Bad Pharma Symposium on the front page of Mare

Mare 2013 11 28 Bad Pharma  - front pageThis week, the Mare decided to run a story on Bad Pharma book by Ben Goldacre and our related symposium. The author, BB did an outstanding job in describing the argument Goldacre brings forward in his book. As you might know, we are organising a symposium for our 300 students that are following our course “academic and scientific training”, because I believe that doctors should learn about their field that they will graduate in once they have graduated. A quote from me in the Mare (in Dutch)

Dokter zijn gaat verder dan alleen het behandelen van één patiënt. Onze beroepsgroep heeft een bijzondere positie in de samenleving; mensen leggen letterlijk hun leven in je handen. Naast je arts-patiëntrelatie heb je ook te maken met de wetenschap, beleidsmakers en de farmaceutische industrie. Aankomende artsen moeten daarvan bewust worden en goed op de hoogte zijn van de ontwikkelingen in hun veld. Dit boek sloeg de spijker op zijn kop.

one little error slipped in… I am not a doctor and therefore it is officially not ‘onze beroepsgroep’ but i think people will grasp the point that I try to make. The complete article can be read here.

The pharmaceutical industry, a blessing in disguise?

I will speak at the “Gezondheidszorg in Vogelvlucht” symposium, organised by the Leidse Co-raad for all students doing their clinical rotations on the topic of the role of the pharmaceutical industry in medicine. Although I do not have any experience with working with commercial partners, I do have an opinion on such collaborations. The stories that were published before on this website might give you a hint: The Diane-35 story (part 1, 2 and 3) and the “Bad Pharma” the book by Ben Goldacre.

However, in the preparation of the course that started today I keep on wondering whether it’s all that bad. I guess it’s not. Sure, there is a lot to change in the way new medications find their way to their patients. Also, I believe that at some level commercial interest should not be the driving force of medicine. But there are lessons to learn from pharmaceutical companies: their R&D departments are highly effective and come up with great stuff. Also, companies like these have adopted strict protocols which might be used as a template to order the flow of data in academia to minimise sloppy science! These thoughts will keep me busy for the next couple of days while i prepare for my talk. To be continued!

Academic and scientific training about to start

After 7 months of preparation the new and improved version of the second year course ‘Academic and Scientific Training’ is about to start. Tomorrow, 300 students will come together for two weeks to learn the how and why of clinical epidemiology. We emphasize on testing new treatments in RCT, and how doctors should critically appraise the articles that describe these studies.

Together with AvHV, JS and others we were able to secure funding to buy 400 copies of the book “Bad Pharma” (click for more background) In order to organise a ‘Bad Pharma Symposium’. In this symposium, all students will read the whole book, do some research on three topics which will be debated in the final debate. This will take a lot of commitment of all students, but what to think of the 40+ Teaching Assistants that we need for this course!

All in all, it’s time to start!

On being a scientist – first pilot was a succes

Last week we had our first pilot of our workshop ‘on being a scientist’. When I first wrote about this I was talking about a LUMC workshop, but we’ve got an upgrade: the workshop is now targeted at PhD candidates from all over the university. This way ll participants can learn from the dfiferences and similarities between areas of research. Exciting stuff!

We started last week with a small group of 12 PhD candidates from all over the university. This pilot included candidates from law, physics, psychology, medicine and the campus The Hague were all present. Also present were TdC as a co-organiser and KS as our guest.

Although the formal evaluation forms have not been processed I guess we can establish that the pilot was succesful and with that I mean that the pilot showed that we are on the right track: of course some of the content needs to be changed, but the general flow of the workshop was great. The same goes for the participants and the location.

Below a short programme

  • Introduction
  • A short history of scientific misconduct, the case of the Netherlands
  • From Fishy to fraud – a discussion about the grey area
  • PhD candidates: a special case?
  • Closing remarks

The guys from the human resource department who are responsible for the general eduction programme of all PhD who start at the Leiden University have decided that this workshop is a great way to get this topic to the attention of young researchers. The first thought is to take this workshop as a compulsory part of the eduction programme. To cater to all the 400 new PhD students the university has, we need more scientist from all over the university who can teach this course. This means we need to work on the reproducibillity of the course. with more generic examples and a clear descrition of the reason why some parts are included etc. But if we succeed, I believe that this workshop is a great way to let PhD candidates talk and think about this subject matter, which hopefully will be of help in their scientific career.

journalclub: change in program

The articles that need to be read for the journalclub meeting #7 and #8 are switched! See below for an update.

