Mere moments following NEJM’s release of the Avandia meta-analysis and editorial there were millions of Google search queries for Avandia according to a recent post from Clinical Cases and Images. Malpractice attorney ads began appearing only hours later. Hype spreads more rapidly than nuanced critical analysis. So, long before defects in the paper had a chance to be exposed, the popular media, consumer activists and the trial lawyers had taken over the debate. Within hours Avandia was the new Vioxx. More recently we have learned that the ongoing prospective RECORD trial, designed to look at macrovascular outcomes in patients taking Avandia, is in jeopardy (hat tip to Kevin M.D.) due to patients dropping out as a result of the publicity. Something’s terribly wrong with this picture.
Some are accusing NEJM as being like a tabloid and PharmaGossip proposes a new cover style. Is NEJM deserving of the tabloid label? In my considered opinion, yes, for two reasons. First, the journal could have published a more critical, less inflammatory editorial. Even worse was the journal’s decision for early open access release of the paper and editorial. Such a tactic might be appropriate for a public health emergency such as the SARS outbreak. This is not SARS. This is not a public health emergency.
Clearly tabloid based medicine has trumped evidence based medicine and done much harm. I have repeatedly argued that discussions of science are corrupted when played out in the arena of public debate. The Avandia controversy is a case in point.