Publication Bias: Why the Drugs might not work

Research is an area I have been wanting to write a post on for a while now. But for one reason or another I have never gotten around to it. Until now.

For some time now, I’ve been following the work of a chap called Dr. Ben Goldacre. He originally trained in medicine in Oxford and London, but is now a full-time academic in the field of epidemiology, as well as a best-selling author and broadcaster.

His current work looks at how doctors might never know if the drugs they are prescribing are actually safe, or just as importantly, actually work! This might seem an unusual premise, but unfortunately it’s seems quite accurate.

Publication bias may be a term you have heard before. It may even be something you know a little bit about. But for most, it’s not a phrase we actually fully understand.

For instance; you might not be aware that studies with positive data are twice as likely to get published than studies with negative data, regardless of how well the studies were conducted in terms of design or method.

You almost certainly will not be aware that following initial research in 1980, the new anti-arrhythmic drug Lorcainide was prescribed widely to people after having a heart attack. The research showed that patients receiving this drug had a higher survival rate as a result of taking Lorcainide. But some key data from this study was not published. This data actually showed Lorcainide increased patient mortality, leading to over 100,000 preventable deaths in the United States.

This just goes to show that publication bias is a very literal risk to us all.

So rather than me regurgitate more things that have already been said, I have embedded the latest talk from Dr. Goldacre himself, speaking at the world-famous TED conference in Washington, D.C. earlier this year (April 2012).

Now the purpose of sharing this with you all is not to scare or worry you. After all, most of you reading this will have more pharmaceuticals in your cupboard than most third world countries.

You might even be on one of the highly expensive anti-TNF drugs like myself. Considering the hoops we’ve had to jump through to receive this treatment, along with the special funding required, surely this means the research is robust?

I guess we have to hope so.

But like I said, my reasons for sharing this is not to scare or panic you. And I most certainly do not want you to lose faith in your clinicians. I assure you they are doing the best they can, with the information they have.

All I’m asking is that you are aware that publication bias is a problem. This is not something one man can change, but something we all need to speak up about for legislation to change. 

If you want to read into this subject some more, check out the related posts and links below. We are all responsible for the treatments and care we receive. But how can we fix a problem if we don’t know the problem exists?

Well now your aware it exists.

Related Articles and Links:

Original TED talk in Scotland 2011 – http://www.ted.com/talks/ben_goldacre_battling_bad_science.html

Publication Bias (or, Why You Can’t Trust Any of the Research You Read) – http://www.forbes.com/sites/freekvermeulen/2012/01/06/publication-bias-or-why-you-cant-trust-any-of-the-research-you-read/

The drugs don’t work: a modern medical scandal – http://www.guardian.co.uk/business/2012/sep/21/drugs-industry-scandal-ben-goldacre

British Medical Journal seeks to re-evaluate medical ‘evidence’ – http://www.drbriffa.com/2011/04/29/british-medical-journal-seeks-to-re-evaluate-medical-evidence/

Medical Journals, Reprints And Publication Bias – http://www.pharmalot.com/2012/07/medical-journals-reprints-and-publication-bias/

Publication Bias – http://www.cochrane-net.org/openlearning/html/mod15-2.htm

9 thoughts on “Publication Bias: Why the Drugs might not work

  1. Mollyc1i

    Did you mean Lercanidipine? Nasty drug. Was on it, threw bad side effects. Came off it of own accord. These anti-hypertensive meds are…v. doubtful! Just read a write up on the beta-blockers – they don’t work as well as touted (!); have bad side effects; should at best ‘only’ be used with ‘great’ caution. Ho-Hum.

    Thanks for this. More muscle to my pitching arm as I chuck a googly at my cardi – he is soooo pharma driven. Am about to dump him.

