A recent Washington Post article described a recent article in the medical literature challenging the long held notion and recommendation that pregnant women should limit their fish consumption. The recommendations from a variety of agencies, including the Environmental Protection Agency and the Food and Drug Administration, that pregnant women limit fish intake comes from a long history of calculations based on the presence of methylmercury and PCBs and their purported effect on neurological function. These recommendations are very well meaning, based on sound science and logic.
So, imagine the surprise when a longitudinal study observing a large cohort of women who consumed a variety of fish showed that the highest consumers had children with the highest neurological function. Granted, there are a variety of biases that are associated from such studies and this is far from a gold-standard randomized controlled study of fish consumption in this population, but the findings are thought-provoking on the one hand and confusing to the public on the other.
Whether it is hormone replacement therapy, fish oil, garlic, multivitamins, and Celebrex or fish consumption during pregnancy, there are just so many conflicting studies on a variety of topics that are near and dear to the public. This is natural. This is science. There is nothing wrong with this and, ultimately, the beauty of science and research is that the truth eventually emerges.
The problem is that, in this day and age of the Internet and the need to publish quickly, there is just a complete flood of information that reaches the public, often via the pages of the New York Times or CNN, and that these studies are taken as the word of God. The public then stands confused when a conflicting headline is showcased months or years later.
I think that, in some ways, this constant conflict of thoughts and ideas that are aired constantly in public only serves to undermine medicine and our confidence in medical science. It drives, in my view, the increasing confidence of patients in "alternative" medicine or anecdotal therapies. I can't tell you how many times patients come to me on all kinds of pills and therapies that I know nothing about. Drugs that they read about on the Internet. Attitudes from extremely intelligent people that "doctors just don't know everything.."
I agree. We don't know everything. Often, we know nothing. I'm not sure what the solution is. Maybe it is limiting what gets published and released in the media. Maybe it's better science education and background for the common layperson. Maybe it's more nuance in our discussion of health. Maybe it's just waiting and thinking and just not sensationalizing every little new discovery that confuses patients and doctors alike. Alright, I'm taking my multivitamin and fish oil now. Oh, and my baby aspirin.
Thursday, February 15, 2007
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6 comments:
you could write a book... 'Medicine is Flat' . internet access has leveled the information playing field and in this case, people tend to confuse information with education. any of us can read an article and technically be 'informed' on a given subject, but without the context of the appropriate education, most of us cannot think critically or be considered an expert on it. in it all, the doctor has definitely lost status. i see it in my own patients - they are more skeptical of docs and can be quite confrontational with info gleaned from the internet. and if you refute it, you're at risk of being viewed as paternalistic, narrow-minded, not thinking 'out of the box', etc. then again, modern medicine promotes the idea of pts playing an active role, being their own best advocate, being accountable for their own health. that's a tough balance to strike.
I had an older relative, a slim, healthy, health-concious woman, once remark to me, "First they told us that butter was bad for us. Now they're telling us that margarine is bad. What are we supposed to do!" She was almost distraught about the whole thing.
I wanted to tell her "Just go back to butter. No one is going to arrest you." But I didn't have the heart to tell her that.
I don't care what anyone says, I drink whole milk. And you know, I almost feel guilty about it, like I'm indulging in a subversive activity. But I comfort myself with the knowledge that I'm increasing my calcium intake. What's bad for my heart is good for my bones.
How can the medical establishment be trusted when the CDC and the gene researchers ignore a known risk factor for autism and other neurological genetic developmental disorders? This knowledge could lead to fewer cases of these devastating conditions.
http://ebdblog.com/paternalage/How can one trust the establishment when it is profit driven and lies to the public?
Thier distrust is understandable, considering the following:
Published on www.brainblogger.com
The Human Injury of Lost Objectivity
If I were to rate the corruptive tactics performed by big pharmaceutical companies during my intimate experience with them , the intentional strategy of implementing fabricated and unreliable results of clinical trials performed by others possibly top the list, as they often were sponsored by a pharmaceutical company. By this atrophy of the scientific method absent of authenticity, harm and damage is possibly done to the health of the public. Most would agree that the science of research should be sound and as sterile and aseptic as possible- completely free of interference. However, it appears, money and increased profits can be a catalyst for reckless disregard for human health that is largely unregulated. This is particularly a factor on post-marketing studies of various pharmaceutical companies because others seem to be deliberately ignorant.
