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SockFiddler
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It's an interesting article, but I think it takes a very narrow view and overlooks some key points.
For example, in the UK you have a university culture that encourages free and undirected scientific research (no agenda; can't be bought) and a population who still don't trust doctors overmuch.
I think, culturally, we're in a watershed moment when we, as a society, have to decide how we want the word science to be defined: is it hard, repeatable, demonstrable outcomes produced in controlled environments or is it a collection of ideas that may or may now have a kernel of science at their core, but that have otherwise been molded to suit a political agenda?
And before you think that question is a no-brainer, consider Bush's "War on Science" - now Trump's new mantle. People who want Creationism taught alongside Evolution (and they're over here in the UK, too), the lack of hard fact finding in almost anything the print media write about science, cosmetic products filled with made-up ingredients touting "Here comes the science..." in their commercials, and how, even now, female medicine is significantly out-funded by male medicinal research:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1761670/
We as a society are generally more educated and, therefore, aware of science, but we're falling into the trap of not knowing what we don't know (See: https://en.wikipedia.org/wiki/Dunning–Kruger_effect) , and that leads to cynicism and skepticism, often misdirected. When pseudo-medicine (with no supporting evidence) can be funded by the NHS (I live in a city with a homeopathic hospital), it's easy to see why people start mistrusting doctors.
Yes, your Andrew Wakefields and Jenny McCarthys have much to do with it, but in the UK, there still exists the culture of medical mistrust without the pointed political agenda restricting and directing medical research and without prescription drugs being able to advertise themselves everywhere. I think it's more that hard-luck stories and "It could have happened to anyone..." coverage of the NHS shift more copy than happy outcomes and positive stories: there's a lot of innovation and clever ideas being used to improve outcomes and a lot more "miracles" taking place, but we don't get to hear about those.
We're far more likely to engage with watching a family waiting for their baby to die in Great Ormond Street (which I am still horrified by, as someone who used to work with families just like them) than read about how the genius innovations the same hospital is improving family care and outcomes for very poorly children, eg.
For example, in the UK you have a university culture that encourages free and undirected scientific research (no agenda; can't be bought) and a population who still don't trust doctors overmuch.
I think, culturally, we're in a watershed moment when we, as a society, have to decide how we want the word science to be defined: is it hard, repeatable, demonstrable outcomes produced in controlled environments or is it a collection of ideas that may or may now have a kernel of science at their core, but that have otherwise been molded to suit a political agenda?
And before you think that question is a no-brainer, consider Bush's "War on Science" - now Trump's new mantle. People who want Creationism taught alongside Evolution (and they're over here in the UK, too), the lack of hard fact finding in almost anything the print media write about science, cosmetic products filled with made-up ingredients touting "Here comes the science..." in their commercials, and how, even now, female medicine is significantly out-funded by male medicinal research:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1761670/
We as a society are generally more educated and, therefore, aware of science, but we're falling into the trap of not knowing what we don't know (See: https://en.wikipedia.org/wiki/Dunning–Kruger_effect) , and that leads to cynicism and skepticism, often misdirected. When pseudo-medicine (with no supporting evidence) can be funded by the NHS (I live in a city with a homeopathic hospital), it's easy to see why people start mistrusting doctors.
Yes, your Andrew Wakefields and Jenny McCarthys have much to do with it, but in the UK, there still exists the culture of medical mistrust without the pointed political agenda restricting and directing medical research and without prescription drugs being able to advertise themselves everywhere. I think it's more that hard-luck stories and "It could have happened to anyone..." coverage of the NHS shift more copy than happy outcomes and positive stories: there's a lot of innovation and clever ideas being used to improve outcomes and a lot more "miracles" taking place, but we don't get to hear about those.
We're far more likely to engage with watching a family waiting for their baby to die in Great Ormond Street (which I am still horrified by, as someone who used to work with families just like them) than read about how the genius innovations the same hospital is improving family care and outcomes for very poorly children, eg.
B
badcat
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Im no fan of the mail but at least its from the UK
http://www.dailymail.co.uk/health/a...tle-proven-benefits-leading-doctors-warn.html
http://www.dailymail.co.uk/health/a...tle-proven-benefits-leading-doctors-warn.html
Guzzler
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I think there is a growing mistrust here in the U.K what with debacle caused by Wakefield and the shameful actions of those involved in the Alder Hey Scandal. My first thoughts on reading Dr. Fung's article was that there is little altruism in medicine these days but am I being too harsh? I am trying desperately to hold onto the opinion that the vast majority of HCPs only want what is best for patients but as age and experience has shown me, that is not always true. So where does all that leave us? As the OP suggested, you pays your money.....
