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#41
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Big $$$ for Wakefield's spinning...
Jonathan Smith wrote:
Not according to Pubmed. The authors were well known for their measles-Crohn's disease link and not until 1997 was there ever any mention by that group of the possible MMR - neurologic link. In 1997, they were already doing the lawyer study as far as I know. As far as "*you* know, Jonathan? LOL. Not good enough. (And to think, you carp on abacus!) Find out, okay? You do the math - With a Feb 28 1998 publication date - when do you suppose the data collection started? In 1997. Problem solved. Lawyers first, then the money, then the patients, then the results. He's got you there, JG. If the study was published in 1998 there is no way that data collection did not start by at least 1997 (more likely 1995 or 1996). Had the editors known of the funding source and that the content of the article misrepresented the methods used, it would likel;y have been rejectd - according to them. Well, then, they did a ****-poor job of (minimal!) verification, didn't they? g Maybe the good doctor is a convincing liar - considering his fe3llow researchers were also unaware of the connection - well, at least according to quotes in news reports. How are they to verify that he is not being paid by a bunch of lawyers if he is willing to lie about it? SHoul The Lancet have contacted every lawyer (and everyone else who coul dpossibly have a motive) both int he UK and broad to ask if they ahd an arrangement with Wakefield? I wouldn't call the tast minimal. I like my science transparent. I like research articles to be accurate and the conclusions to be supported. I don't like what the lay press does to science. Then take it up with "the lay press," for heaven's sake! He is taking it up with you for citing the lay press as "evidence." I give the lay press no credibility when it comes to interpreting science, as you well know. And to have the Rogers foaming at the mouth when they can spin off of a NYT article makes it all the more humorous. And she said you have to sense of humor. Maybe the two of you (and me) just don't find the same things funny. -- CBI, MD |
#43
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Big $$$ for Wakefield's spinning...
"JG" wrote in message ...
"Jonathan Smith" wrote in message m... "JG" wrote in message ... "Jonathan Smith" wrote in message m... "JG" wrote in message ... "CBI" wrote in message link.net... JG wrote: Not that "two wrongs make a right," but Wakefield has a loooong way to go to reach the level of research funding/testimony fees realized by James Cherry: First of all - yuor figures below confuse money to fund reseach, from which the investigator can draw part of his salary but mostly is spent doing the study, with money that is completely kept by the researcher. Hmmm... I think they're pretty straightforward, myself. (Just what do you think "unrestricted grants" means? They are called "unrestricted educational grants" The Money article didn't refer to them as such. UCLA does. Really? And *you* know this ...because? I have dealt with the university of california sysem in this context. IMO, the salient word is *unrestricted*. Who wouldn't like funding for a pet project (perhaps one wholly unrelated to research that would benefit the grant provider)? Gee - how about that. Yeah, how about that? It just heightens the conflict of interest that Cherry has/had with Lederle. It doesn't heighten squat. You keep insisting that the presence of a funding relationship means that the fundee is in debt to the funder - the Abacus principle we'll call it. I'm quite sure that a letter of thanks went from the university to the funding source, but it does not make it a conflict of interest - it may have that potential, but it is disclosed and you can deal with it any way you want. and the general policy across US universities is that the can only be spent on the educational and research mission of the university. We used to fund graduate students this way - either make them RAs, get them tuition waivers, send them to conferences, etc. We also used it to pay for lab supplies and normal operational costs. And how did Cherry/UCLA use theirs, hmmm? in line with university policy. Bwahahaha ...Please, you gotta stop! PLEASE! My sides are hurtin'! My keyboard's a mess from spewing coffee on it ...Oh, GAWD!!!! I think I'm gonna have to killfile you, Jon; the laughing is too painful! ...and costly!!! Go right ahead. What's so funny? You don't trust scientists and have no faith in their integrity and now it is a conspiracy with the universities? (Five minutes later...) Okay, Jonathan. We all are aware that you think you walk on water and are the be-all, end-all Master of the Universe. I've never suggested it- but I have walked on water. And my life's experiences include actually doing science. (Hope you're saving up for you kids' future psych bills!) Over the years, various unwritten "rules" have been established around here, and (for the most part) they're adhered to by those on both sides of just about every issue/topic. You can't (well, okay, *shouldn't*) post an answer such as yours w/o SOME sort of verifiable evidence. At a minimum, you should add, "I know this because..." ("My real name is____, and I work at UCLA"; "I've audited the UCLA Pediatrics Department's financial accounts"...whatever). I enjoy the marginal annonymity that Yahoo provides. I know this because at one time I was in a position to provide funding of this type to people like Cherry - not to Cherry and not for vaccines, but nonetheless, to academic researchers at well respected universities for the purpose of funding their research programs and often their graduate students. Earlier in my career, I was the recipient of grants just like this as a graduate student and then as faculty at a major US univerisity. The unrestricted part means that there was no specific deliverable or project associated with the money. Exactly. It's left to the discretion of the recipient(s). good. now you are catching on. These (usually small) grants are often seed money to investigators for them to pursue basic or exploratory research. They can come from private industry but often they come from alumni, foundations, or other philanthropic organizations. In a previous life, I'd give grants to university faculty to help them pay for travel to meetings of societies. Why did I do it? because it was the right thing to do to advance the science. And yes, they appreciate it and the next time you call to ask them for advice, they make the time. It doesn't change the advice they give. Are *you* catching on? It's these types of transfers (in this case, of money) that give rise to conflicts of interest! There is always a potential - but it isn't a conflict until it is hidden. Or "gifts"? The amount received for *research* is listed separately from this amount.) Note, too, that the money he (personally) received for research is listed separately from that received by his institution (UCLA). Gifts are discretionary funds. And so are *unrestricted* grants! No, they are gifts. Let A="gifts" Let B="discretionary funds" Let C="unrestricted grants" You say, "A are B." I say. "C are (also) B." You say "No, C are A." If C are A--if unrestricted grants are gifts--then they ARE