Talk:Medical research/Archive 1

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The Ultimate Evidence based Ayurvedic Diagnostic Solution Electro-tridosha-graphy

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Criticism of Clinical Trials

This section needs to move toward a more neutral POV. Right now it looks like something Peter Rost and the editors of the British Medical Journal would write. (both are anti-industry). PhRMA would paint a completely different picture (with its distortions). We might talk about lack of completely independent researchers (examples like the Cleveland Clinic's ethical challenges in 2005-2006 might be good to look at), bias in trials (the JAMA article would need a better citation), but also the fact that many people with HIV and cancer would be willing to have access to products in clinical testing but the system has not been setup for this to be advantageous for approval for the companies. I can elaborate on this further.

There is not an alignment of goals between the actors in the scene (patients-Companies-FDA safety) or sometimes the alignment of goals (doctor-drug company-rewards) may appear to be in conflict with another goal (best choice for the patient). If we reframe the discussion to talk about goal alignment and risks, we can present all sides of the criticism. --Chrispounds 05:01, 1 October 2006 (UTC)

  • Find your comments about the BMJ odd because the very reason I bother to read it every week is just because it is not afraid to give both side of the issue (have you considered how long the editor of PhRMA would keep his job if he upset the sources of all that advertising revenue?). Indeed the online version of the BMJ has the added advantage of the Rapid Responses section -where biases in articles are quickly highlighted. Obviously, it is not possible to sum it up in a nutshell but I would have said: that it is not so much anti-industry as pointing out poorly designed trials and very often their short duration. Especially when in real world proscribing, the treatment would be continued for longer.
I agree with you that there are many short comings in the present system and China might find that they can over take us by allowing certain groups of patients to enter highly speculative trials. Especially, since many sufferers of certain illnesses will expend considerable effort and display great ingenuity in finding a way to trying out some of these treatments - regardless of the law. Also, I don't like the way that political dogma holds back research into potentially useful drugs just because their sole use now is of an illegal nature i.e. Psilocybin, LSD, cannabis etc.
I see a big problem with your suggestion though.
Here in the UK we recently had a complete reorganization of our drug regulatory authority when it became too obvious that they were showing too much complaisance to the pharmaceutical industry. Doctors in America are also aware that the FDA badly needs sorting out for the same reason. So, just on this point alone, there is a big hole were both FDA 'public relations' and industry 'marketing' rhetoric can get in to explain and distort what the FDA's goals are -or are suppose to be- i.e.., protecting the public or protecting the industry. I won't go on here, as this has been done to death else where over resent years, but this is the danger when one starts to sprinkle the vocabulary with terms like -'goals'- 'partnership'- 'best choice'- 'mutual benefit'- 'win win situation'- etc. Why this situation exists is because those who should be able to improve things are unaware of the power of cognitive dissonance caused by working in or in partnership with the industry, thus causing them to suffer confirmation bias to a degree that they misjudge - even when they are made aware of it. However, now you have gotten me to thinking about it:- It would be clearer to have say a diagram showing the various routes from discovery of an 'effect,' and then the search to find some complaint that it might be used to treat, then all the regulatory hoops one needs to jump through in order to get product a license, and of course post marketing surveillance and product recalls and or license cancellation. Not forgetting the search to widen the scope of the license to include more 'indications' for treatment. This would be a hell of a lot easier to take in and understand than any textual explanation of the process. A similar diagram might be possible for medical devices (but perhaps there might be differences with in vivo types as against MRI scanners and the like), and another for radiological tagging and then there is blue sky 'medical research' so on. It is still a very undeveloped article for what is a very lage field. BUT You will be sowing the seeds for an edit war by going down the road that introduces an attempt at explaining the psychology of satisfying (or exploiting fairly or unfairly) human need - which will also include (in some cases) creating need where no exist. It would invite other editors to include the 'rose colored' prose -or rhetoric- of the pharmaceutical industry as a substitute for the reality. Your approach -I would have said- is really more suited to an article on how to form public opinion. Edward Bernays was a proponent for lining things up like this; in fact - he invented it. How good are you at drafting diagrams instead? P.S. Can you start new topic on talk pages at the bottom of the page so that they are easier to archive when the pages grow too big.--Aspro 13:25, 1 October 2006 (UTC)
Mmm... I hope you realise that when you post enormous messages like that, few will read them...--Steven Fruitsmaak (Reply) 19:17, 1 October 2006 (UTC)
BMJ has better balance than I give it credit for. The current issue has a nice article that addresses some of the challenges of the research method. I do not want this article to turn into a treatise on logic, but rather would like us to have a neutral point of view. The industry side would say that the FDA is paranoid, but given the setting of the post-Vioxx debacle, that may be where public and political sentiment would like to have us go. I do love drafting diagrams, as long as they are not pie charts. Sorry for posting this 1 up from the bottom of the page. --Chrispounds 16:04, 2 October 2006 (UTC)