SockFiddler
Well-Known Member
It took a bit of digging (as lots of secondary media outlets had used the Mail story as their source, and, frankly, I'd not trust that paper for yesterday's weather) but here's another write-up:
http://www.independent.co.uk/news/u...about-drugs-costing-hundreds-of-a6893601.html
The specific figures quoted (in both stories) are out of the US where research is directed, funded and co-opted using different regulations to the UK. While I'm not denying that this also happens in the UK - and that FDA approved drugs are often made available in the UK (Jardiance, eg) - NICE seems to be a little more cautious and rigorous in what does and doesn't make the grade.
The interesting question to all of this is: Where do we draw the line?
Elderly people don't want to get old, have their body parts wear out, give up their homes and move into assisted living. Younger people want to be able to eat junk food or recover from head injuries or live and work without pain. These are all lifestyle choices, and these are all things we can medicate people for. Doctors may well be "over-prescribing", but some of that may be optimistic "Prevention is better than cure" prescriptions (the statins), and some might be because people have had to abruptly stop living healthy, independent lives. Either way, though, it can be argued that, with the modern plethora of drugs available, where is the line where we say "Nope, nothing for you." drawn?
I'm playing Devil's Advocate a little bit here - I've made my own (expensive) lifestyle choices that will end up costing the NHS a fortune in the future, but there's two sides to every argument, and I'd say that this points less to a mistrust of medics and more to an over-reliance upon them.
Edit: And can I just throw another thought about medicine into the mix?
Thailand has decided to throw everything at eradicating Malaria within 10 years. It's an incredibly visionary approach, they have a plan, the science and the labs looking into strains that are resistant to current strains. What's the problem? They lack funding.
https://www.theguardian.com/journalismcompetition/drive-to-beat-malaria-thailand
Sri Lanka, however, has already done this:
https://www.passporthealthusa.com/2017/07/how-did-sri-lanka-eradicate-malaria/
My point is, this could only have been achieved with across-the-population treatment, whether people had symptoms or risk factors or not. And that could only have been achieved with the co-operation of people willing to trust doctors.
Sure, we're not trying to eradicate malaria, but it's been demonstrated that HIV could be eradicated within a generation, and some people even say within 20 years:
https://www.theguardian.com/commentisfree/2015/aug/08/eliminate-hiv-by-2030-regular-testing
How? By trust and over-treatment of a "lifestyle" drug (PROP) combined with heavy investment and regular testing.
(Apologies for frequent edits - wanted to get really good sources for those stories!)
http://www.independent.co.uk/news/u...about-drugs-costing-hundreds-of-a6893601.html
The specific figures quoted (in both stories) are out of the US where research is directed, funded and co-opted using different regulations to the UK. While I'm not denying that this also happens in the UK - and that FDA approved drugs are often made available in the UK (Jardiance, eg) - NICE seems to be a little more cautious and rigorous in what does and doesn't make the grade.
The interesting question to all of this is: Where do we draw the line?
Elderly people don't want to get old, have their body parts wear out, give up their homes and move into assisted living. Younger people want to be able to eat junk food or recover from head injuries or live and work without pain. These are all lifestyle choices, and these are all things we can medicate people for. Doctors may well be "over-prescribing", but some of that may be optimistic "Prevention is better than cure" prescriptions (the statins), and some might be because people have had to abruptly stop living healthy, independent lives. Either way, though, it can be argued that, with the modern plethora of drugs available, where is the line where we say "Nope, nothing for you." drawn?
I'm playing Devil's Advocate a little bit here - I've made my own (expensive) lifestyle choices that will end up costing the NHS a fortune in the future, but there's two sides to every argument, and I'd say that this points less to a mistrust of medics and more to an over-reliance upon them.
Edit: And can I just throw another thought about medicine into the mix?