discretionary funds. (Need a Venn diagram?) Gifts are gifts - grants are grants. How you are allowed to spend them is different. How much the University takes off in overhead differs, too. Have you ever done research from a university platform? f you haven't then you have only a layman interpretaton of nomenclature - and you've shown that to be error prone. In many cases, gifts don't include any institutioal overhead though most deans took a cut - usually a lot less in terms of percent. Gift money has a little less stringage attached in terms of how t is spent. Like I said, the dean paid for golf with his gift money but you couldn't do that with grant money. These "gifts" taint everything (e.g., research results) that comes out of the UCLA Pediatrics Department wrt Lederle (Wyeth); what your "testimony" above does is simply add evidence to any assertion that Cherry (UCLA) has a conflict of interest when it comes to doing research for Lederle! OK - fine. Then paint the NIAID with the same brush beause they paid for a lot of the work. Usually the university got a cut but mostly the faculty was able to pretty much spend it on stuff - not salaries, but stuff. Computers were a big thing at one time; lab equipment, telephone equipment, even desks and chairs could be purchased with this money. The dean even sponsored an annual golf outing and used gift money to pay green fees for faculty and students. And your point would be, what? That such "gifts" couldn't/wouldn't create a conflict of interest? Get real! The funding source is disclosed and there is a potential that a conflict of interst may occur. It is not evidence that there is a conflict. JG - you don't understand the difference between a potential conflict and a real conflict. Oh, but I most certainly do, Jonathan, from both an ethical and a legal perspective. Like being "a little pregnant," there's no such thing as a "potential conflict of interest" ONCE A RELATONSHIP FROM WHICH AN INDIVIDUAL (e.g., a university researcher) OR SOMEONE WITH WHOM HE/SHE IS CLOSELY ASSOCIATED/AFFILIATED CONCEIVABLY MIGHT--IN THE EYES OF A DISINTERESTED (OBJECTIVE) OBSERVER--UNDULY BENEFIT HAS BEEN ESTABLISHED Shouting it doesn't make a difference. You are still wrong. Having sex doesn't mean you are pregnant. (e.g., money other assets have been transferred). The only time it's appropriate to use the term "potential conflict of interest" is BEFORE any such exchange has occurred; e.g., when a law firm is discussing whether it should represent "Client B" when it already represents "Client A," a competitor in the same field as "Client B," or a faculty department is deciding whether it should undertake research/conduct testing on behalf of XYZ Corporation, a company that's given "unrestricted grants" (or "gifts") to either individuals in the department or to the department/institution. I disagree - a conflict only exists if it influences the results. If there is an appearance of a conflict or the potential exists, it is not necessarily impactful on the results. Think of it this way - two guys with guns standing across a canyon from each other - no bullets. No potential for conflict. You give them both bullets - now you have a potential for conflict. They shoot at each other - now it is a conflict. Sure; this is entirely in line with what I stated above. You said a conflict exists in the presence of bullets but no shots fired. Until you show me the smoking gun, as long as I know there's a potential conflict, I am quite content. Okay, in keeping with your hypothetical... Until both (1) assets (e.g., "unrestricted grants," "gifts," whatever--"bullets") have been transferred ("shot") from, say, a pharmaceutical manufacturer to a university and (2) university employees (faculty members/researchers) have agreed to conduct research/testing for the manufacturer (have returned fire, if you will), only a potential conflict of interest exists. (Both sides are, of course, "armed"; the manufacturer has funds [bullets] available to spend, and the university has the capacity and capability [bullets] to conduct research.) Once both conditions are met--i.e., assets have been transferred and the university has agreed to undertake the research/testing--a conflict of interest has been created. You screwed up the analogy big time. Not until the publication is shown to misrepresent the data because of the funding or the research design is impacted negatively (unscientific) because of the funding is there a conflict of interest. I'll evaluate the merits of the research on the research, not because of how it was paid for or who wrote it. That's how it should be. No one's said the research IS bogus/fraudulent, just that one might wish to question/examine it *more* closely--with more skepticism--if a conflict of interest exists. You did. Why subject the research to closer scrutiny because of the funding source? Why do you think journals use blinded reviews? In the peer review process, that is what is required - blinded reviews. ...and no one's said otherwise! Yet you argue that the reviews should be unblinded - one should know who the author is and what his financial relationship is and if it is a potential conflict, then the work is tainted. Your words, not mine. Besides, you miss the point. Did Cherry hide these arrangements? I don't know, did he? You're the one, no doubt, with better access to the journals in which his articles dealing with pertussis vaccination have been published. Grant Support: Dr. Cherry's pertussis studies were supported in part by contracts No1AI15124 and No1AI45249 from the National Institute of Allergy and Infectious Disease and by grants from Lederle-Praxis Biologicals. Cherry's written dozens, if not hundreds, of pro-pertussis vaccine/vaccination articles. Were his ties to Lederle (American Home Products/Wyeth) disclosed in *all* of them? You tell me. Here is an example from one of the leading journals where it is clear that his work has industry funding participation. Here? Where? (I'm assuming you got the above info from his January '98 editorial, "Pertussis in Adults," that appeared in the "Annals of Internal Medicine.") Editorials are not science. Like the lay press, editorials are nothng more than someones opinions, not fact. Has he extolled some (profitable) theory with a vehemence that is not supported by the science in a manner that suggests he is seeking to maximize publicity? IMO, yes; he's the "Number One Fan" (promoter) of adult (pertussis) vaccination. Maybe he actually believes in it and has the data to show that his belief is scientifically supported? By whom? Apparently not by enough other researchers/medicos to have effected a recommendation for adult vaccination. (And he's been exhorting adult vaccination for *years*.) So then - ACIP isn't the industry spokesperson? Seems to defeat your argument that vacination policy decisions are purchased through gifts to Cherry? Huh? Look, Jon, your inclination for putting words in others' mouths---for creating straw man arguments--has already been duly noted. When in the gutter with you, john and Schlafly, it's hard no to stoop to the same level. Sorry At no time have I ever said, or even intimated, that "vacination policy decisions are purchased through gifts to Cherry." (Who knows, maybe the flak about Cherry that the CDC/ACIP has received from vaccine/vaccination critics/skeptics