“Navigating numbers” is a series of Masterclass initiated by a team of Charité researchers who think that our students should be able to get more familiar how numbers shape the field of medicine, i.e. both medical practice and medical research. And I get to organize the next in line.
I am very excited to organise the next Masterclass together with J.O. a bright researcher with a focus on health economics. As the full title of the masterclass is “Papers and Books – series 1 – intended effect of treatments”, some health economics knowledge is a must in this journal club style series of meetings.
But what will we exactly do? This Masterclass will focus on reading some papers as well as a book (very surprising), all with a focus on study design and how to do proper research into “intended effect of treatment” . I borrowed this term from one of my former epidemiology teachers, Jan Vandenbroucke, as it helps to denote only a part of the field of medical research with its own idiosyncrasies, yet not limited by study design.
The Masterclass runs for 8 meetings only, and as such not nearly enough to have the students understand all in and outs of proper study design. But that is also not the goal: we want to show the participants how one should go about when the ultimate question is medicine is asked: “should we treat or not?”
If you want to participate, please check out our flyer
As said, I spoke 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.
Previously I told you that I wondered what kind of presentation it would be. During the preparation the story became clear to me… there is no way to choose between good or bad… they are both. How come? There are some serious problems in the way medicine is organised how it comes to new decisions on treatments. Missing data from trials indeed hamper the way doctors can decide what treatment to give and which not. So, I did talk about the book Bad Pharma and our Bad Pharma Symposium. But this was not all. Science has taken a beating lately, for example in the Economist article from October. And while preparing this talk I learned that Science and pharmaceutcal companies can learn a lot from each other.
During the presentation I used two books: Bad Pharma, which can be bought everywhere, or borrowed from the Walaeus Library of the LUMC, and Arrowsmith, a great coming of age novel by Sinclair Lewis, about a young scientist doctor who is struggling with the questions young doctors/scientist all encounter. I will write a longer post on that novel somewhat later, but in the mean time you can download the free e-book here.
A pdf from my lecture can be downloaded here: Big Pharma co raad symposium 2013 (pdf)
300 students reading one book, summarising it contents and discussing three propositions in order to grasp the essence of the book. This might sound a bit boring perhaps…But what if it Goldacres book Bad Pharma, you only have to read 30 pages and still get the content of the complete book, and get to Skype with the author? Great fun!
And we weren’t the only who had fun: Ben Goldacre addressed 300 students, all with critical questions, and apparently he enjoyed the whole debate:
We also invited AV, a spokesperson of NEFARMA an organisation who represents most pharmaceutical companies in the Netherlands. With him we discussed whether the AllTrials campaign was a waste of time and money. Also, BB a reporter from the Mare, who has knowledge on conflict of interest of professors joined in on the discussion whether professors should declare their COI before each lecture. All in all, it was a great day in which some of the students were shocked by the message of Ben Goldacre, whereas other students were not impressed and doubted whether there view is too one-sided… The debate still continues!
This 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.
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!
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!
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.
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)!
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)