"Today, class, I would like you to consider and discuss the following
proposition: '[Medical] journals have devolved into information
laundering operations for the pharmaceutical industry.'"
The statement was made in 2004 by Richard Horton, editor of Britain's
leading medical journal, /The Lancet/ in: Horton, R. (2004, March 11).
The dawn of McScience. /The New York Review of Books, 51/, 7--9.
It is quoted by noted cognitive psychologist and statistician, Gerd
Gigerenzer on p. 78 of a 2008 monograph on today's rampant statistical
illiteracy published in /Psychological Science/. Along the way, he
gives examples of major medical journals (BMJ, JAMA, Lancet), not to
mention government "protection" agencies, mishandling statistics in ways
that maximize the appearance of benefits and minimize the appearance of
risks.
For example:
"In some cases, benefits and harms of treatments are reported in
different currencies: benefits in big numbers (relative risk reduction),
but harms in small numbers (absolute risk increases). We call this
technique mismatched framing. For instance, the Guide to Clinical
Preventive Services of the U.S. Preventive Services Task Force (2002)
states the relative risk reduction (not the absolute risk reduction)
when describing the benefits of screening-- 'sigmoidoscopy screening
reduced the risk of death by 59% for cancers within reach of the
sigmoidoscope' (p. 93); but when the harms associated with the procedure
are described, these are reported in absolute risks---''Perforations are
reported to occur in approximately 1 of 1,000-10,000 rigid
sigmoidoscopic examinations'' (p. 94). An analysis of three major
medical journals, BMJ, JAMA, and The Lancet from 2004 to 2006 revealed
that when both benefits and harms of therapeutic interventions were
reported, 1 in 3 studies used mismatched framing and did not report the
benefits in the same metric as the harms. In most cases, relative risks
were reported for benefits, and absolute frequencies were reported for
harms (Sedrakyan & Shih, 2007).... [However,] a relative risk reduction
of 50% is compatible with both a substantial mortality reduction from
200 to 100 in 10,000 patients and a much smaller reduction from 2 to 1
in 10,000 patients."
[Refs: U.S. Preventive Services Task Force. (2002). Guide to clinical
preventive
services: Report of the U.S. preventive services task force (3rd ed.).
Baltimore, MD: Williams & Wilkins.
Sedrakyan, A., & Shih, C. (2007). Improving depiction of benefits and
harms: Analyses of studies of well-known therapeutics and review of
high-impact medical journals. Medical Care, 45, 523--528.]
Why would they do such a thing? Gigerenzer et al. say: "One answer is
competing interests. One third of the trials published in the BMJ and
between two thirds and three quarters published in the major North
American journals were funded by the pharmaceutical industry (Egger,
Bartlett, & Juni, 2001). Richard Smith (2005), former editor of the BMJ
and former chief executive of the BMJ Publishing Group, explained the
dependency between journals and the pharmaceutical industry:
The most conspicuous example of medical journals' dependence on the
pharmaceutical industry is the substantial income from advertising,
but this is, I suggest, the least corrupting form of dependence....
For a drug company, a favourable trial is worth thousands of pages
of advertising.... Publishers know that pharmaceutical companies
will often purchase thousands of dollars' worth of reprints, and the
profit margin on reprints is likely to be 70%. Editors, too, know
that publishing such studies is highly profitable, and editors are
increasingly responsible for the budgets of their journals and for
producing a profit for the owners.... An editor may thus face a
frighteningly stark conflict of interest: publish a trial that will
bring US$100,000 of profit or meet the end-of-year budget by firing
an editor.
[Refs: Smith, R. (2005). Medical journals are an extension of the
marketing arm of pharmaceutical companies. PLoS Medicine, 2, e138. DOI:
110.1371/journal.pmed.0020138.
Egger, M., Bartlett, C., & Juni, P. (2001). Are randomised controlled
trials
in the BMJ different? British Medical Journal, 323, 1253--1254.]
You can find a copy of the complete Gigerenzer et al. article here:
http://www.psychologicalscience.org/journals/pspi/pspi_8_2_article.pdf
Regards,
Chris
--
Christopher D. Green
Department of Psychology
York University
Toronto, ON M3J 1P3
Canada
416-736-2100 ex. 66164
[EMAIL PROTECTED]
http://www.yorku.ca/christo/
==========================
---
To make changes to your subscription contact:
Bill Southerly ([EMAIL PROTECTED])