over the past 15+ years has made them [the CDC/ACIP] leery and they're reluctant to listen to him...perhaps he's been hoist by his own petard.) So once you sell your integrity, it's tough to get it back - as I have pointed out, this is the BIG reason why the presence of disclosure acts as an effective deterent to conflicts of interest. If you know that everyone else knows that the sponsor of your work has a vested interest in its outcome you are going to make sure that you remove any doubt as to your integrity. The first time you scrw this up will be your last. Think about Wakefield. Do you ever think he'll be able to walk into a courtroom as an expert witness and NOT have this little episode come up? "Cherry, a physician and professor of pediatrics at the University of California at Los Angeles, is a widely recognized pertussis expert who has been a leader on advisory committees that help frame immunization policy for the American Academy of Pediatrics and the Centers for Disease Control. Back in 1979, at a symposium, he said, "All physicians are aware that pertussis occasionally produces severe reactions and that these may be associated with permanent sequellae [complications caused by the vaccine] or even death." But by 1990, Cherry had changed his mind, proclaiming in the Journal of the American Medical Association that severe brain damage caused by pertussis vaccine was nothing but "a myth." From 1980 through 1988, Cherry got about $400,000 in unrestricted grants that he termed "gifts" from Lederle. From 1988 through 1993, he was given $146,000 by Lederle for pertussis research, and from 1986 through 1992, UCLA received $654,418 from Lederle for pertussis research. Additionally, drug manufacturers paid Cherry and UCLA $34,058 for his testimony as an expert witness in 15 DPT lawsuits brought against the companies." (Andrea Rock, "Money" article; December 1996. The entire article is available at http://www.mindspring.com/~schlafly/vac/money.txt and http://www.whale.to/vaccines/money_mag.html.) The references are telling. Got anything not from a whacko conspiracy site that hasn't been discredited on a daily basis in this forum? Guess JGs answer is no. Okay, time for an OT constructive criticism: Apostrophes are our friends, Jon. Your writng would be improved if you learned to use them. ...You're welcome. This is the internet - you're lucky with me - many posters can't even spell. The source is (the highly respected) "Money" magazine, It is a journalistic piece - not a peer reviewed science piece. Hyphens are our friends, too. (Sorry; tried to [but couldn't!] resist. g) You put too much stock in "peer-reviewed" articles, Jon. (I imagine Wakefield's Lancet article was peer-reviewed.) Like I said - it's the internet - did you get the point? Good. Clarity is our friend, as is logic and consistency. Try it. you friggin' twits (first Probert, then CBI, and now you, Jonathan ...yes, that's an ad hominem attack), NOT Roger's or John's sites. (They've simply furnished verbatim copies of the article. If you wish to read the article "direct from the source," go to https://www.timeinc.net/subs/secure/...neymag_search/ and subscribe.) Sheesh! I invoke the Schlafly law - if it isn't delivered free of charge to my door I don't have to read it...nananananahhhhhh. The "Money" article HAS been delivered (free!) to your computer screen; it IS (has been made) available. (Thanks, Roger and John!) I'm sorry, but if you think I--they--have altered it in any way, it's up to YOU to make an effort to find out. The link wants my money. Invoke tha Abacus principle? I know it because its true and I don't have the time to prove it? I've asked you to prove some things, Jonathan (e.g., that Cherry's funding was *always* disclosed). Better get cracking.... Maybe the best answer is - show me when it wasn't disclosed. Sorry, Jon, I asked you first (if Cherry's ties to Lederle were invariably disclosed.) I have never seen a research paper of Dr. Cherry's published n a major medical journal that reports data where the funding source of the study has not been disclosed. I looked. I have never had a doubt where research funding comes from. I think that its a great tribute to the collaboration between the private sector, universities, and the government. La-de-da. Goody for you. *Yawn* Goody for all of us. You go ahead and discount any scientific piece that isn't independent and unfunded and base all your medical decisions on those two articles. Straw man (yet AGAIN! g). It's getting tiresome, Jon. Really. OK - then don't tell me that anything not done exclusively independently is tainted - you said i, not me. I ask agai, do you eat tainted meat? Meanwhle, the rest of us scientists will get back to making new knowledge in collaboration with the scientific community - which, beleive it or not, includes the big bad pharmaceutical industry, the evil empire of the NIH, and the whoring educational system. "Us scientists"? Sorry, Jon, but I've seen no evidence, whatsoever, that you're a scientist. (A scientist *wannabe*, yes.) I guess you're right - but then again, your judgement is suspect. JG P.S. I've only killfiled about half a dozen posters; the last one was the "enema guy" several months ago. You're joining the list, Jonathan, not so much because of what you post, but because of your obnoxious attitude. You just can't handle it when someone comes right out and challenges the basic premise for your existance. You have to be right about everything and you can't use science to support it. You obviously have an intractable "anyone who disagrees with and/or challenges me is a contemptible moron" mindset. Me? Give it a rest. John's a flake. Roger doesn't get along with anyone. Abacus can't argue so he takes the "high" road. I agree - the three of you are moronic in what you post a lot of the time. This last series of threads particularly. You want to insist that all science is tainted by the presence of funding. I'll give you this - Wakefield surely gave you a great example of how a scientist can be corrupted - but that is hardly evidence that it is consistent and pervasive. I judge science on the merits of the science. I do science (did) that stands up to scientific review and my peers scrutiny. Honestly, I don't need a housewife with nothing more than a dictionary and a keyboard to endorse it - that's what the peer review process is all about - keeps the wannabees on the sidelines or on their soapboxes. You're also, based on the many posts of yours that I've read, completely devoid of humor (which I truly find quite sad; life's too short not to laugh at anything other than those people whom you consider inferior--which, in your case, appears to be *everyone* ....your poor kids.) So... Ta-ta. Take care. Good - let's see how long it lasts. Your silly little gs are hardly humor. You can't put together a supportable argument without defering to editorials in the lay press. Argue your points in science, not based on what some journalist says is what you should think. Are you really that much of a sheeple? I don't generally killfile people - and I will post whenever and whatever. So, you won't have the priviledge of reading my insightful banter. Your loss (and you said I don't have a sense of humor g). js |
#44
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Big $$$ for Wakefield's spinning...