7 5-nov Ovaska MT, Madanat R, Huotari K, et al. Risk Factors for Deep Surgical Site Infection. 2013;348–353.
8 12-nov Hernán M a., Hernández-Díaz S, Robins JM. A Structural Approach to Selection Bias. Epidemiology. 2004;15(5):615–625.

How science goes wrong? we’re improving!

econ

Fraud, shoddy and sloppy science, conflicts of interest… Who said a science career is boring? When I write on these topics I sometimes have the feeling that I am doing science more harm than good; am I doing science a favor by showing its weaknesses and caveats? The answer still remains yes, for I believe that we need problems need to be identified before you can act on them. This is also the theme of this post: What is all being done on these topics in the last couple of days. A point by point list:

  • AllTrials: The AllTrials initiative which I support is going into its next round.Pharmaceutical companies are opening up (LEO, GSK), there are hearings in brussels and the debate in Medical journals (especially the BMJ, as one of the founders of AllTrials) is going on. Great stuff!
  • PubMed commons (a commenting system in PubMed, as a new post publication peer review) got online. It’s still a trial, but boy this is cool. I love its punchline: “A forum for scientific discourse”.
  • We organised a try out of our ‘on being a scientist’ workshop on which i wrote earlier this post. IN this post i say that is if going to be a LUMC workshop, but this changed to a workshop for all starting PhD students from the university Leiden, thus including all faculties. I am truly exciting and it our first run in november works out, this workshop might even become part of the official PhD education program of the university Leiden. The economist published a coverstory on How science goes wrong. It tells how science, peer review, statistical false positives etc work. It is a good read, especially when you are interested in science as a social process. Some remarks can be made: it’s not all that bad because scientist tend to be familiar with how the system works… the system might not be perfect, but it is at the moment the best we can do… luckily there are ways to get better, ways that are also discussed in the article.It is good that the economist and other media shares these concerns, because now this might up to build to critical mass to really change some of the weak points in the system. I thought about using the graph published next to the paper, but once I discovered the animated version of the graph i fell in love. See for yourself below. (PS false positives: another reason why not only to rely on statistical testing!)
  •  – edit: i changed the title of the pot… the first title was a bit pretentious –

Continue reading “How science goes wrong? we’re improving!”

Diane 35 and thrombosis risk – Zembla broadcast

The oral contraceptive pill ‘Diane 35- was’ in the news again. I wrote about the diane-35 pill on this website before, even twice,  when there was a broadcast of the radio show Argos.

The first time I wrote:

[…] this is a bit strange: there is nothing new about the information that third and fourth generation oral contraceptives have an increased risk of thrombosis compared to the risk conveyed by second generation oral contraceptives. Because the desired effects of the older and newer generation pills are similar (not getting pregnant, preventing or curing acne) there is limited, if any, reason to prescribe the newest and more expensive pills. See also the recent comment by Helmerhorst and Rosendaal in the BMJ. However, still 160.000+ (Diane 35) 500.000 (third generation) women take these newer pills. […]

Those words also fit the broadcast of the TV show Zembla last week. Zembla has a reputation to be ‘activist reporters’ and some of the broadcast is not to my taste. It is however good to see that Zembla tried to figure out how it is possible that Diane-35, which is not registered as an anti-conception pill, still gets prescribed as such. However, the broadcast leaves me unsatisfied for it does not provide answers, or even get to talk to everybody they wanted to? (Why did they reporters did not proceed to work on their WOB? a missed change!)

As in the previous two blog posts on this topic, I feel like these story are important but they also need to have the proper amount of nuance. Therefore, also this time I conclude with saying that the absolute risk of thrombosis in young women (both venous and arterial) is very low, even when using oral contraceptives. But all unnecessary risk without any benefit that can be avoided should be avoided. As always, consult your GP if you have any questions.

Diederik stapel on TEDx Maastricht BrainTrain

I am a frequent reader of the retraction watch blog. Today they’ve put up a video from a TEDx event called, TEDxbraintrain. From their website:

“TEDx BrainTrain is a side event of TEDx Maastricht and is organised in collaboration with Dutch Railways and the SocialCoupé. In the intercity train between Maastricht and Amsterdam Central Station, inspiring talks by interesting speakers will be held in the same way as the main TEDx Maastricht event in the theatre at the Vrijthof”

Interestingly, one of the speakers is Diederick Stapel, a former clinical social psychology researcher with so far 54 retracted publications. The speech is quite similar to his book, which i’ve read out of interest in his part of the story: it sounds nice, but I don’t really understand what the message is. What struck me most is the part where he describes why he “invented research data and blew up his career as a scientist”:

“I became detached from myself (…) I lost my passion and desires… my personal goals became less important than my professional goals, and my professional goals completely overtook me”

This sounds weird to me…is good research practice not a ‘professional goal’? I am lost with this guy…

Edit: on the LUMC PhD-day, a day long PhD fun organised by the VAO, I will give an interactive workshop (together with TdC) on scientific integrity to the PhD students of the LUMC. This workshop is titles “How NOT to become the next Diederick Stapel”. Lesson 1: don’t think that inventing research data to get published is the right way to adhere to your professional goals!

