As always, we are happy to feature articles that expand on ideas discussed on Sensible Medicine – even when the author agrees more with Dr. Prasad than with me.
I also wonder about the manipulation of methods and results. It's so easy to fall into that even without overtly desiring to do so. Your point about many cards trials not having low risk of bias shows the vulnerability here.
I would strongly dispute the idea that observational research is worthless. Before retirement, my field was pediatric pulmonology with a special expertise in lung transplantation. There is clearly no place for placebo-based trials for lung transplantation used in very uncommon diseases. Take for instance the spectrum of diseases associated with genetic defects in the production of Surfactant Proteins B and C and in the more common gene ABCA3 which oversees intracellular metabolism of surfactant in the young infant and child. Observational reports about interventions and complications are immensely valuable to clinicians and families. This is true for other rare genetic diseases involving lung development. There must be many other examples in adult medicine. In the case of my 100+ published manuscripts, there was no role for any pharmaceutical company to support or distort any of the research.
Marcia Angell, the former editor of the New England Journal of Medicine, claimed that the vast majority of scientific research was useless at best because of pharmaceutical industry corruption of the peer reviewed journals. John Ionnadis, the legendary Stanford statistician, wrote two decades ago that most published research is false and he's on the record in more recent years saying it's only gotten worse. The only research being done on the root causes of chronic illness is industry supported and often has outcomes that work in favor of the processed food industries. Become a vegan, eat fake meat, etc. The NIH basically only does research that results in pharmaceutical royalties for their staff. Hopefully some of this is going to change with the new leadership at HHS.
If the government is no longer involved in medical research, we are left with almost all research funded by big pharmaceutical and equipment companies. And those studies are probably worth less than the paper they are written on. So what are we then left with…..
I wonder if those who properly decry the politicalization of medical care and research realize that there is only one way to stop it. Get the government completely out of the medical care field. Reforms and replacing old bureaucrats with new ones has accomplished nothing. There are plenty of disease advocacy groups that raise funds for research from voluntary donors. Of course many also subsist on government grants but those should be eliminated along with the government departments and agencies. Private groups distributing voluntary donations would be much more likely to closely monitor the quality of the work that they fund. I expect that the number of private fund raising organizations would increase significantly if government funds were eliminated.
My goodness, does this person even know that most NIH research is not clinical trials? Much is basic science research. Better clinical trials is a good idea, less funding for basic science research seems rather a bad one.
Much if not most NIH-funded basic research suffers from the same shortcomings as those outlined for clinical research. Poor experimental design and analysis, rife with diverse biases, unreliable / not replicable, often conducted with the primary goal of publishing papers in scientific journals to advance the researchers’ career / professional standing career rather than producing solid results that advance our collective knowledge.
Clearly, part of the blame is with the FDA, which accepts flawed studies for approval or permits INDs with biazed comparisons. Reforming FDA would be the most useful first step in improving clinical research quality.
Relevance of research can be hampered by FDA procedure. Drug trials are designed to clear a bar set by the FDA. When the FDA sets the bar wrong, relevance is reduced.
Would you agree that quality research would have a basis in the literature? There is no better example of low quality research than the Great Barrington Declaration which does not contain a bibliography, not a single reference to support its conclusions.
This tactic may eliminate spending on excess research, but it won’t improve the quality. The limited amount of research money will now go to research that supports this administration’s biases and worldview.
If one is sincere and intent on improving, the quality of medical research I have a recommendation;
Asterix any pharma funded research and the legend should state “read with caution and circumspection!”
Better yet create a new journal “Pharma Sponsored Research” (commonly referred to as the PSR journal!) -that way we would know that it’s biased, & intent on lining the pockets of the investigators as well as the sponsor.
The NIH has its warts, but Pharma research is a cancer. Leave the NIH alone, it’s not perfect, but it’s benefits are infinitely greater than it’s warts
It's so very strange to me that more or less funding is seen as a political take. We can argue whether or not it's an effective strategy to address the obvious problem if poor quality research, but it doesn't seem inherently political in my view, other than people are currently trailing against ANY cuts to anything because apparently we can't be "for" anything if Elon Musk might be "for" it as well. 🤦
https://substack.com/@cassandrasaunders/note/p-157333198?r=10uo8b&utm_medium=ios&utm_source=notes-share-action
I also wonder about the manipulation of methods and results. It's so easy to fall into that even without overtly desiring to do so. Your point about many cards trials not having low risk of bias shows the vulnerability here.