(Jonathan Smith) wrote in message om...
(Beth) wrote in message . com... (Jonathan Smith) wrote in message om... A financial association exists between a sponsor and a researcher A publication is forthcoming that describes the sponsors innovation in a favorable light The author provides disclosure of the relationship. Are the results, by YOUR definition, tainted? Well....if not tainted, it is at least justification for suspicion regarding the results. Why is it necessary to be suspicious? It's not necessary to be suspicious of anything. One can accept whatever one wants without question if one so chooses. However, I find it useful and appropriate to be suspicious of certain things rather than accepting them at face value. Study results that promote a sponsor's interests are one of those things. Isn't it better to read the study and then derive a conclusion based on the merits of the study as opposed to jumping to a conclusion that it cannot pssible be "accurate" because the sponsor has a stake in the outcome? Yes, it's better to read the study than jumping to conclusions. When I say that I am suspicious, that simply means that I am less inclined to accept the conclusions without first reading the study than I would be otherwise. Is that really inappropriate? I may, for a study I find of particular interest, read the original , but I can't read every scientific study published. I can't even keep up with my own field. So I usually just read the summarizations in the news media and from other sources and maintain what I think of as a 'healthy skepticism' regarding everything I read. Particularly if there was a provision that allowed the sponser to withhold unfavorable results from publication. That has NOTHING at all to do with what is published. The question of publication bias (it's the term used to refer to the absence of negative studies) is a separate and distinct issue. I'll grant you that such a distinction exists, but I don't find it a particularly useful distinction when I'm evaluating the results of research outside of my area (which means all health related research since that isn't my field). I consider the fact that research that doesn't promote sponsers goals and objectives isn't very likely to be published (many research grants have clauses that allow them to forbid publication of results that are not to their liking). I also realize that research that doesn't promote sponsers goals and objectives isn't likely to be done at all (no funding). So I keep that in mind when I'm reading results in the lay press and making health care decisions for me and my family. When I say 'suspicious', I don't mean that I'm suspicious that the science wasn't performed properly. I generally trust the peer-review process to weed out poorly performed science. What I mean is that I'm suspicious that recommendations based on that research are necessarily in the best interest of me or my family. Is a new medication, surgery, or other health recommendation really the best solution to a problem, or is an un-scientifically tested herbal remedy or perhaps a better diet and exercise regime likely to be just as effective and much less expensive, though not near as profitable for the sponsors? Is a new vaccination really the best thing for my child, or is it more appropraite to wait awhile? That's the sort of *suspicion* that runs through my mind. As a voter, do you presume that just because a politician discloses all of his sources of funding that he or she is without bias in regard to those sources? As a voter and citizen, I don't trust any politician, be they left, center, or right. As a scientist, I judge the quality of science based on the science, not who sponsored it. A politician brings views, positions, and policy to the table, not data. Your analogy is a strawman. Sorry it wasn't to your taste. Would you presume that his/her congressional votes will not reflect the interests of the major campaign contributors? They will reflect the people who support him - clearly. Just remember, the voters elected him, not the campaign contributions. That's a debatable position. Campaign contributions have a very real impact on the election results. A politician who cannot raise money is a losing politician. If a politician were to NOT accept ANY money from ANYONE, does this make him a better candidate? No. It just makes him a losing candidate. Personally, I presume that those compaign contributions either a) will have an effect or b) were made because the politician's views were already in line with those of the contributor. Disclosure of the sources of funds doesn't eliminate the bias, it only allows me to assess it more accurately. Likewise, in your example, disclosure of the sources of funds doesn't eliminate bias, it only allows the users of the information to assess it more accurately. I cannot agree that science and data are equivalent to politicians and politics. No, they are not equivalent. I didn't mean to imply that they were. It was an analogy, not a metaphor. Politicians and scientists are both subject to the same human weaknesses. When someone accepts large sums of money from some source, that person is indebted to the source. What that will mean in terms of future behavior, credibility, etc. varies from person to person, but rationalizations that allow a person to maintain their own sense of integrity and find a position in line with their sponsors are likely. It doesn't matter whether we're talking about scientists or politicians. I don't find it inappropriate to assume that such human failings can occur in scientists as well as in politicians. Just as special interest groups are more likely to fund politicians whose personal beliefs and values are in line with their own, I think that any company making large funding grants to researchers is going to select scientists who, for whatever reasons, have interests that align well with the companies. And just as such campaign contributions aren't going to change the politicians votes - he can maintain his integrity and still accept the funds - so also can the scientist accept such funding and maintain his integrity by making sure the results are scientifically valid as well as supporting both his and his sponsors beliefs. But that doesn't mean that either the politician or the scientist would be considered unbiased from my point of view. |
#45
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Big $$$ for Wakefield's spinning...
(Beth) wrote in message om...