Nacht van Kunst en Kennis

On the 14th of september (a saturday) the Nacht van Kunst en Kennis will be organised in Leiden. During this festival, the differences and similarities between arts and science will be explored on several locations. A great initiative, which might just increase the public awareness of the necessity of interest free research.The program is quite interesting with inspiring scientist and great artists!

I will also be helping out during this festival night: I will host the section that is organised by science cafe leiden. This organisation tries to bridge the presumed gap between science and the lay person. We will be discussing several themes which are still subject to change… currently we are thinking along the lines of bounderies… Where is the line between just the right amount and to much. More information on this special section can be found here

Journal club 2013: application form is now available

Just like the last 2 years I will organise a journal club together with RAvA. Students of the LUMC who want to participate please use this form to apply. Since there is only a limited number of places available, application does not guarantee participation.

During this journal club students will learn how to read and be critical of articles that describe clinical research: from crossover trials to nested case-control studies. We will read the good, the bad and the ugly. And off course, some methodology will also be present!

The level of knowledge needed to participate is high: students in doubt of their knowledge and experience  in clinical research should note this in the application form.

Scientific fraud on TV – improvisation program

onderzoeksfraude de vloerop

I find the several Dutch examples of scientific fraud and misconduct quite intriguing and  I consider this topic to be one of my ‘projects’. I believe that these examples from the past learn us how the exactly the scientific community works. Different books, documentaries and reports have been published on this topic (such as the books from Frank van Kolfschoten, the  weird apology-in-book-format from Diederik Stapel, the nice documentary on Buck, and the comprehensive reports from the KNAW such as the Schuyt report), and since last friday we can add an episode of the Dutch program “de vloer op” a TV program in which Dutch top actors improvise scenes which are only described in one little sentence.

For this scene, two actors are placed in an empty university dining hall, and the junior scientist is about to confront the senior prof with his suspicion of scientific fraud. The result can be seen here (unfortunately the video cannot be embedded on this wordpress.com website)

PS if you like “de vloer op” please consider to support this great program because the government support for HUMAN is not guaranteed. please visit their special website.

WEON 2014

twitter logo

The WEON is the annual meeting of the VVE, the Dutch Epidemiological Society. The whole conference is held in English though, given that each more and more non Dutch also attend. These might be working here in the Netherlands, but we also have visitors from abroad. Last year, the WEON was organised in Utrecht with a couple of organisation from Utrecht and surroundings. The conference was a great succes with great preconferecence workshops and great plenary speakers, as I wrote before on the causality blog.

But now onto next year, when the WEON will be held in Leiden! Before you start with anything, you need to start with a motto and logo. Since the focusgroup “causality” is also based in Leiden the motto and the logo are off course linked to causal inference! Currently, we are working hard on the basic program. And specifically, I’m working on a special preconference workshop that is targeted at young epidemiologist. I got some ideas, but if you have any suggestions, please join the conversation via @WEON2014!

 

ERA-EDTA CME course – “interpretation and presentation of study results”

During “conference season” I visited several conferences: ISTH, eurostroke, WEON, NVTH,  UK-CIM and the ERA-EDTA. During all conferences I got the opportunity to present my own research, except for during the ERA-EDTA. For this conference I was asked to teach in a CME course on how to perform and interpret a clinical research project. The program:

– Setting up your study: study questions and study designs
Vianda Stel, Amsterdam, the Netherlands

– Threats to validity of study findings: bias and confounding
Kitty Jager, Amsterdam, the Netherlands

– Prognosis vs aetiology
Friedo Dekker, Leiden, the Netherlands

– Interpretation and presentation of study results
Bob Siegerink, Leiden, the Netherlands

Since this is a conference on kidney diseases, the examples that I use are from that field. Although not necessarily my field, I believe that the talk can be of interest for anybody who is at the start of their research career. Please click the picture below to see the talk (slides + audio)

click here for audio and slides

Bad Pharma Symposium

I just got word that we got funding from an external to buy 400 copies of Bad Pharma to use as instruction material in our redesigned course on academic and scientific education. The book touches upon the role of  the pharmaceutical industry in the design, execution, presentation and dissemination of results of clinical trials. The author, Ben Goldacre, identifies several problems and brings forth several solutions. But are these all correct?

