Ken Gillman: Medical science publishing: A slow-motion train wreck

Ken Gillman’s reply to Edward Shorter

        Thank you for those of your comments that were complimentary — it is sometimes uncertain how the word “polemical” is intended. I shall accept the Oxford dictionary definition of “argumentation against a doctrinal opinion”; I enjoy countering doctrinal opinions.

        “I’m puzzled by the introductory indictment of publisher Robert Maxwell.  Surely, his Pergamon Press couldn’t have been solely responsible for the wreckage-strewn trail that Gillman identifies.” (Shorter)

        You do not appear to be reading what I have written: the introductory sentence says clearly, “influences that have shaped medical science publishing,” and as I outlined, he was the foundation and, initially, the major player.  Surely few will take “influence” and “shaping” to infer he was solely responsible?  In the conclusion I state: “It is ironic that you chose the word ‘indictment,’ since he was indicted, on at least two quite separate and very serious charges.  That may well have been relevant to his death, which may have been suicide. 

        Has your emotional reaction to what I have written, if only temporarily, clouded your judgement? That is good, it means you will better remember what I have written.

        “If Gillman is right, poor Kety was oblivious to being ‘led like a lamb to the slaughter.’  I recall Kety as being quite astute.  Could Maxwell have infected even him or is Gillman’s analysis vastly overwrought?” (Shorter)

        Again, that does not reflect the precision of my words and over-generalises — I stated: “some of whom were naïve and compliant”; not “all”, not even “most,” just some.  Perhaps your hyperbolic “vastly overwrought,” is itself overwrought.

        This commentary was posted on my own website, which is aimed at a general readership.  The INHN then asked to re-publish it.  There are difficulties writing for a wide audience without having some people who interpret something differently and make assumptions that I would not have intended them to make: after all, they are coming from different directions and with different experiences and knowledge-bases. 

        Of-course there are brilliant and astute writers, researchers, editors, referees, etc., all motivated by the common good and upholding the probity and standards of scientific discourse and publishing.  I would not expect it to be thought that I was insinuating that all editors (or reviewers) are unqualified and incompetent. How could I possibly think that with such a small personal window of direct experience (although the many references I cited do point clearly in that direction)?  Yet, it seems the good editors are now few and far between; they may even qualify to be designated a “protected-species.”  I would assert that for general readers the act of discerning good from “less-good” is not just difficult, it is unachievable.  As I argue, constructively, there is a realistic prospect of post-publication assessment solving that problem.

        “I must say, I know many of these editors and they are among the brightest bulbs in the field.” (Shorter)

        Edward, in statistical terms at least, how great is your personal knowledge of particular contemporary editors and their perspicacity, compared to the multitudes out there, many of them on other continents and speaking different languages?  The point is there are not just hundreds of journals, there are tens of thousands (I quoted 30,000 as the current “PubMed” total, but probably more like 100,000 in circulation altogether, publishing at least 2.5 million papers a year).

        I restate: a psychopath like Maxwell can, and did, dupe all and sundry, especially people like doctors, who delude themselves they cannot be conned or influenced by drug companies after being taken out to dinner — I recall one paper that showed most of them thought their colleagues were influenced, but not they-themselves!  Likewise, a magician can trick anyone (including eminent scientists, as has so often happened, remember Uri Geller?).  When Horton “stepped-down” as Lancet editor he described himself as having been conned for years.  So, however astute Kety was, or you perceive him as having been, that has no bearing on whether a psychopath could manipulate, or hoodwink, editors in general.  “Maxwell” conned a lot of bankers to the tune of hundreds of millions, at least some of whom must have been astute; remember the quote from Rothschild about “shooting that man 17 times.”  We can be confident that he was one of the most slippery eels that ever slithered from the slime.

        “Roland Kuhn, who discovered the clinical effectiveness of imipramine in melancholic depression, despised numbers.” (Shorter)

        I agree. I have written at length about clinical observation vs. statistics and RCTs elsewhere and cited (more than once) Sir Austin Bradford Hill who made the same point when stating: “you need neither randomisation, nor statistics, to analyse the results, unless the treatment effect is very small.”

        “Industry doesn’t put ghost-written papers in obscure pay-to-play journals that no one reads.” (Shorter)

        Yes, they do.  They do not win quite all the time.  The reprints (the major income source) their reps hand out to doctors are as important as the journal in which they are published.  Inconvenient results are sometimes deliberately published in foreign languages and obscure journals, to wit, the deceitful data concerning mirtazapine, about which there is an article on my website.  And what about the failed trials of duloxetine, sibutramine, radafaxine — buried ghosts, of which most readers have never seen or heard?

        Reprints from poor, and even bogus, journals are handed out to medical practitioners, who are unlikely to know the status or reputation of the journal; that is especially so in the sub-specialties, like orthopaedics (think “Lyrica”).  I would go further than that and say that the majority of doctors do not have much idea of the reliability and status of the journals they read, and also, researchers such as myself struggle to assess the quality of different journals.

        “The industry-funded, ghosted and manipulated papers absolutely end up in tip-of-the-lance publications.  And this is because some editors — not necessarily the best ones — fear the withdrawal of advertising if they behave sceptically.  For Big Pharma, only the top-drawer is good enough.” (Shorter)

        You are confirming my argument that even top journals are corrupted; money rules, hence the sacking/”resignation” of Kassirer, Smith, Horton, Angel and others — the “best” ones are the ones more likely to be sacked.

        “And you, as the author of a critical piece, will beat your head against the wall if you try to get it published in a first-line journal.  These are realities.  Gillman, of course, is aware of this, but he prefers to tilt against other targets that are important though secondary.” (Shorter)

        Your meaning seems to be shrouded in misty metaphors of “tilts, roads, and swerves.” The above paragraph is opaque, but I commented on that, if briefly, by explaining my reasons for preferring to publish directly on my own website.*  One cannot cover everything, so perhaps there will be suggestions about other issues I might cover if I do a “part two.”

        “These issues — inappropriate quantification, sinking into trivia and the hijacking of our scholarly literature — should be in the forefront of our critical agenda.  Gillman seems to drive straight at them, but then swerves off the road.” (Shorter)

        More misty metaphor.  I have the luxury of choosing what I write about. On this occasion it is evidently not quite what you would have liked me to write about.  Again, that paragraph is unclear; if those issues are particularised, then I might consider an attempt to deal with them in a prospective “part two,” but you may agree I have already tackled them in previous commentaries, of which, until now, you had no reason to be aware.

        Apropos to the ‘hijacking of our scholarly literature,’ my commentary is substantially about big pharma and greedy publishers doing just that — they control it, entirely; that is hijacking, the warp and weft of my commentary.

        As far as “inappropriate quantification” is concerned read the criticism I made of the “Lancet ‘21 antidepressants’ meta-analysis” and “Guidelines: problems aplenty.”  Incidentally if you put such phrases into Google my commentaries come up top of the page and have done since publication.  That supports my point about publishing in mainline journals being decreasingly productive and it encompasses your comment that they would not publish it anyway, even if it was only 250 words and submitted within a week of their publication of the original (after such an arbitrary short time period journals will tell you your response is “now insufficiently relevant”).  Also, Edward, I imagine you will be interested in my criticism of the STAR*D study, one central point to that being a dissection of the meaning-deficient concept of “treatment resistant depression”; there is also another commentary about the myriad of meaning-deficient terms in circulation, such as “mood stabiliser.”

*Ken Gillman’s website is “PsychoTropical.info.”

October 24, 2019