(Jonathan Smith) wrote in message om... (Beth) wrote in message . com... (Jonathan Smith) wrote in message om... A financial association exists between a sponsor and a researcher A publication is forthcoming that describes the sponsors innovation in a favorable light The author provides disclosure of the relationship. Are the results, by YOUR definition, tainted? Well....if not tainted, it is at least justification for suspicion regarding the results. Why is it necessary to be suspicious? It's not necessary to be suspicious of anything. One can accept whatever one wants without question if one so chooses. It's not that one should accept data at face value, but to evaluate it based on the data not presume that the data must be wrong because the researcher was funded by an organization that you don't agree with. However, I find it useful and appropriate to be suspicious of certain things rather than accepting them at face value. Study results that promote a sponsor's interests are one of those things. Evaluate science on the basis of the science. Read the science, not the soundbite. Isn't it better to read the study and then derive a conclusion based on the merits of the study as opposed to jumping to a conclusion that it cannot pssible be "accurate" because the sponsor has a stake in the outcome? Yes, it's better to read the study than jumping to conclusions. When I say that I am suspicious, that simply means that I am less inclined to accept the conclusions without first reading the study than I would be otherwise. Is that really inappropriate? Do you actual accept what a newspaper says about a scientific article at face value? I may, for a study I find of particular interest, read the original , but I can't read every scientific study published. I can't even keep up with my own field. So I usually just read the summarizations in the news media and from other sources and maintain what I think of as a 'healthy skepticism' regarding everything I read. So, you discount the validity of data because it happens to be sponsored by someone who actually has an interest in the results? And then accept at face value what some third party says about it? A third party that has NO obligation to detail its potential conflicts of interest? Particularly if there was a provision that allowed the sponser to withhold unfavorable results from publication. That has NOTHING at all to do with what is published. The question of publication bias (it's the term used to refer to the absence of negative studies) is a separate and distinct issue. I'll grant you that such a distinction exists, but I don't find it a particularly useful distinction when I'm evaluating the results of research outside of my area (which means all health related research since that isn't my field). I consider the fact that research that doesn't promote sponsers goals and objectives isn't very likely to be published (many research grants have clauses that allow them to forbid publication of results that are not to their liking). There is not a single research grant that I have been involved with that has ever limited the publication rights of the investigator other than delaying the publication of those results because of intellectual property considerations. Not one. I would never sign one, my university would never allow it, and later in my career my employers never required it. The only clause is the right to review and comment prior to submission. And that is only fair. I also realize that research that doesn't promote sponsers goals and objectives isn't likely to be done at all (no funding). And this is a problem? Remember, the private sector isn't the only source of research funding. And, also note that the private sector does fund quite a bit of basic and exploratory research on an unrtestricted grant basis and through foundations. So I keep that in mind when I'm reading results in the lay press and making health care decisions for me and my family. If you rely on the lay press to make health decisions, you are doing yourself a disservice. Do you rely on the lay press to amke decisions about what candidate to vote for? When I say 'suspicious', I don't mean that I'm suspicious that the science wasn't performed properly. I generally trust the peer-review process to weed out poorly performed science. What I mean is that I'm suspicious that recommendations based on that research are necessarily in the best interest of me or my family. The transfer of data to policy is suspect because the interests of the translators are rarely made explicit. I trust the ACIP a lot more than the CDC. Is a new medication, surgery, or other health recommendation really the best solution to a problem, or is an un-scientifically tested herbal remedy Don't even go there with me. or perhaps a better diet and exercise regime likely to be just as effective and much less expensive, though not near as profitable for the sponsors? You have choices, you have a brain. Use them. Is a new vaccination really the best thing for my child, or is it more appropraite to wait awhile? That's the sort of *suspicion* that runs through my mind. And that has nothing to do with whether the data are credible or the researcher is ethical or even if the potential of conflict of interest exists - that's just a natural skepticism of something new. As a voter, do you presume that just because a politician discloses all of his sources of funding that he or she is without bias in regard to those sources? As a voter and citizen, I don't trust any politician, be they left, center, or right. As a scientist, I judge the quality of science based on the science, not who sponsored it. A politician brings views, positions, and policy to the table, not data. Your analogy is a strawman. Sorry it wasn't to your taste. I don't equate politics with science. Would you presume that his/her congressional votes will not reflect the interests of the major campaign contributors? They will reflect the people who support him - clearly. Just remember, the voters elected him, not the campaign contributions. That's a debatable position. Campaign contributions have a very real impact on the election results. A politician who cannot raise money is a losing politician. Because he can't get his word out? Ten million people each donating $10 is no different than one person donating 100 million. Plus, the ten million will also vote for you. If a politician were to NOT accept ANY money from ANYONE, does this make him a better candidate? No. It just makes him a losing candidate. You bet. And so it should be. If no one is willing to put their money where their mouth is, what makes you think the have any value as a representative? Personally, I presume that those compaign contributions either a) will have an effect or b) were made because the politician's views were already in line with those of the contributor. Disclosure of the sources of funds doesn't eliminate the bias, it only allows me to assess it more accurately. Likewise, in your example, disclosure of the sources of funds doesn't eliminate bias, it only allows the users of the information to assess it more accurately. I cannot agree that science and data are equivalent to politicians and politics. No, they are not equivalent. And that makes the return analogy problematic. I didn't mean to imply that they were. It was an analogy, not a metaphor. So you want to quibble semantics. Goody. Politicians and scientists are both subject to the same human weaknesses. When someone accepts large sums of money from some source, that person is indebted to the source. When someone accepts payment for services, what then? Take a look at what these grants and contracts pay for - they pay for services rendered, time spent, advice given, papers written. What does a politician sell? Votes? What that will mean in terms of future behavior, credibility, etc. varies from person to person, but rationalizations that allow a person to maintain their own sense of integrity and find a position in line with their sponsors are likely. It doesn't matter whether we're talking about scientists or politicians. I don't find it inappropriate to assume that such human failings can occur in scientists as well as in politicians. I have no doubt and I point to Andrew Wakefield as a classic example. Fortunately, these are few and far between. Just as special interest groups are more likely to fund politicians whose personal beliefs and values are in line with their own, I think that any company making large funding grants to researchers is going to select scientists who, for whatever reasons, have interests that align well with the companies. You are only half right, actually. Funding of clinical research is predicated on the abiluity to deliver quality data quickly. Funding of exploratory or discovery research is predicated on the ability to create new knowledge. If a company is interested in pursuing diabetes research I would expect an endocrinologist would be a better collaborator than a cardiologist. And just as such campaign contributions aren't going to change the politicians votes - he can maintain his integrity and still accept the funds - so also can the scientist accept such funding and maintain his integrity by making sure the results are scientifically valid as well as supporting both his and his sponsors beliefs. But that doesn't mean that either the politician or the scientist would be considered unbiased from my point of view. The individual may have personal convictions you call bias - but the data do not. Politicians deliver votes, not data. Scientists deliver data, not votes - in spite of what Roger may suggest about the ACIP. I appreciate your position, Beth, but it is naive. As you yourself admit, you are not expert in health care research and you rely on the news media to keep you informed. I find data to be the root of all science and the media to be the wart on the nose of good science. js |
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Big $$$ for Wakefield's spinning...
