adrian_turtle (![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png)
adrian_turtle) wrote2009-03-05 07:40 am
adrian_turtle) wrote2009-03-05 07:40 am
beginning to comprehend why a person would take this course
The headline in Anesthesiology News is "Fraud Case Rocks Anesthesiology Community."
http://www.anesthesiologynews.com/index.asp?section_id=3&show=dept&ses=ogst&issue_id=486&article_id=12634
A pain management researcher is being accused of multiple forgeries. His name is Scott Reuben, and he works in western MA. The article speaks of outright falsification of data, not just presenting conclusions based on a bit of ambiguous data and a lot of wishful thinking. Some of the discredited research is about how well Lyrica and Celebrex are supposed to work for pain control, better than opiates. (When Redbird posted about this yesterday, she focused on this aspect of the news.) The state of the art for these drugs has changed from "For certain kinds of pain, this combination of drugs (if the patient can afford them) is known to work better than opiates," back to, "It might help some people, but there have not yet been controlled experiments showing that it works consistently." I think all his research has been devoted to "proving" combinations of anti-seizure, anti-depressant, and anti-inflammatory medications are better or safer for pain control than narcotics. (Multimodal analgesia)
Steven Shafer edits Anesthesia and Analgesia, which published some of Dr. Reuben's work. Dr. Shafer said of the research fraud, "I cannot begin to understand why a person would take this course." There's a difference between "I would never do anything like that myself," and "I don't understand why a person would have done that." See also, Jean Valjean.
I've never done medical research, but I can see some of the pressures on researchers. Dr. Reuben's work was funded by research grants from Pfizer (manufacturer of both Lyrica and Celebrex), and he was on the Pfizer speakers' bureau. I don't know if there was any direct pressure. "The company has not been accused of any wrongdoing in this matter," suggests no evidence of quid pro quo has been found. When somebody is supporting a lab (and possibly subsidizing a clinical practice) with grant money, it's really scary to know the money depends on publishing good research results, results the funding source wants to see.
Of course, it's not common to go into medical research just because a person wants the money. Financial motives can be strong, and self-perpetuating, especially for somebody buried in debt, but the power of a True Believer out to save the world is formidable. (Those of you who don't work in labs would probably be amazed at the force of True Belief that can be brought to bear on subtle details of heat transfer theory whose capacity to save the world has yet to be determined.) Dr. Reuben has been accused of fraud in 15 papers so far. Most of them have to do with Pfizer drugs, but it looks like they all "prove" opiate pain medications are dangerous, ineffective, or inferior to alternatives. From the picture with the article, which is also on the website of the Baystate Medical Center where he works, I'd estimate Dr. Reuben is in his 40s. That would have made him a teenager when the Partnership for a Drug-Free America ad were new and hitting hard. That would have put him in med school when they were full of dire warnings about the dangers of narcotic addiction. The War On Drugs pushed anti-drug propaganda everywhere.
It's a fairly recent change for pain control to become an official medical priority, to balance against the risks of narcotic use. The Joint Commission for the accreditation of healthcare organizations in the US only started requiring hospitals to keep track of patient pain in 2001. The first time my primary care doctor sent me to a specialist at a "comprehensive pain clinic," back in 2000, it was unsettling to find their priorities were to reduce patients' use of opiates and increase patient functioning (range of motion, ability to lift things, driving.) Actually hurting less was not on the list at all. In recent years, pain control has come to be recognized as valuable for its own sake. And some studies have shown opiates to be useful for that. There are still a lot of doctors, researchers, and people in charge of funding who spent half their careers being taught the True Belief that narcotic medications are physically and morally dangerous. Some of them put a lot of effort into saving people from narcotics, in the belief that using opiates must be worse than any amount of pain. (A surgeon told me that once, but it didn't convince me to let him operate.) It's easy for me to imagine setting up an experiment to measure just how dangerous the obviously dangerous drugs are, and just how much better the great new improved treatment is. It's easy for me to imagine looking at the data and thinking, "This can't possibly be right."
Ethical researchers check the results as comprehensively as possible, and publish them if they can. Maybe with a tentative conclusion like, "The new improved treatment does not seem to be quite so great in this particular situation." I remember reading a journal article from a pain researcher at the Mayo Clinic, 7 or 8 years ago. It was about the long-term use of opiates for chronic pain, and he was trying to measure how dangerous and ineffective it was. He was really surprised to find how often the drugs continued to be safe and effective...Nevertheless, they cannot recommend the use of opiates for any non-terminal pain. The abstract just had the theory, a quick summary of the study design, and the recommendation. I was flabbergasted, until I remembered a physics professor talking about how measurements of the speed of sound in vacuum had approached an asymptote. The class knew something of lab instruments, but nothing at all of scientific publishing, so we were surprised. The professor said everybody was using more or less the same equipment, but nobody published measurements that were too far from the previously accepted values. Aha. Of course.
It's no excuse for Dr. Reuben's fraud to think about why he might have done it. I'm just thinking about how other researchers can be tempted to do the same sorts of things, and many of them make better choices. Part of the problem may be researchers and reviewers starting from True Belief or pet theories, relying on data to confirm them, rather than starting from the data and following where it leads.
