Open Questions to Understand 650 People’s Experiences With Antipsychotic Drugs | Schizophrenia Bulletin | Oxford Academic

In this study, 650 people, from 29 countries, responded, in an online survey, to “Overall in my life antipsychotic medications have been _____?” and “Is there anything else you would like to say, or emphasise, about your experiences with antipsychotic drugs?” Of the total participants, 14.3% were categorized as reporting purely positive experiences, 27.9% had mixed experiences, and 57.7% reported only negative ones.

How many of 1829 antidepressant users report withdrawal effects or addiction? - PubMed - NCBI

A total of 1829 New Zealanders who had been prescribed antidepressants completed an online survey; 44% had been taking antidepressants for more than 3 years and were still taking them. Withdrawal effects when stopping medication were reported by 55%, and addiction by 27%. Paroxetine had particularly high rates of withdrawal symptoms.

Electronic Health Records Vendor to Pay $155 Million to Settle False Claims Act Allegations | OPA | Department of Justice

or example, in order to pass certification testing without meeting the certification criteria for standardized drug codes, the company modified its software by “hardcoding” only the drug codes required for testing. In other words, rather than programming the capability to retrieve any drug code from a complete database, ECW simply typed the 16 codes necessary for certification testing directly into its software. ECW’s software also did not accurately record user actions in an audit log and in certain situations did not reliably record diagnostic imaging orders or perform drug interaction checks. In addition, ECW’s software failed to satisfy data portability requirements intended to permit healthcare providers to transfer patient data from ECW’s software to the software of other vendors. As a result of these and other deficiencies in its software, ECW caused the submission of false claims for federal incentive payments based on the use of ECW’s software.