"Jonathan Smith" wrote............... I find data to be the root of all science and the media to be the wart on the nose of good science. js That is one of the more refreshing statements I have read here. carabelli |
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Big $$$ for Wakefield's spinning...
(abacus) wrote in message . com...
(Jonathan Smith) wrote in message om... (abacus) wrote in message . com... (Jonathan Smith) wrote in message om... (abacus) wrote in message om... But as long as the issue is on the table and everyone is aware of the potential bias, the conflict of interest is not an insurmountable problem. It is not a conflict of interest when associations exist and these are readily and fully disclosed. There is a potential of a conflict and the potential is exaccerbated by a failure to disclose. Sir, I must respectfully disagree with this position. Yes, it is necessary that such associations be disclosed, but such disclosures do not completely mitigate the effects of such conflicts of interest. Mitigate - defined as "To moderate (a quality or condition) in force or intensity; alleviate" What is "completely mitigate"? Disclosure allows the USER of the information to understand the context in which the data were derived and the conclusions made. Hence, the EFFECT of the potential conflict is mitigated. The disclosure makes the provider accountable and the user aware. That's what science is all about - accountability and transparency. You keep arguing that the only information worth considering is one in which no potential conflicts exist. Guess what - there is no such case. That doesn't mean that the data aren't actionable. If one is informed of the potential conflicts that may exist, and one is informed of the methods and statistics used to collect and analyze the data, then one can make an informed decision about the quality of the data and the veracity of the conclusions. You are absolute correct sir, about everything but my argument. Apparently I have failed to make myself clear in that respect. Is it the JG argument that funding is the single necessary and sufficient condition to guarantee that data are tainted? "In the U.S., the Centers for Disease Control (CDC), an agency of the federal government. The schedule is based primarily on recommendations of the Advisory Committee on Immunization Practices (ACIP)." ACIP makes recommendations to the CDC, it does not set policy. Only the CDC can set policy. The FDA operates in a similar fashion. This happens across government on a regular basis. This would be a serious problem and make all decisions put forth by such a committee suspect. That sort of situation should and does cause outrage. Why? If all members of a committee are biased in a common direction, it is to be expected that the discussion, recommendations, and decisions made by such a committee will be affected by that bias. You mean to tell me that these experienced thought leaders in the medical community can't make scientifically valid assessments of technologies? No, that's not what I meant to tell you. It is what you said. Unless you didn't mean to use the word bias or that the term does not refer to unobjectivity of the conclusion? Scientific validity requires unbiased estimates. Journalism does not. I believe such a distortion is generally called a straw man argument. Twice now you have been unclear. If you insist on semantic games and require me to guess what you mean, don't be surprised if you are misunderstood. And you know this because nine of the ten actually DO the science and as part of DOING the science, they rely on funding from a variety of sources INCLUDING government and private industry? Wakefield was PAID to produce results that were specifically and completely intended to show a vaccine autism link in support of a legal action. The ACIP is charged with the responsibility to review data (not produce it) and provide a recommendation. For more examples of such situations (not about vaccines though) in the U.S. and the seriousness and extent of the problem, I suggest you check out the report on "Scientific Integrity in Policymaking" put out earlier this week by the Union of Concerned Scientists. Their entire report in online at http://www.ucsusa.org/global_environment/rsi/index.html The argument is not about the quality of science but how the science is used by the administrative branch of the US government. That would be akin to the ACIP recommended that a vaccine NOT be used and having the CDC include it in the schedule anyway. Back to the old tricks? I'm not sure what you mean by this. It borders on a personal attack, but no matter. You did the same thing with Crossens book, Abacus. You proposed that it was evidence of one thing when in truth it wasn't that at all. In the case of the report referenced above, what you proport it to be, it is not. Given that you have failed to grasp the rather unsubtle nuance of my argument Now that makes three times I failed to read in between the lines. and haven't actually read the book in question, I find this statement more amusing than insulting. I have read the book. I went to the library and checked it out. Now, tell me, Abacus, have YOU read the book? But thank you for taking the time and trouble to explain yourself. No trouble. Here's what you said: "That isn't the problem at all, you've set and demolished a strawman argument here. I don't expect anyone to be an altruist 24/7. The idea that accepting funding for research won't taint the results is IMO a big part of the problem. For more information on this particular issue and how it can bias results, may I suggest the book "Tainted Truth : The Manipulation of Fact In America" by Cynthia Crossen, a reporter and editor for the Wall Street Journal." And I said: "A "reporter"? That's the last source I would go to for credible. Using NYT, WSJ, Time Magazine etc as a credible source of scientific information is just a hair short of whaleto." And I posted a quote from her: "Despite the many temptations modern scientists face, they still believe their discipline is self-correcting because it is open, verifiable and subject to close review by scientific peers. In American medicine, however, all three of these pillars are deteriorating." And I asked for the proof - to which you replied: "Yes, of course. The reason she made such a statement must be due to her own bias. It can't possibly be because what she says is true." Well, in terms of the chapter titled "Drugs and Money", what she says is at best biased anecdote, incomplete information, and incredible conclusions. In context, what she concludes is in fact untrue. She uses three primary anecdotes. I'll use the first as the example how she screwed it up