"Dr. Shafer said that although he still believes “philosophically” in multimodal analgesia, he can no longer be absolutely certain of its benefits without confirmation from future studies."
http://www.anesthesiologynews.com/index.asp?section_id=3&show=dept&ses=ogst&issue_id=486&article_id=12634
A pain management researcher is being accused of multiple forgeries. His name is Scott Reuben, and he works in western MA. The article speaks of outright falsification of data, not just presenting conclusions based on a bit of ambiguous data and a lot of wishful thinking. Some of the discredited research is about how well Lyrica and Celebrex are supposed to work for pain control, better than opiates. (When Redbird posted about this yesterday, she focused on this aspect of the news.) The state of the art for these drugs has changed from "For certain kinds of pain, this combination of drugs (if the patient can afford them) is known to work better than opiates," back to, "It might help some people, but there have not yet been controlled experiments showing that it works consistently." I think all his research has been devoted to "proving" combinations of anti-seizure, anti-depressant, and anti-inflammatory medications are better or safer for pain control than narcotics. (Multimodal analgesia)
Steven Shafer edits Anesthesia and Analgesia, which published some of Dr. Reuben's work. Dr. Shafer said of the research fraud, "I cannot begin to understand why a person would take this course." There's a difference between "I would never do anything like that myself," and "I don't understand why a person would have done that." See also, Jean Valjean.
I've never done medical research, but I can see some of the pressures on researchers. Dr. Reuben's work was funded by research grants from Pfizer (manufacturer of both Lyrica and Celebrex), and he was on the Pfizer speakers' bureau. I don't know if there was any direct pressure. "The company has not been accused of any wrongdoing in this matter," suggests no evidence of quid pro quo has been found. When somebody is supporting a lab (and possibly subsidizing a clinical practice) with grant money, it's really scary to know the money depends on publishing good research results, results the funding source wants to see.
Of course, it's not common to go into medical research just because a person wants the money. Financial motives can be strong, and self-perpetuating, especially for somebody buried in debt, but the power of a True Believer out to save the world is formidable. (Those of you who don't work in labs would probably be amazed at the force of True Belief that can be brought to bear on subtle details of heat transfer theory whose capacity to save the world has yet to be determined.) Dr. Reuben has been accused of fraud in 15 papers so far. Most of them have to do with Pfizer drugs, but it looks like they all "prove" opiate pain medications are dangerous, ineffective, or inferior to alternatives. From the picture with the article, which is also on the website of the Baystate Medical Center where he works, I'd estimate Dr. Reuben is in his 40s. That would have made him a teenager when the Partnership for a Drug-Free America ad were new and hitting hard. That would have put him in med school when they were full of dire warnings about the dangers of narcotic addiction. The War On Drugs pushed anti-drug propaganda everywhere.
It's a fairly recent change for pain control to become an official medical priority, to balance against the risks of narcotic use. The Joint Commission for the accreditation of healthcare organizations in the US only started requiring hospitals to keep track of patient pain in 2001. The first time my primary care doctor sent me to a specialist at a "comprehensive pain clinic," back in 2000, it was unsettling to find their priorities were to reduce patients' use of opiates and increase patient functioning (range of motion, ability to lift things, driving.) Actually hurting less was not on the list at all. In recent years, pain control has come to be recognized as valuable for its own sake. And some studies have shown opiates to be useful for that. There are still a lot of doctors, researchers, and people in charge of funding who spent half their careers being taught the True Belief that narcotic medications are physically and morally dangerous. Some of them put a lot of effort into saving people from narcotics, in the belief that using opiates must be worse than any amount of pain. (A surgeon told me that once, but it didn't convince me to let him operate.) It's easy for me to imagine setting up an experiment to measure just how dangerous the obviously dangerous drugs are, and just how much better the great new improved treatment is. It's easy for me to imagine looking at the data and thinking, "This can't possibly be right."
Ethical researchers check the results as comprehensively as possible, and publish them if they can. Maybe with a tentative conclusion like, "The new improved treatment does not seem to be quite so great in this particular situation." I remember reading a journal article from a pain researcher at the Mayo Clinic, 7 or 8 years ago. It was about the long-term use of opiates for chronic pain, and he was trying to measure how dangerous and ineffective it was. He was really surprised to find how often the drugs continued to be safe and effective...Nevertheless, they cannot recommend the use of opiates for any non-terminal pain. The abstract just had the theory, a quick summary of the study design, and the recommendation. I was flabbergasted, until I remembered a physics professor talking about how measurements of the speed of sound in vacuum had approached an asymptote. The class knew something of lab instruments, but nothing at all of scientific publishing, so we were surprised. The professor said everybody was using more or less the same equipment, but nobody published measurements that were too far from the previously accepted values. Aha. Of course.
It's no excuse for Dr. Reuben's fraud to think about why he might have done it. I'm just thinking about how other researchers can be tempted to do the same sorts of things, and many of them make better choices. Part of the problem may be researchers and reviewers starting from True Belief or pet theories, relying on data to confirm them, rather than starting from the data and following where it leads.
"Dr. Shafer said that although he still believes “philosophically” in multimodal analgesia, he can no longer be absolutely certain of its benefits without confirmation from future studies."