Decades ago, clinical trials were conducted at academic settings that focused on the acquisition of knowledge and the completely objective discoveries of meds and devices to benefit mankind. Then, in 1980, the Bayh-Dole Act was created, which allowed for such places with their researchers to profit off of their discoveries that were performed for pharmaceutical companies and others in the past. This resulted in the creation of for-profit research trial sites, called Contract Research Organizations that are often composed of primarily community patient care clinics absent of any research training compared with the former. Because of this structure, investigators of these pharmaceutical sponsored trials are likely void by sponsor design of necessary research experience or quality regarding their research purpose and ability to ensure its sterility, yet benefit it’s supporter. These quite numerous CROS are in fact for- profit, with some CROs making billions of dollars a year.
The trials conducted at such places again are sponsored by pharmaceutical companies that control and manipulate all aspects of the trial being conducted involving their particular med being studied in the trial. Etiology for their deception regarding this manipulation is because the pharmaceutical company that sponsors such a trial is basically creating a marketing tool for this studied drug of theirs. This coercion is done by various methods of deception in subtle and tacit methods. As a result, research in this manner ensures favorable results of the sponsor’s medication after the trial is complete. Their activities are again believed to be absent of true or applied regulation, and therefore have the autonomy to create whatever they want to benefit what may be a collusive relationship between the site and the sponsor; as such sites are largely unregulated.
Guest authorship has been known to be aggressively recruited by sponsors and usually the sponsors seek investigators to be recruited for this function in addition to being the lead investigator of their fabricated clinical trial. The trial manuscript and protocol design is prepared by those employed by the pharma sponsor upon specific direction of this pharma sponsor. The medical program coordinator of a particular sponsored trial is an actual employee of the sponsoring pharma company and also acts as the publisher, manuscript version reviewer and trial director who works with their pharma company’s hired CRO editors whose objectives are to benefit the sponsor. Typical and ultimate cost of the final manuscript of the trial to the sponsor created by the hired CRO exceeds 1000 dollars per page, some have said. Merck engages in this behavior, which shocked many, as they were always viewed as an ethical pharmaceutical company that always placed patients over profits. Apparently not.
Further disturbing is that once the creation of the trials is completed, the research paper is often composed with specific directions by the sponsor to writers known as ghostwriters. These people are not identified and acknowledged by the sponsor, and may not be trained in clinical research overall, as they are simply freelance writers, as one does not need research training or certification in order to perform this function. Rarely do trial ghostwriters question their instructions about their assignment, which is clearly deceptive and undocumented by the sponsor. Also, these hired mystery writers are known to make about 100 grand a year. This activity removes accountability and authenticity of the possibly fabricated clinical trial even further. The corruptive act is finally completed by the sponsor hiring an author to have their name be placed on the trial, while this hired author likely had absolutely no involvement with the trial, or even reviewing the trial is not asked by the hired author.
To have the trial published, the sponsor has been known to pay a journal, and the sponsor bribes the journal in a few ways, such as the sponsor purchasing from a selected journal thousands of reprints of their study from the journal, for example. Again, how often this process is performed is unknown, yet frequent enough to create hundreds of such false writers mentioned earlier and progressively growing research sites to receive the support the pharmaceutical industry. So benefits of meds studied in such a malicious way potentially can harm patients and their treatment options along with clear safety risks. The purchased reprints bought by the sponsor of the study are distributed to the sponsor’s sales force to share the content with prescribers, with the sales force completely unaware about this manipulation. As a bonus, the sponsor may pay this journal to advertise their products to be placed in this journal as well.
Such misconduct discussed so far impedes research and the scientific method with frightening ethical and harmful concerns, as stated previously. If so, our health care treatment options with meds are now undetermined in large part due to such corruptive situations, as well as the absence of objectivity that has been intentionally eliminated with trials produced in this way. Trust in the scientific method in this type of activity illustrated in this article is absent and replaced with what could be harmful to others.
More now than ever, meds are removed from the market or are given black box warnings, which is basically eliminating future growth of the black box drug. Now I understand why this may be occurring.
Transparency and disclosure needs to happen with the pharmaceutical industry for reasons such as this as well as many others, in order to correct what we have historically relied upon for conclusive proof, which is the scientific method. More importantly, research should not be conducted in a way that the sponsor cannot in any way interfere in such ways described in this article, which would require independent clinical trial sites with no involvement of the drug maker. And clearly, regulation has to be enforced not selectively, but in a complete fashion regarding such matters. Public awareness would be a catalyst for this to occur, after initially experiencing a state of total disbelief that such operations actually are conducted by such people, of course. We can no longer be dependent on others for our optimal health. Knowledge is power, and is also possibly a lifesaver.
“Ethics and Science need to shake hands.” ……. Richard Cabot
Dan Abshear
Author’s note: What has been written was based upon information and belief.
How can the medical establishment be trusted when the CDC and the gene researchers ignore a known risk factor for autism and other neurological genetic developmental disorders? This knowledge could lead to fewer cases of these devastating conditions.
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browny
Holistic Rehab
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