royally - I'll leave it to you to figure out the rest. The first is the Amoxicillin study by Bluestone. She argues that Cantekin was right - there was no drug effect and Bluestone's publication was wrong where he concludes that the drug worked. She missed the point of the research. But she didn't miss the opportunity to make him a martyr - here is what she wrote elsewhere - http://lists.essential.org/pipermail...ry/000733.html "Fifteen years later, Dr. Cantekin is broke, his career is in shambles, and he is widely known in his field as a "troublemaking whistle-blower," as he puts it." "It was a fraudulent study," says Dr. Cantekin, who was Dr. Bluestone's co-investigator on the project. "This isn't a question of scientific interpretation. They made certain changes to make the drugs look better." Partly as a result of this compromised research, he argues, millions of children have been taking antibiotics unnecessarily, spawning a population of antibiotic-resistant "superbugs" that threaten everyone." Here's a link to the abstract of the original study publication in the NEJM. http://content.nejm.org/cgi/content/abstract/316/8/432 In the book, Crossen The issue between Cantekin and Bluestone wasn't related to the quality of the data at all, they argued over what endpoint was appropriate as the primary efficacy measure. The study included otoscopic evidence of resolution of the infection as the primary endpoint and tympanometry as one of a series of secondary endpoints. Bluestone presents efficacy based on clinical impression (otoscopy) - the way that docs ACTUALLY treated patients. Amoxicillin was readily available and prescribed by docs in 1984, when the study was done. This was NOT a registration study. When you do work like this, if you want the results to be generalizable, you do it consistent with clinical practice. Even today, the diagnostic accuracy of pneumo-otoscopy beats that of tympanometry. Here is how Crossen describes it: "Bluestone chose to use otoscopic measurements, in which an observer looks into the ear through an instrument and assesses the amount of fluid buildup in the ear. Cantekin argued that the more objective measure of tympanometry should be used." Tympanometry is NOT more objective (actually is more error prone especially if it isn't routinely used and in 1984 that was EXACTLY the case) and the fact that the study was double-blind, any measurement error would be randomized across groups. The second point of contention is when the efficacy measure is made. Bluestone used a 4-week endpoint. Clinically this is the correct interval. It is sgtill in the antibiotic efficacy guidelines that FDA insists are to be used in URI studies. The endpoints are consistent with medical practicve and FDA guidelines - Bluestone was right in insisting that the primary endpoint as specified in the protocol was to be used. The issue of interim analysis and subsequent protocol ammendment is also a non-issue. With over 500 patients enrolled, the scheduled interim analysis suggested that more information could be obtained by adding other antibiotic regimens to the protocol. "Among the subjects without effusion at the four-week end point, recurrent effusion developed in approximately half those in both the amoxicillin and placebo groups during the subsequent three months. We conclude that in infants and children with otitis media with effusion, amoxicillin treatment increases to some extent the likelihood of resolution." Efficacy as measured by clinical resolution at 4 weeks was shown. The initial study achieved its endpoint. The third point she uses to discredit Bluestone and to support her conclusion of tainted research is: "And finally there was the the important question of hearing loss. Bluestone did not address it; Cantekin did." That isn't true at all - on two counts. First, single episode hearing loss is not a readily measurable endpoint - it is chronic OME that impacts on this - where hearing impairment results in developmental delay. Therefore, one would not expect any changes and when none occured it shouldn't have come as a surprise, except to Crossen. In here continued expose's and articles (to sell her book?), Crossen writes: " But as the dispute has moved slowly through these tribunals, medical science has gradually come to its own conclusions about antibiotics and ear infections -- and they are in line with Dr. Cantekin's." Bull. This isn't true at all. AOM recommendations include antibiotics. ABs in OME of duration (chronicity) are recommended. The only thing not currently recommended is ABs in initial OME. Medical science has moved to a more judicious use of ABs in these populations, not an elimination of ABs. Crossen writes further on in her later exposes (not in the book) that: "In the past few years, some pediatricians have begun to prescribe shorter courses of antibiotics, or even to take a different tack entirely: so-called watchful waiting. If the infection doesn't clear up in a few days, then antibiotics are used." Of course, she just confused AOM and OME. These are two different conditions though associated by their location (in the ear) and that one can follow the other. Do you understand WHY a journalist should NOT be making prescribing decisions? Here's the differential diagnosis for OME and AOM: "The diagnosis of otitis media with effusion (OME) is distinguished from AOM by the presence of an effusion with a lack of signs or symptoms of inflammation or pressure behind the eardrum." Here is a VERY simple treatment paradigm endorsed by a medical system in a country that values cost savings on drugs - Canada. It's the last place in the world you'd expect any prescribing influence from commercial interests. http://www.cpsbc.bc.ca/policymanual/guidelines/ome.htm The use of antibiotics in OME is still the subject of extensive debate and varying systems of care have different approaches. Even after 20 years, there isn't concensus BUT Crossen insists that Cantekin was right. ile I do enjoy vigorous debate about many varied subjects, I'm afraid that I have not the time or inclination to indulge my taste for a lengthy discussion right now. I'll pop in again when I get the chace. Honestly, I don't care if or when. You are hardly a worthy adversary. And I've shown you why. You cite Crossen as evidence yet cannot understand that scientific journalism is the highest order of oxymoron. "Bias is a fact of life in research" She uses Chalmers 1983 work on bias based on trial design. I read it and fell over laughing. Chalmers TC, Celano P, Sacks HS, Smith H, Jr. Bias in treatment assignment in controlled clinical trials. N Engl J Med 1983; 309:1358-61. What she concludes and what Chalmers concludes are two differnt things. Of