Then we need to find some common ground to take this forwards (although this probable will have to wait for 2-3- weeks).
Vioxx a good example of opportunities lost. Many people found it alone freed them from pain to enjoy a better quality of life than any non-opioid. It was the discovery of evidence of holding back data that planted the seed of the emotional backlash and a knee jerk withdrawal. It needn't have been a problem handled properly. Here in the UK our 'British National Formulary' states that its OK to prescribe even oral morphine for 'distressing cough' under special circumstances -Vioxx (one can presume) could have been given extra proscribing guidelines that agreed with the growing 'improvement' in estimating its Benefit to Risk Ratio. Instead, there are possibly (in total around the world) many hundreds of thousands that are now denied an 'effective' pain control drug. Clozapine was was very effective but withdrawn by its manufacturer due to problems; but doctors managed to persuade them to reintroduce it by working out a protocol: restricting it to only patients that fulfill certain criteria and with a schedule of blood tests, and not before informing all concerned of the signs that would indicate the medical intervention is urgently require. Thalidomide is another very effective drug but the behavior of the manufactures when the problems stated to surface though to final judicial judgments, put everyone off it. In all of these examples it has not been from within the respective department of applied science that took this action but from without; in other words they were business decisions. Thus this detailed info would not belong in an article such as this. ( When your science teacher introduced you to the importance of not allowing separate classes to mix they might have mentioned Francis_Bacon, would perhaps say that the above examples falls into idola fori and idola theatri.
I live in an area where there exist several large pharmaceutical R&D divisions. The scientists there would not think of using words like paranoid etc. It is the PR personnel or outside promotion agents and FDA spokespeople who search their copies of Roget's Thesaurus to create spin with completely different connotations of fact, and call each other names. They (along with some journalists) are the source of many a misunderstanding arising in the mind of the pubic and their elected politicians. Again, this behavior is 'outside' the actual science. To see what I mean about weighing issues evenly is difficult (because the pivot its self, is being moved off center) One need only look at the worst branch of pharmaceutical medicine which with out doubt (I would say) is psychiatric meds. [3]
The article simply points out that pivot of judgment is off center and leaves the other articles (should they choose) to explain in detail. What is needed is more information on what actually happens acroos all related fields. For instance most 'break throughs ' in the last century have been result of taxpayer funded research. It is only when a there is enough knowledge to see a way though to a practical product that it gets taken up by a company. MRI scans and most other things only became releasable due to this blue sky research. Only by pure research into understanding acid regulation and the chemical compounds used to explores it, that a commercial company took the financial risk to see if they could get it licensed (as an h2 blocker). Same for the first antibiotics etc., etc., etc. It is the non-commercial side that is badly lacking and needs to be balance out the commercially driven side. What is not needed here (or in any other article of this type) is contagion from other 'idola'. --Aspro 15:02, 5 October 2006 (UTC)

Biomedical research?

The biomedical research and this page appear closely inter-related: so much so that it is tempting to consider a merger. The second paragraph of the biomedical research page, at least, seems suitable for presentation on this article. That would bring in the animal research article into the text, and human experimentation could be readily inserted. — RJH (talk) 17:36, 27 September 2006 (UTC)

It might look this way because non-biomedical research is -at present- poorly covered in this article. What about all the research into new dental fillings, artificial joints, plastic testicles, hearing aids, stints, splints, sutures, robot aided surgery, keyhole surgery, hypothermic surgery, and the list goes on and on and on. Feel free to reading though a few trade magazines and expand the article. If it starts getting too big, that would be the time to split into separate sub categories.--Aspro 18:50, 27 September 2006 (UTC)

Merge proposal

Seems to me that clinical research could be merged into this article as an expansion of the clinical trials sections. —G716 <T·C> 21:14, 11 January 2009 (UTC)