Thailand has decided to throw everything at eradicating Malaria within 10 years. It's an incredibly visionary approach, they have a plan, the science and the labs looking into strains that are resistant to current strains. What's the problem? They lack funding.
https://www.theguardian.com/journalismcompetition/drive-to-beat-malaria-thailand
Sri Lanka, however, has already done this:
https://www.passporthealthusa.com/2017/07/how-did-sri-lanka-eradicate-malaria/
My point is, this could only have been achieved with across-the-population treatment, whether people had symptoms or risk factors or not. And that could only have been achieved with the co-operation of people willing to trust doctors.
Sure, we're not trying to eradicate malaria, but it's been demonstrated that HIV could be eradicated within a generation, and some people even say within 20 years:
https://www.theguardian.com/commentisfree/2015/aug/08/eliminate-hiv-by-2030-regular-testing
How? By trust and over-treatment of a "lifestyle" drug (PROP) combined with heavy investment and regular testing.
(Apologies for frequent edits - wanted to get really good sources for those stories!)
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Bluetit1802
Legend
Thanks for posting this. Love it.
B
badcat
Guest
I think there are real poblems sorting the wheat from the chaff when it comes to 'research'
I spent my working life in the NHS and childrens services and have seen data manipulation at work
In one setting I was asked to write a report showing that Most of parents invited to attend a parenting programme (targeted at families with adolescents in trouble with the law ) attended at least 1 of the sessions and that the majority gave positive feedback. In reality while a lot of parents came to the first session the majority of those came to express tha view that their children needed to be either locked up or beaten - that participant group did not return or complete feedback formswhile the other families remained for the whole of the course and gave 100% satisfaction reviews. i didnt write the requested report which was designed to please OFSTED
I saw another research trial in the nhs run by a consultant psychiatrist looking at interventions with depressed adolescents where randomisation was a joke and adolescents who did not fit the expected / required outcome were eliminated from the data set
Im sure there is much good research but I am equally sure that there is massive manipulation by excluding data / conducting research in areas withnthe lowest rigour / averaging out data to a level of meaninglessness
As i said, you pays your money and makes your choice
I spent my working life in the NHS and childrens services and have seen data manipulation at work
In one setting I was asked to write a report showing that Most of parents invited to attend a parenting programme (targeted at families with adolescents in trouble with the law ) attended at least 1 of the sessions and that the majority gave positive feedback. In reality while a lot of parents came to the first session the majority of those came to express tha view that their children needed to be either locked up or beaten - that participant group did not return or complete feedback formswhile the other families remained for the whole of the course and gave 100% satisfaction reviews. i didnt write the requested report which was designed to please OFSTED
I saw another research trial in the nhs run by a consultant psychiatrist looking at interventions with depressed adolescents where randomisation was a joke and adolescents who did not fit the expected / required outcome were eliminated from the data set
Im sure there is much good research but I am equally sure that there is massive manipulation by excluding data / conducting research in areas withnthe lowest rigour / averaging out data to a level of meaninglessness
As i said, you pays your money and makes your choice
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Oldvatr
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Having seen several lists of corporate sponsors that support some notable institutions (DUK, PHE, BNF, BHF, et al) as well as looking at research papers and the list of sponsors paying for it,then this article comes a sno surprise to me. The drug trials have similar ethical issues especially those published pre 2016. When a study into statin use is paid for, performed by , conclusion supplied by, report published, reviewed and edited by the very Pharma company who supplied the statins and defined the test methodology. All Nice had to do is tick the box.
When the study submitted to support Actos and Avandia for FDA approval that I managed to review a pre issue copy (since deleted) where it was clear that the deaths that occurred during the trial were put down as natural causes (yes, CVE is a natural way of dying) and omitted from the report.
Subsequent review by ADA in light of bad press did lead to these drugs being withdrawn in USA,Europe and India but NOT IN UK.
If I had not seen this other 'evidence' myself from other sources, then I mught have dismissed Jasons article as a case of conspiracy theory banging the drum, but now I think I know better about these matters. With Trump in the White House, will we see any change? I think NOT.
When the study submitted to support Actos and Avandia for FDA approval that I managed to review a pre issue copy (since deleted) where it was clear that the deaths that occurred during the trial were put down as natural causes (yes, CVE is a natural way of dying) and omitted from the report.
Subsequent review by ADA in light of bad press did lead to these drugs being withdrawn in USA,Europe and India but NOT IN UK.
