Thursday, May 24, 2007

The Avandia meta-analysis: critical appraisal versus hype

Musings of a Distractible Mind shared some Thoughts on Avandia today (via Kevin M.D.) and is rightfully concerned that irresponsible popular media coverage seems to be guiding scientific discussion. In discussing some of the flaws of the meta-analysis he notes this:

We had an endocrinologist in our office a few days ago (not representing GSK) and we discussed this issue, and his comment was that Dr. Nissen is “the Michael Moore of the medical industry.” Strong words. Mr. Moore is a crusader against the big and rich for the protection of the little guy (in his opinion). The problem is (in my opinion) that Mr. Moore does not always come to conclusions based on evidence, but starts with a conclusion and finds evidence to support this. This is precisely the danger of a meta-analysis of the sort that was done in this case.

But the Medscape piece he cites seems to portray the writers of the related NEJM editorial, Psaty and Furberg, as the real crusaiders:

Dr Steven Haffner (University of Texas Health Science Center, San Antonio), who was involved in the ADOPT study of rosiglitazone, said the paper needed to be published, but it should have undergone a more extensive review, and there should have been a different editorial with more emphasis on the flaws of the study. “The NEJM was irresponsible to go to [Drs Bruce] Psaty and [Curt] Furberg for the editorial--they were always going to emphasize concerns about drug safety; that’s what they do," he commented.

Dr. Robert Califf of Duke University commented on the harmful effect of scientific discussions being played out in popular media:

“It would be better if we had a system of postmarketing signal detection in which signals were vetted scientifically rather than splashed over TV and newspapers. I can't help but wonder if the NEJM is functioning more like the mainstream press than a scientific journal at this point, since many potential peer reviewers seem to feel that Dr Nissen's analyses are missing key elements that could have been added."

Points I’ve made many times in these pages.

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