Jon Jureidini and Leemon MacHenry: The Illusion of Evidence Based Medicine
David Healy’s comment
The participants in this “listserve” are well-placed to engage in a debate about the issues raised in The Illusion of Evidence Based Medicine or the challenge thrown down to them by McHenry and Jureidini.
At the heart of the challenge are two articles involving a misreporting of clinical trials – GlaxoSmithKline’s study of paroxetine in adolescent depression (Study 329) and Forest Laboratories study of citalopram in adolescent depression (CIT-MD-18). Both have resulted in substantial fines against the companies concerned but not against the clinicians who appeared on the authorship lines of these articles – most of these academics will be known to readers of this list, almost of all of them will likely seem just like one of us. Are they just like one of us or were they different to anyone else on this list?
The cases presented are shocking. Some of the most shocking details appear in a list of appendices to the main text, a set of letters sent to various journal editors or university authorities looking for comment on the fraudulent articles now linked to their publication or institution and supporting a call for retraction of these articles. Names on this list will have been editors, university deans or other figures comparable to those who gave Jureidini and McHenry the brush off – would you have done the same?
My personal experience is that, contrary to general expectation, it has been editors formerly employed within industry who have been more willing to publish material critical of Pharma or pointing to adverse effects of treatment than the virtue signaling editors or deans who have never had a conflict of interest who end up publishing junk and are unwilling to recognize, never mind condemn, what their colleagues have done. In your experience are the virtue signalers lily-livered, and if so what accounts for this?
Jureidini and McHenry’s book, written for a much wider audience than this readership, introduces readers to the ghost-management of the scientific literature, referencing the work of Sergio Sismondo and setting him up as a social constructionist. It is likely that readers here know more about ghost-management, if this term appeals to you, than Sergio ever will. You will have seen it, whatever it is, evolve and perhaps are glad you got out of the game before seeing the field populated by a bunch of lightweights with more than 1,000 articles to their name.
Some of you will have gotten out of the game before Bruno Latour put social constructionism on the Psychopharm radar and managed to alienate many if not all neuroscientists in the process.
As a foil to Sergio, the authors turn to Karl Popper, definitely not a social constructionist, as a guide through an epistemic morass. Popper may even have been known in person to some people on this list and to others because of his dabbling on the fringes of the philosophy of neuroscience, but is Popper, who knew nothing about medicine, a good choice as a guide through our current epistemic morass?
Is Richard Feynman’s view of fringe or “Cargo Cult” science, something likely completely unimaginable to Popper and, as applied to psychopharmacology, likely unimaginable to Feynman also, a better take on what has happened? If so, what are the political underpinnings of the situation we now have where the greatest concentration of Fake News on earth centers on the medicines a doctor prescribes?
It was to escape just this kind of scenario that Hayek and Popper, associated with state control of science that led both men to advocate for a return to liberalism and free markets. Many today however would likely blame the free market for the outcome we now have. Which is to blame – the free market or state control?
More to the point, is there a way to restore us to the heady days of 1960s Psychopharm – some of us might even accept the 1970s. Is Jureidini and McHenry’s suggestion of having clinical trials run by government, or at least by bodies independent of industry (although funded by industry), the way forward?
It might seem like this question of who funds trials is a retreading of an old argument but the examples of corruption aren’t old – they are current. The appearance of “corruption” in the inner sanctums rather than in some dingy outpost is also new and current. Having a pharmaceutical industry that pursues a profit is old – not new – but there may never have been a time when Pharma adhered as closely to as many good practices as it does currently. So where are things going wrong? Is it with the editors of journals, the deans of universities or with doctors – the silent majority of whom seem to behave like a shoal of fish and just go with the flow?
This is a book to read and for readers of this list to offer a view. You’ve been there.
December 17, 2020