I would strongly dispute the idea that observational research is worthless. Before retirement, my field was pediatric pulmonology with a special expertise in lung transplantation. There is clearly no place for placebo-based trials for lung transplantation used in very uncommon diseases. Take for instance the spectrum of diseases associated with genetic defects in the production of Surfactant Proteins B and C and in the more common gene ABCA3 which oversees intracellular metabolism of surfactant in the young infant and child. Observational reports about interventions and complications are immensely valuable to clinicians and families. This is true for other rare genetic diseases involving lung development. There must be many other examples in adult medicine. In the case of my 100+ published manuscripts, there was no role for any pharmaceutical company to support or distort any of the research.
Marcia Angell, the former editor of the New England Journal of Medicine, claimed that the vast majority of scientific research was useless at best because of pharmaceutical industry corruption of the peer reviewed journals. John Ionnadis, the legendary Stanford statistician, wrote two decades ago that most published research is false and he's on the record in more recent years saying it's only gotten worse. The only research being done on the root causes of chronic illness is industry supported and often has outcomes that work in favor of the processed food industries. Become a vegan, eat fake meat, etc. The NIH basically only does research that results in pharmaceutical royalties for their staff. Hopefully some of this is going to change with the new leadership at HHS.
less is more...novel
If the government is no longer involved in medical research, we are left with almost all research funded by big pharmaceutical and equipment companies. And those studies are probably worth less than the paper they are written on. So what are we then left with…..
Garbage in equals garbage out. And I wonder how so many of these studies get past the REB/IRB.
I wonder if those who properly decry the politicalization of medical care and research realize that there is only one way to stop it. Get the government completely out of the medical care field. Reforms and replacing old bureaucrats with new ones has accomplished nothing. There are plenty of disease advocacy groups that raise funds for research from voluntary donors. Of course many also subsist on government grants but those should be eliminated along with the government departments and agencies. Private groups distributing voluntary donations would be much more likely to closely monitor the quality of the work that they fund. I expect that the number of private fund raising organizations would increase significantly if government funds were eliminated.
My goodness, does this person even know that most NIH research is not clinical trials? Much is basic science research. Better clinical trials is a good idea, less funding for basic science research seems rather a bad one.
Much if not most NIH-funded basic research suffers from the same shortcomings as those outlined for clinical research. Poor experimental design and analysis, rife with diverse biases, unreliable / not replicable, often conducted with the primary goal of publishing papers in scientific journals to advance the researchers’ career / professional standing career rather than producing solid results that advance our collective knowledge.
Clearly, part of the blame is with the FDA, which accepts flawed studies for approval or permits INDs with biazed comparisons. Reforming FDA would be the most useful first step in improving clinical research quality.
Relevance of research can be hampered by FDA procedure. Drug trials are designed to clear a bar set by the FDA. When the FDA sets the bar wrong, relevance is reduced.
Would you agree that quality research would have a basis in the literature? There is no better example of low quality research than the Great Barrington Declaration which does not contain a bibliography, not a single reference to support its conclusions.
This tactic may eliminate spending on excess research, but it won’t improve the quality. The limited amount of research money will now go to research that supports this administration’s biases and worldview.
If one is sincere and intent on improving, the quality of medical research I have a recommendation;
Asterix any pharma funded research and the legend should state “read with caution and circumspection!”
Better yet create a new journal “Pharma Sponsored Research” (commonly referred to as the PSR journal!) -that way we would know that it’s biased, & intent on lining the pockets of the investigators as well as the sponsor.
The NIH has its warts, but Pharma research is a cancer. Leave the NIH alone, it’s not perfect, but it’s benefits are infinitely greater than it’s warts
Ben Hourani , MD, MBA
“We need less research, better research, and research done for the right reasons”.
It's so very strange to me that more or less funding is seen as a political take. We can argue whether or not it's an effective strategy to address the obvious problem if poor quality research, but it doesn't seem inherently political in my view, other than people are currently trailing against ANY cuts to anything because apparently we can't be "for" anything if Elon Musk might be "for" it as well. 🤦
Maybe it's everything is MADE political?
The current crew sticking up for the bureaucracy seems so out of touch to me, but I have seen the other side preach out of touch stuff too earlier.
It seems like the one who's less in touch loses, or could it be that what's in is engineered, at least in some cases.
Of course a political party espouses the desires of their donors to at least a certain extent.
I think the only thing to do is think for yourself.