We will use this basic question as the basis for a complete symposium on this topic: are the problems identified by Goldacre the real problems, or just cherry picked examples from the past? And are the solutions that he provides real solution that could work? And can we think of any other way to improve the care of our patients in the future?

I had this idea a long time ago when i first read this book. It touches upon a matter that is discussed in the old version of this course for a couple of years. Even more so: during this course students are asked to grade the quality of trials and the subsequent reference to this publication. The results show that the quality is often low, even in high impact journals, and that the references do not always justify the claims made in medical advertisements. These results have been published in several publications and are even cited in the book.

It was quite a hassle to get a ‘normal’ book into the curriculum of our medical center. Most people liked the idea of reading a book and organising a symposium, but a lot of people told me that it was impossible to do so. A “normal” book could not be placed on the mandatory reading list, and just buying electronic or hard copy  versions is just way to expensive. luckily, with help from the Walaeus Library of the LUMC and prof FMH we were able to obtain external funding. And no, its not funded by ‘big pharma’, but a small fund that subsidises small but nice projects that make the world a bit smarter.

Measuring aerosols with your smartphone

Today I participated in crowdsourced science: Measuring aerosols with my smartphone. Thousands of measurements in one day, all about the air quality in the Netherlands. The nice thing about this project is that laypeople are the researchers: everybody that ordered a free gadget for their iPhone is a researcher on this great sunny day. How the measurements work? See for yourself!

More on this project can be seen on their website ispex.nl. This project was made possible with funds fron the Dutch lung foundation and the Academische Jaarprijs. So is it time to think of a big epi project in which crowd sourced data can be used?

New publication in NTVG: patient crossover studies

Recently another paper became available online. Although accepted couple of months before and not yet in print, the paper on patient crossover studies can now be read and downloaded from the NTVG website. This paper, with first author REJR,  is a continuation on the paper on crossover trials on which I’ve blogged earlier. Together, these articles provide a comprehensive overview of the possibilities to use a study subject as its own control.

Eurostroke 2013

Today, I write from the Eurostroke conference. This conference is a yearly conference for stroke physicians and researchers to share knowledge, both existing and new. I always liked the idea of combining research and education in a conference.

There are about 3500 delegates, as can be seen from the panorama photo I just took during the plenary clinical trials session. Although most of these topics are not directly of interest fr my own research, I enjoyed seeing how these PI share their work, which sometimes is a real impressive feat.
Image ESCI gotta run to my poster session, where I will present the poster below. If I referred you to this site to download the electronic version of the poster, you can click the link below.

 Poster eurostroke 2013 Siegerink et al P255

New course started today: Scientific education

Today, the course scientific education started. This course, a regular 2nd year course in the LUMC curriculum, runs for three weeks and is organised by AvHV and myself. This is the last year this course will be given in this form, and we are working hard to modify the course to make it fit in the new curriculum. This means that this year we have a opportunity to test some of my our ideas. One of these things is a non compulsory journalclub, in which we’re going to read one article with all students at the same time. I’m curious how may students really would like to train their scientific skills, outside of the curriculum.

Also, we are preparing a new full day interactive assignment and sympium, which is centered around the book Bad Pharma of author Ben Goldacre. I hope to fine some students that are wiling to help me in this development of this part of the new course. Exciting stuff!

– edit 30/5 : the course just finished and 320 students took their exam friday 24th. Although i do like students, I hope I won’t have to see them again for that will mean that they failed the course.

Grant awarded to investigate the long term effects of cardiovascular disease at a young age

Today I got a letter from the Leiden University Fund (LUF) to inform me that the grant we requested was granted. This is great, because now we can investigate the long-term effects of young stroke, myocardial infarction and peripheral arterial disease. We will do this by linking our data from the RATIO to the several national databases (e.g. cause of death registries and hospital admissions) that are under control by the central bureau of statistics (CBS). I will perform this research together with AM and other Italian colleagues from Milan. 

The grant (11K) that was awarded is the Den Dulk Moermans Fonds, which exist since 2010, as we can read from the Dutch information the LUF website:

Het Den Dulk-Moermans Fonds is opgericht in 2010 na ontvangst van een erfenis van dhr. A.M. den Dulk. De doelstelling van het Fonds is het financieren van onderzoek naar gezondheid in de breedste zin van het woord.