    Good one Trax –

    Molly C

    Reply
  2. Mollyc1i

    Answered my own question – go check gal…so put in a google

    Int J Cardiol. 1993 Jul 1;40(2):161-6.
    The effect of lorcainide on arrhythmias and survival in patients with acute myocardial infarction: an example of publication bias.
    Cowley AJ, Skene A, Stainer K, Hampton JR.
    Source
    University Hospital, Nottingham, UK.
    Abstract
    Ninety-five patients with suspected acute myocardial infarction were randomly allocated on admission to hospital on a double blind basis to treatment with lorcainide, a Class 1C anti-arrhythmic drug, or matching placebo. Treatment was continued for 6 weeks. Twenty-four-hour ECG tape recordings were made immediately on admission, on the sixth or seventh day after admission, and again just before the end of the treatment period. Lorcainide was shown to be an effective anti-arrhythmic agent. The study was not designed to evaluate the effect of lorcainide on survival, but there were nine deaths among the 49 patients treated with lorcainide compared with only one in the patients given placebo. These findings are consistent with the results of the First and Second Cardiac Arrhythmia Suppression trials (CAST and CAST-II). This study was carried out in 1980 but was not published at the time: it now provides an interesting example of ‘publication bias’.

    Phew. That is so NOT funny. Lethal. Nine deaths in 49 patients treated with Lorcainide. Is it still scripted? Go on another search. I soooo do not trust the medical world out there.

    Thanks –

    Molly C

    Reply
    • Endless Trax

      It was because of this evidence in 1993, the makers of Lorcainide made a public apology regarding the data that was not published. I’ll try and find a relevant link for you regarding this.

      It is not a drug that is licensed for use in the UK (as per British National Formulary). I not sure if it’s still licensed in the US, sorry.

      My intention wasn’t to make you loose trust in your physicians, but make you aware of the battles healthcare professionals are up against, just to do their job. I hope this post didn’t influence your lose in trust.

      And thank you for your comments, and for linking the article.

      Reply
  3. ErickT

    As dynamic and entertaining as Dr Goldacre is, he should not be given credit for doing the original work when that is not the case.

    From the reference on lorcainide given above by Molly C, Dr Goldacre is not listed as an author.

    Similarly, in the TED talk, he speaks about a study of publication bias with antidepressants, but he did not participate in the study. I know because I am its lead author. Here’s the reference:

    Turner EH, Matthews AM, Linardatos E, Tell RA, Rosenthal R (2008) Selective publication of antidepressant trials and its influence on apparent efficacy. N Engl J Med 358: 252–260.

    It was flattering to have Dr Goldacre cover my study in a TED talk, but not so flattering that I’m willing to relinquish credit to him.

    Reply
    • Endless Trax

      Thank you Erick for your comment, and sharing your article reference.

      In the TED talk, I didn’t get the impression that Dr. Goldacre was intending to take credit for these works. But I will make sure I watch it again in case I missed something.

      I of course completely understand your concern that someone might be taking credit for your hard work, that certainly would not be fair and just.

      As someone who is obviously more of an expert in this field than myself, I would like to ask you; do you feel that publication bias is being sufficiently addressed of late, or do you feel it is as much of a problem than ever?

      Reply
      • ErickT

        Thanks for your reply. I didn’t mean that Dr Goldacre was taking credit for anyone else’s work. It’s just that, in your opening comment, you referred to “the work of a chap called Dr Ben Goldacre” and “his current work”, yet his role is more that of a “messenger”–a very effective one, I might add.

        Regarding your follow-up question, publication bias is by no means fully addressed. There are flaws in the way the system is set up, and it practically cries out for such things to occur. But the system is so deeply entrenched that it would be very difficult to overhaul it.

        Reply
        • Endless Trax

          Ah – that makes more sense now. Apologies, that was probably a poor choice of words on my behalf.

          I am under no illusion that Dr Goldacre, is indeed more of a “messenger”, and agree with you, he is an effective one. Hence this article.

          I do find his lack of interest in his hair-do a little distressing though. I guess the whole ‘nutty professor’ look suits him. Is that fashionable these days? I haven’t a clue.

          Anyway….

          Thank you for answering my follow up questions. Its nice to hear another persons view, especially from someone with experience in this field. I hope you enjoyed this post none the less. Feel free to poke around and read my other posts. 🙂

          Reply

Leave a Reply

Your email address will not be published. Required fields are marked *