The war on the NEJM

Under attack by the red brigades of transparency

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The war against the New England Journal of Medicine has gained visibility after Charles Ornstein traced its developments in the pages of the Boston Globe.  The story was amplified in a number of trade publications, and was even picked up by a NPR-affiliated show.

This has emboldened the attackers to open fire on Twitter with calls for “transparency,” “open science,” and a “unified research community.”   Their ideological alliance is with the BMJ.

Those who refuse to partake in the cause of transparency live in a world of “silos,” “conflicts of interest,” and “industry ties.”

The NEJM‘s lukewarm attitude towards the movement is “an oppression,” says Eric Topol, as quoted by Ornstein.  Did he intend to use a term with Marxist connotation? The loose coalition of scientists, healthcare journalists, and muckrakers ready to overthrow the established order might as well be known as the Data Liberation Front!

To prepare for the post-liberation era, Professor Harlan Krumholz, a data expert at Yale University, has put in place an online platform where released data can be rehabilitated by caring scientists.  So far, in this market for second-hand information, buyers and sellers are few.

That may change, of course, even if the plan currently under consideration by the International Committee of Medical Journal Editors to impose data sharing on researchers falls through.  A Vioxx-type scandal, even on a small scale, may be all that is needed for Western governments to pass “Data Safety and Transparency” legislation mandating data sharing for clinical trials. 

If that came to be, Professor Krumholz would be well-positioned to serve as health data commissioner and have his Yale Open Data Access (YODA) platform become a de facto, if not de jure, central repository for all clinical trial data.  

The science-saving activity, of course, will not be free of charge.  Who is to pay for all the work remains to be seen, but one could venture a guess…   

Who knows? In the end, Jeff Drazen’s infamous metaphor of the parasites may turn out to be more apt than people currently realize.

Meanwhile, Fiona Godlee (a.k.a. “Fi”), editor of the BMJ, is also leading a crusade to “clean up bad science,” says CBC News.

Fi is convinced that “the people are not stupid and deserve being made aware of the uncertainties that pertain to scientific conclusions.” Her goal: defeating conflicts of interest.  How the public are going to benefit from an endless game of finger-pointing, however, is unclear.

“Medicine and science is [sic] run by human beings. There’ll always be crooks,” says Fi. That’s true, of course, but it leaves one wondering who will run science’s clean up.  Saints?

Possibly.  The disciples of transparency believe in science and, like the apostles of less-is-more, preach a gnostic gospel of salvation by knowledge: The data will make you free.  What they fail to acknowledge, however, is that data cannot speak for itself.  Like historical gnosticism, scientific purism needs a caste of the elect, versed in the arcane language of statistical science, to interpret the data for the benefit of the masses.

What strikes me most about the whole movement is how inconsequential it might end up being: A laborious 2-year effort by the BMJ (aided by Krumholz’s YODA Project) to get Australian investigators to release data from a study published in the NEJM eked an admission that an effect initially sanctioned by a P-value <0.001 turned out, upon re-analysis, to be only assured by a P-value of 0.006.  Not all medical reversals need to be earth-shattering, I suppose, but one may wonder if this is a foretaste of the kinds of revelations data sharing will produce.

The data freedom fighters seem to miss another point.  If the pharmaceutical and device industries are indeed all powerful and in need of constant surveillance, isn’t it likely that the centralization of healthcare financing and the promotion of uniformity of treatment for millions of people in the Western world plays a role in the disproportionate power these industries have gained?

Besides, the real problem with published medical and scientific output is not necessarily that it is fraudulent, but that it is mostly irrelevant or untimely.  I imagine that if we retracted at random fifty percent of journal articles, their removal would largely go unnoticed by the public and by most doctors and scientists.

Meanwhile, more fundamental and “structural” questions regarding conflicts of interest are deliberately ignored by all journals, including the BMJ and the NEJM.  For example:

— Is there a conflict when doctors who profess commitment to individual patients are paid by (and under the control of) collective payment systems, i.e., health insurance entities—be they private or public?

— Do these collective payment systems, which inherently divorce price from value, put patients who use health services in conflict with those citizens, born and unborn, who must eventually pay the bill?

— Are conflicts likely to emerge when public health is conflated with medical care?  Is it sensible to expect doctors to treat patients individually while at the same time demand that they manage “population health?”

These and other essential questions are almost never broached in medical publications, and neither the BMJ nor the NEJM seem to have any real interest in challenging the status quo.  These two journals are both secure fixtures of the English-speaking medical establishment and, regarding the basic assumptions and ideas that govern Western healthcare systems, there is little disagreement between them.

Let’s not confuse grand posturing about science and transparency for a real uprising to shake things up.  This war against the NEJM is, at most, a self-important tempest in an ideological teapot.

[Related post: A guide to top medical journals]

One thought on “The war on the NEJM

  1. Posers, all of them. Reminds me of Boehner calling Cruz “Lucifer.” (I only know because a friend posted it to FB. I avoid political propaganda) Like the pot calling the kettle black; and no real change in the political forecast.

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