New article published: review on obesity and venous thrombosis

Together with colleagues I worked on a review on the role of obesity as a risk factor for venous thrombosis. I’m second author on the article, which come online last week, and most work has been done by SKB from Norway, who is visiting our department for a full year.

The article is written from an epidemiological point of view and discusses several points that are worth mentioning here. First of all, obesity is an ill-defined concept: are we only talking BMI, or do also other measures of obesity need to be taken into account? Second, even when defined, the results are not always easy to interpret. In causal research there are a couple of things that need to be fulfilled before one can answer the question whether something is risk factor of disease. For example, BMI can be reduced by means of exercise   diet or disease, which all three have completely different effects on thrombosis risk. We discuss all these epidemiological problems, together with the existing body of evidence in the new article in seminars of thrombosis and hemostasis. These question are not only important for our understanding of thrombotic disease, but also to grasp the causal role of obesity in (cardiovascular) disease. This research question has in ast couple of years been put on the research agenda of the NEO study, on which perhaps more in the future.

The article, with the full title “Role of Obesity in the Etiology of Deep Vein Thrombosis and Pulmonary Embolism: Current Epidemiological Insights” can be found via PubMed, or via my personal Mendeley page.

The protective effects of statins on thrombosis recurrence: a letter to the editor of the European Heart Journal

Recently, Biere-Safi et al published the results from their analyses of the PHARMO database describing the relation between statin use and the recurrence of pulmonary embolism (pubmed). This article was topic of a heated debate on our department: is it really possible that statin use halves the risk of recurrence in this patient group? During this discussion we found some issues that could led to an overestimation of the underlying true protective effect. We described these issues in a letter to the editor which has been accepted as an e-letter. Some journals use e-letters to facilitate a faster and more vivid debate after a publication, but unfortunately, these e-letters are only to be found at the website of the publisher and not for example in Web Of Scienc or Pubmed. This could mean that these critical parts of the scientific debate could have a smaller reach, which is a pity.

Nonetheless, the text of our e-letter is to be found on the website of the Eur Heart J, or via my Mendeley account.

Mendeley bought by elsevier – good or bad?

(image via litroost)

I use Mendeley (paid subscription) to keep track of my literature and as a reference manager etc. I even use it as my main method to share my publication on the internet (see also my personal Mendeley profile) I like it. I like it a lot. Sure, there were some hiccups, it being  start-up and all, but I like the idea: share with colleagues all the papers and your comments on them you need to write that paper. But now Mendeley has been bought by Elsevier, which is not really known for its friendly attitude towards the whole idea of sharing scientific articles. More about this Elsevier-Mendeley buying operation can be read in this column of the New Yorker. So what to do? cancel my subscription as a sign to the folks at Elsevier? Well, the guys from Mendeley promised that all will be all right (it will even get better!) and that the great adventure of sharing your literature and results will not be harmed with the acquisition, so perhaps canceling my subscription might be to fast. Let’s wait and see…

ISTH Soccer Match | celebrating NVTH 25th birthday

Dring the ISTH conference which will be held in Amsterdam this summer we will be organising the traditional ISTH Soccer Match (hostland vs the world) on saturday 29th of june in the Olympic Stadium Amsterdam. Before, during and after the soccer Match we will also celebrate the 25th birthday of the NVTH, the Dutch version of the ISTH. More information will follow, but for now I can present you the design of the entrance tickets. Woehoe!

NVTH fussballfest ticket front final

News from AllTrials.net

So I got an email from the folks from alltrials.net on their progress. I explained the initiative in an earlier post in which I also told that I  as well as the Dutch Epidemiological Society (VVE) signed the petition. So did it help? Just read the following section from their email.

You, and 40,000 other people around the world, have signed the AllTrials petition. We are on the threshold of significant change, but we now urgently need help from all of you to make this a reality.

Your support has already persuaded hundreds of organisations to commit to the aim of getting all clinical trials registered and their results reported. These include regulators and faculties. GSK, one of the biggest drug companies in the world, has signed up and others are considering it. Some of these groups are now starting discussions about the practical ways to stop trial results being withheld.

So far we’ve created a ripple, and got some important commitments. We have empowered individuals in large organisations to speak up, and it has changed the mainstream opposition on this issue. In doing so, we have also challenged those who try to pretend that the problem doesn’t exist, or who falsely claim that it has already been fixed.

But this is only the start if you ask the alltrials.net folks: they want to push on with three goals:

  • One million signatures on the petition. 
  • More international organisations signed up.
  • £40,000 so we can keep going.