If I had not seen this other 'evidence' myself from other sources, then I mught have dismissed Jasons article as a case of conspiracy theory banging the drum, but now I think I know better about these matters. With Trump in the White House, will we see any change? I think NOT.
I wish... I would happily bet that almost all new research is "sponsored" by pharma somewhere along the line.. or am I just overly cynical these days..
Oldvatr
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I think Big Food is also in this gane too. Just look at who sponsors the BNF and DUK anf PHE
Bluetit1802
Legend
Is this entirely correct? This university research is paid for by someone, and I'm darned sure it isn't the university other than through sponsorship.
Oldvatr
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Just replied to this post. It appeared correctly in thre forum but then disappeared. Have I been nobbled by a Moderator, or is Big Pharma to blame?
I can still see it..
Oldvatr
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Yep it is there. But I did scan up before I blew my top, and had the same thing happen in the Conversation thread. I had 2 posts go from there. I have also lost edit function completely ftom this thread, but could still edit in Conversations thread, peculiar
SockFiddler
Well-Known Member
It's still there!
@Bluetit1802 : Actually, your question is a major post-Brexit concern for a lot of researchers. Currently, the UK benefits from trans-Euro partnerships, where labs strewn across the continent can work together under joint Euro funding streams, strengthening the work done. As soon as the day after the Brexit result was announced, there were fears of funding cuts starting (most often in the form of grants not being renewed):
https://www.theguardian.com/politic...-science-research-links-eu-brexit-pascal-lamy
This Euro pot of money is (I don't understand the exact process) made available through the "Innovation Union" (http://ec.europa.eu/research/innovation-union/index_en.cfm?pg=home ) an idealistic organisation that was created to ensure scientific research in Europe was both ideas-driven and could find its way to benefiting people as quickly as possible:
http://ac.els-cdn.com/S187704281100...t=1501163236_b8d793603a1615b7c69daab0dfbd9b12
Horrifically blurby, dense paper - sorry. The salient point to your question is on the first page, though:
That's their first stated objective, the one that gets the priority.
Organisations such as BNF (oh, we LOVE those guys!) will carry out "research" specifically sponsored by their "corporate partners" (British Sugar, Coke, Pepsi etc), and that's to be taken into account and shouldn't be considered in the same breath as something that comes out of a collaboration of Euro Unis.
It's time consuming, but it pays to look into the sources of a report. The "best" universities have that reputation for a reason, and it's not just for the Etonian percentage of their populations
Oldvatr
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My son is doing his Doctorate, and he is industry sponsored. His research is industry sponsored. The Professor's Chair is industry paid for. My son's Masters degree is paid for by industry.
Funding, project placement and sponsorship is EVERYWHERE. And most definitely present in UK universities just as in other universities across the world.
Even in Professor Taylor's Newcastle Diet research, the Brand Optifast is repeatedly mentioned in the literature, leading to numerous enquiries here on the forum along the lines of 'can I use other shakes? or does it HAVE to be Optifast?'
Yet Prof. Taylor has stated in his lectures on the subject that other brands are fine, and he only chose Optifast for practical (sponsorship/convenience) reasons.
Having worked in a university myself for years, I can confirm that research is very expensive, and that funding and funding sources can and do affect the subject matter that is being researched. Students are advised, when picking their PhD subjects to choose something new, unique and 'sexy' - yes, that was the word I heard used - to help ensure their futures in research. All on the understanding that any industry funding would be entirely dependent on how 'sexy' the purse string holders found the subject matter.
SockFiddler
Well-Known Member
What's he studying, though? I think there are lots and lots of areas where industry money makes a real difference to whether something is understood properly, improved, made safe etc... But also, even if a company invests heavily in research, it doesn't mean it's saying "Find better brake fluid so we can patent it!" (or whatever). It just means it's investing in science.
I'm not saying that all (medical) research is undirected. Just that without free, undirected research we'd not have cool stuff like cures for cancer, antibiotics, X-Rays, lasers or the Web.
https://www.aps.org/publications/apsnews/201401/backpage.cfm
I'm not saying that all (medical) research is undirected. Just that without free, undirected research we'd not have cool stuff like cures for cancer, antibiotics, X-Rays, lasers or the Web.
https://www.aps.org/publications/apsnews/201401/backpage.cfm
Oldvatr
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Physics
Phd imminent now. He is researching new investigative techniques, not product per se,