course, that doesn't stop her. "The reason most doctors do not realize that cheaper existing drugs might be as good as new expensive ones is partly because the drug companies do not always test their drugs against other drugs." Another example of Crossen either being stupid or naive. FDA regulation requires placebo controlled studies (in most cases) for registration. Subsequent comparator trials are conducted against the market leading products - for obvious reasons. One page 173, she quotes Michael Crichton (Jurassic Park - you know, the novel about dinosaurs) as evidence of the falling pillars! "Drug companies got the picture. They did not have to filter their drug research through doctors and medical journals. They did not have to wait for FDA approval. They could market their drugs directly to the consumer by way of the news media." And this is exactly what I said - the media get it wrong. She is part of the problem, in fact, I would argue, she IS the problem "Clinical studies are expensive, time-consuming, and virtually impossible to replicate, making untruth harder to uncover." With rare exceptions, a single, unreplicated clinical trial CANNOT support an NDA. Period. In most cases, NDAs include dozens of studies in thousands of patients, all in support of the product. If you file with a negative study (and this can happen) it needs to be thouroughly evaluated and reasons - scienticfic reasons - given. And, it will impact on your label. Retin-A and the WSJ article are provided as examples of media misuse of science. She suggests it would be years if ever for the product to receive FDA approval for cosmetic use in adults. It was approved in 1995 - ONE year after her remark was published. See page 176. On page 178 she poopoos the peer review process arguing that "...peer review is biased in favor of well-known professors.." What a load of manure that statement is - or is she too naive to recognize that the reviews are done blind? I do this stuff and I have never gotten a manuscript to review with the author's name on it - in fact, I routinely get reviews where the institution where it was done has been blinded and references that could even give a hint, were obscured or deleted. On page 81 she writes about the media reporting of two almost identical articles in a 1991 JAMA. The positive article (the one that was remarkable in its result) was covered exclusively in 9 media oputlets, both were covered in 10 additionmal outlets and not one covered the negative piece in the absence of covering the ;positive piece. In other words, headline grabbing is a standard practice of the MEDIA, not the science. On page 187 she starts in on her imitation of Ilena - and with that, I'm done. TYou want to read the rest, again, go right ahead. I stand by my previous statement - Crossen proved nothing other than she doesn't understand science, can't interpret a study to save her life, but can grab at headlines with the best of them - them being journalists, not scientists. I have argued and argued - do not use media reports as the basis for medical information. It is unreliable. it is often inaccurate. It is never, yes never, complete. Read the original research. As you wish sir. I never disagree when someone makes such an assessment about me. They are always judging according to their own personal standards, not mine. At any rate, you strike as someone who has never personally experienced having a 'worthy adversary'. In fact, I suspect you rather consider the phrase an oxymoron. You do remind me of rather amusing young lady though. You can take a look at her at http://www.ozyandmillie.org/2004/om20040219.html Here's a little something you can work on. http://www.improbable.com/teach/less...o-billion.html And Hoffer had you pegged when you commented: "Naïveté in grownups is often charming; but when coupled with vanity it is indistinguishable from stupidity." js |
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Big $$$ for Wakefield's spinning...
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Big $$$ for Wakefield's spinning...
"Eric Bohlman" wrote in message ... (Beth) wrote in om: Yes, I think that it is. For example, I'd like to see legitimate scientific health care research funded for inexpensive alternative treatments. But without a reasonable expectation of profit, no one funds them. Without funding, no scientific research gets done. Without the research, alternative treatments remain outside of mainstream western medicine. Is that a problem? Given our current spiraling health care system costs, I think that it is. You may disagree. But there you're wrong. Such funding *is* available through the NCCAM. And yet the NCCAM's budget for grants actually *exceeds* the amount of all grants applied for each year. So the problem isn't a lack of funding; the problem is the unwillingness of the promoters of "inexpensive alternative treatments" to investigate them scientifically. Somehow they expect *others* to apply for the grants and do the actual work. Or they expect to be able to receive grants to do nothing but put together a bunch of testimonials. Sorry, neither of those is science. In science, he who makes the claim is the one who has to test the claim, and the testing has do be done according to the principles of scientific method, among which is the principle that one can't simply "cherry-pick" those results that are most favorable to one's hypothesis. They're being offered money to play by the rules, and they're turning it down. As best as I can see, these alties who do not bother to apply for the $$$ can only have one reason for not doing so, i.e., they are afraid the results will show that their concotions, etc. are useless and the results would be bad for business. |
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Big $$$ for Wakefield's spinning...
Eric Bohlman wrote in message . 4...
(Beth) wrote in om: Yes, I think that it is. For example, I'd like to see legitimate scientific health care research funded for inexpensive alternative treatments. But without a reasonable expectation of profit, no one funds them. Without funding, no scientific research gets done. Without the research, alternative treatments remain outside of mainstream western medicine. Is that a problem? Given our current spiraling health care system costs, I think that it is. You may disagree. But there you're wrong. Such funding *is* available through the NCCAM. And yet the NCCAM's budget for grants actually *exceeds* the amount of all grants applied for each year. So the problem isn't a lack of funding; That's an interesting claim. If true, it's information I wasn't aware of. Could you provide a link or site? |
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