I can only agree: consider signing (if you haven’t done so already)!

Paper published in Arthritis Care & Research now quoted in NTVG

The arthritis Care and Research paper which I co-authored (PubMed) attracted attention from the guys of the NTVG. This paper, originally a collaboration between the Reumatology department and the department of Clinical Epidemiology described the relationship between BMI as a proxy for obesity and treatment response in patients with rheumatoid arthritis as is described on the news section of the NTVG website. The text of the news item from the NTVG website can also be read on this website if you ….

Continue reading “Paper published in Arthritis Care & Research now quoted in NTVG”

LUMC workshop on scientific integrity

Together with my colleague TdC from the department of geriatrics I am working on a workshop for starting PhD students on the topic of scientific integrity under the working title “On being a scientist: a workshop in scientific integrity”

The LUMC code of scientific integrity, the recent KNAW report of cie. Schuyt and the publication of the National Academy of Science “On being a scientist” will form the backbone of the this workshop (see also the video below of the NAS, with the great quote “scientist should be people too!”). We are still developing the actual content, but this workshop will primarily based on several cases that will be discussed, ranging from cases of clear scientific misconduct to cases of conflicting demands of supervisors. How can you spot these problems in advance, solve or preferably prevent them? What additional measure should be put in place to sustain a critical but workable environment?

I am excited that I can be part of the team that develops this workshop. As I said before, I do not believe that this workshop will prevent all possible scientific misconduct, but I do believe that educating PhD students helps to prevent hem from making honest mistaken. Also, I hope that this course will help to create a critical but positive atmosphere in which science will thrive.

This workshop will be part of the PhD training that the LUMC offers free of charge. The first edition of the this workshop will be held on September 18 2013. Please contact me via email for more information.

————————–

video “on being a scientist” from the NAS

Grant awarded to investigate the role of coagulation FVIII in the aetiology of ischaemic stroke in RATIO study

I just received a letter from the KNAW stating that the grant proposal I sent to one of the fund of the KNAW, the van Leersumfunds, was awarded. From their website, we can only learn a little about this fund:

“The Van Leersum Fund supports neuro(bio)logical, radiological and pharmaceutical research by awarding a series of research grants.

The Fund was established in 1922 and is named after P. van Leersum. The assets of the fund are made up of his estate and the estate of Ms I.G. Harbers-Kramer.”

With this grant we will be able to measure coagulation favtor VIII in the ischaemic stroke substudy of the RATIO study. Coagulation factor FVIII is one of the most potent risk factors for venous thrombosis in the coagulation system, and were quite curious what effect it has on the risk of ischaemic stroke in young women.

Diane 35 and thrombosis risk – Argos broadcast part II

Last week I wrote a post after hearing the radio broadcast of Argos. They concluded that broadcast with the promise to discuss how it is possibe that a more expensive, just as effective medicine which has more side effects still can be prescribed (in large numbers) in the Netherlands.

So I’ve listen with great interest the second part of the story, which can be heard on the Argos website. They journalists did a good job by covering all sides of the story , and they provide insight in the differences between ‘advertisement’ and ‘providing information’. What if information that is provided is only one sided? Does that count as advertisement? and if you want to play a nice game during the broadcast, ‘spot the logical fallacy’ is good suggestion… Gems!

In case you are wondering: the absolute risk of thrombosis in young women is low, even when using oral contraceptives. But I still believe that all unnecessary added risk without any benefit that can be avoided should be avoided by you in dialogue with your GP!

Is science self-cleansing? An article in the “Academische Boekengids” discussing report cie. Schuyt

Earlier I wrote about the “Adviescommissie onderzoeksgegevens in de wetenschap van de KNAW” and their report “Zorgvuldig en integer omgaan met wetenschappelijke onderzoeksgegevens”. This report induced a discussion in the March 2013 edition of the Academische Boekengids .

Three scientist give their vision: Miedema (dean of Medicine at the UMCU) Vandenbroucke (KNAW professor and professor of epidemiology at the LUMC, member of committee Schuyt) and Paul (professor of secularization studies in Groningen). Important to note is that the contradiction between the authors was known beforehand.

Miedema identifies a change in science, especially medical and social science, in which economic and social forces influence science and scientists. These forces have led to a ‘system failure’ of science, leading to shoddy science or in his words ‘post academic science’. Miedema argues that these changes cannot be undone and certain measures need to be taken to correct this system failure. What measures? Miedema points toward Quality Assurance and Quality Control (QA/QC) making a comparison with so called pharmaceutical research embedded within Good Clinical Practice (GCP). This should be done by governments, universities and funding bodies. Interestingly, he leaves scientist out of this list. And what does Miedema think of the report of the committee? He believes the vision of the report is based on the old idea of science where all scientist are directly held accountable by peer pressure, a vision that according to Miedema is not valid in this day and age.

Vandenbroucke points out an error in the argumentation: Miedema targets post academic science. Vandenbroucke agrees that this is a problem, but not the problem discussed by the committee. Their task was to see how data during and after research should be treated in order to keep science workable without to many hiccups and problems. The committee provides some answers but one of the main themes is that scientist should self-regulate, for they are the only experts in this area. This is in contrast to who Miedema who abhors the idea of self-regulation: science is not science anymore, so how can scientist self-regulate with all these strong forces that are incomprehensible to grasp for a simple scientist. Vandenbroucke counteracts Miedema by explaining that his vision of science (science is the search for truth) is not at odds with the problems that arise with post academic science (science is a complex social construct in which forces other than the truth have a big influence). Even more: these two notions can coexist, a concept first noted by Stephen Jay Gould.

Paul tries to reconcile the two previous writers: he agrees with Miedema that in earlier times the scientist was appreciated for his behavior as a person, whereas this view seems to be outdated in this day and age. But Paul also approaches the problem from the other side: the solution of the problems that come with post academic science calls for strong personalities that can counter unwanted forces that trouble science. Paul mentions the work of the science historian which he – ought enough in this context- announces as an ‘honored scientist’ (Dutch: gelauwerde wetenschapper) who published his ‘handsome study’ (Dutch: fraaie studie).

So what are the suggested solutions? Because the authors disagree on the origins of the problem, their solution also differ. Especially Vandenbroucke and Miedema find themselves on first glance diametrically opposed to one other. Vandenbroucke wants to start a discussion bottom up on what it is to be a good scientist, whereas Miedema wants top down QA and QC. These ideas are not new. For example, Jacobus Lubsen also brought this concept in an article in the NRC of December of 2011. Quality control and forensic statistics should increase the detection rate of wrongdoing and should therefore be instituted. I responded to this article with a small letter to the NRC in which I state that complete control is difficult and expensive and often only identifies shoddy and fraudulent science with hindsight. Additionally it will have a preventive effect on bad science, but will it have such an effect on fraud? After all, other fields that have huge governance structures such as banking and accountancy also have their fraud scandals. Even more, the frequency of sloppy science is hardly affected by these measures. A better way to prevent both sloppy and fraudulent science is, I believe, a better training of young scientist. By introducing young scientist to the key concepts of scientific conduct, creating a critical but non-repressive atmosphere, perhaps even in several research groups to prevent tunnel vision of individuals, will lead to an increased informal control and a decrease in sloppy and shoddy science. The committee also mentions this concept and calls this “increasing peer pressure” and puts scientist at the helm of this operation.

It will not surprise you that I agree with Vandenbroucke for the most part. But I also see merit in the argumentation of Miedema. Perhaps I agree with both to some extent because they address two different concepts: science is the quest for knowledge and based on epistemic virtues. Self-regulation by education of young aspiring scientist in a positive but critical atmosphere will increase the quality of research over time. But science is also a social construct and scientist need, besides guidance by peers, governance and regulations for certain scenarios: the cases Stapel and Poldermans as well as the previously discussed book ‘Bad Pharma’ by Ben Goldacre are examples why this might be true. Besides informal peer review and guidance, an extended system of checks and balances, GCP or not, might help to keep colleagues accountable for their work. Science in itself is a system of checks and balances, but this system might be expanded with some form of regulation and standardization with efficacy and efficiency kept in mind. But most of all, now is the time train the young.

– update on 25/3/2013: an interview with both JvdB and FM was published in the NTVG. Together with the editor-in-chief they discuss performing research, obtaining a PhD and publishing your results. click here for the pdf (NTVG website, in Dutch)

 

Hora Est – thesis is topic of a Cicero article

cicero maart 2013The Cicero, the monthly magazine of the LUMC, wrote an article on my thesis. During the interview, I was able to bring fort the nuances of the work in the thesis. That is, my thesis does not fully provide all the answers in details for allr esearch questions but it does provide a simple overview: an increased clotting potential is a risk factor for ischaemic stroke but not for moycardial infarction. Unfortunately, space limitations dictated that some remarks had to be left out. Fortunately, the last remarks is about the relevance of teaching experience as a PhD: a great link to one of my propositions.

The picture above was placed in the Cicero to accompany the interview. I like it very much because it has a certain epidemiological feel to it: a group (a cohort?) of women all different, but with certain patterns.

The text of the interview can be downloaded from the media page, directly directly clicking here (pdf). The text can also be read online if you… Continue reading “Hora Est – thesis is topic of a Cicero article”

Diane 35 and thrombosis risk – Argos broadcast

The oral contraceptive pill – especially the Diane 35- was in the news again. However, this is a bit strange: there is nothing new about the information that third and fourth generation oral contraceptives have an increased risk of thrombosis compared to the risk conveyed by second generation oral contraceptives. Because the desired effects of the older and newer generation pills are similar (not getting pregnant, preventing or curing acne) there is limited, if any, reason to prescribe the newest and more expensive pills. See also the recent comment by Helmerhorst and Rosendaal in the BMJ. However, still 160.000+ (Diane 35) 500.000 (third generation) women take these newer pills. Since thrombosis risk might be highest in the first few months, it is unclear whether these women all should switch to the safer second generation oral contraceptives. But for women who get their first prescription, a second generation oral contraceptive the best way to go (also according the Dutch GP guidelines).

A lot of the research on this topic has been executed by my colleagues from both the MEGA study and the RATIO study. Want to learn more about the pill controversy, please listen this episode of Argos, a Dutch radio programme.

In case you are wondering: the absolute risk of thrombosis in young women is low, even when using a newer generation oral contraceptives. But all added risk that can be avoided should be avoided by you in dialogue with your GP!

New article accepted for publication in NTVG

A new article has been accepted in the Nederlands Tijdschrift voor Geneeskunde. The article with the title “patient crossover studies” or “case-crossover studies” is an educational in the Methodology series of the Journal. REJR is the first author of this article and she did a great job on explaining the similarities and differences between this observational study design and the experimental version of this within person comparison. These crossover trials have been discussed by TNB en JGvdB in a previous article in the same series on which i wrote earlier.

Ben Goldacres ‘Bad Pharma’ and research from the LUMC

Ben Goldacre, known from the bestseller Bad Science (book and blog) has a new book, Bad Pharma. Goldacre is always fun to read: science, both the method as the social phenomenon, explained for non-scientist while still interesting for scientist. The same goes for his new title Bad Pharma, where he explains what is right and wrong in the field of clinical trials needed to determine what treatment is best given. Before I am going to review the complete book, perhaps this TED talk will explain it all:

Basically, his point is that for good answers to questions on what treatment is best to save lives, it is pivotal that all the results of all trials are published. This sounds a bit old, since there are databases in which trials should be registered. However, only registering the existence of a trial is not enough: all data should become known to the public. This sounds familiar: this standpoint is off course the same standpoint of the AllTrials.net petition, which is initiated by a.o. Ben Goldacre. For more on AllTrials.net, please see a previous post.

While reading the book of Goldacre it started reading about reasearch done in the Netherlands, where 250 students were looking into the adverts for medication: they checked their quality (was the science OK?) and correct use (does it support the claim?) of the trials in major journals and found that half was of good quality and only half supported the claim. And the nice thing about this research? It was executed at our department as part of one of our  undergraduate courses! All students scored trials and a couple of students were also engaged in the analyses/writing/submission process. The paper from this research, cited by Goldacre, is available from the website of the Netherlands Journal of Medicine.  (pdf, open access) An earlier paper with the same concept but focussed on rheumatoid arthritis medication is also published, also open acces. (pdf)

Paper published in Arthritis Care & Research

A paper which I co-authored has been indexed for PubMed. This paper is a collaboration between the Reumatology deprtment and the department of Clinical Epidemiology. LH and MvdB have done a great job by describing the relationship between BMI as a proxy for obesity and treatment response in patients with rheumatoid arthritis.

Ref: Heimans L, van den Broek M, le Cessie S, Siegerink B, Riyazi N, Han KH, Kerstens PJSM, Huizinga TWJ, Lems WF, Allaart CF. High BMI is associated with decreased treatment response to combination therapy in recent onset RA patients – a subanalysis from the BeSt study. Arthritis Care & Research. 2013

ABC promotes EBM thesis printing with my cover as example

foto

The American Book Center decided to actively promote thesis printing by their EBM. They asked me whether they could use the cover of my thesis on their promotional material because of the nice design Iris made for the cover. Since the EBM operator Joe was very helpful during the lay-out and printing process, I am willing to promote the EBM from the ABC! Curious what I am talking about? Please refer to my previous post on printing my thesis.