Guess where
First Sabbatical, mid-1980s
On 5/22/12 I wrote a blog about Dr. John P. A. Ioannidis, a citizen and predominantly a resident of Greece. At the time I thought he was primarily a Stanford University professor, but that appears to be only one of his part time jobs; He does most of his damage (I should say “work”) from his home country. He is a world-renowned biostatistician and, it appears, one of the more influential persons in medical research. My ignorance led me to give him short shrift: see ALL IS NOT LOST, 5/22/12.
I returned to Dr. Ioannidis because I ran onto an article by a fellow Greek biostatistician, Dr. Eleftherios Diamandis. Dr. D. was born on Cyprus, educated in Athens, and currently is a prominent member of the University of Toronto medical establishment. This makes him a big gun, no question.
Dr. Diamandis published a paper in 2010 which reminded me of Dr. Ioannidis’ ideas. The title of the paper is “Cancer Biomarkers. Can we turn recent failures into success?” * It was published by the National Cancer Institute, which is no fly-by-night outfit, as you no doubt realize. The paper is mildly discouraging. In it Dr. D. summarizes work de-bunking several recent studies that, when published, seemed to promise rapid advancement in the war on cancer, but which later were shown to be either inconclusive or downright fallacious. Painfully, some of them almost smacked of deliberate fraud!
This is a serious avenue of thought I have stumbled upon, and I want to muddle it about in my head before I go any further. Maybe after my first gin and tonic this evening it will all become clear. In the meantime, one thing is obvious. We need incentives to verify published research findings. Even big, expensive clinical trials should be tested. Repeated, even, by disinterested investigators. As I wrote earlier, as things stand now there may be ample reason to verify work already published, but there is little incentive. Journals don’t want to publish stuff like that, unless of course it leads to a juicy scandal. Granting agencies and drug companies don’t want to fund “verification” proposals and – maybe the most powerful disincentive of all – you don’t get promoted by publishing negative results. And, of course, if you do that sort of work nobody will want to eat lunch with you at the AMA convention.
Anyway, stay tuned for a Comment. In the meantime, here is an article from The Atlantic that you might find rewarding. As usual with that rag, it takes 104 words to describe what the NYTimes and The Economist could do in 103, and The Week could do fairly well with a couple hundred. But give it a try, anyway.
By the way, my second great grandbaby is now at home in Cordova (I think)., joining what my daughter Kristen refers to as Her Royal Cuteness. Should be quite a sight.
*http://jnci.oxfordjournals.org/content/102/19/1462.full
*http://jnci.oxfordjournals.org/content/102/19/1462.full
This is not the “Comment” I mentioned in the main blog; I am still mulling. However, I ran on a Letter to the Editor of the latest Economist that I think is relevant – and also funny. It was written by a retired professor, presumably of biomedical science, from Eastern Kentucky University. He states that years ago he made the decision never to see a doctor, except in cases of dire emergency. He says that he prefers to trust his health to the effects of hundreds of thousands of years of unbiased biological evolution – to produce a self-sustaining and correcting entity (i.e., himself)-rather than to rely on the advice of medical practitioners, whose decisions often are informed by inaccurate and/or biased experiments (I.e., doctors). He ends by declaring that his way is a safer bet, at a statistical significance level of ???
ReplyDeleteNext week I will be able to give you the web address, and I will – if I remember.
Here is the letter referred to above
DeleteSIR – For three decades I studied biomedical science. Your articles summarised well the basis for my decision years ago never to see a doctor, except for emergencies. Given the option of relying for my well-being either on hundreds of thousands of years of objective, biological evolution contained in an organism that is self-maintaining and healing (me), or on advice and treatment from a physician relying on knowledge that, for whatever reason, is probably biased, false and misleading, I choose the former.
It’s a safer bet (at a level of significance greater than…).
John Denton
Professor emeritus
Eastern Kentucky University
ReplyDeleteNow, this is interesting... I usually have between 10 and 20 "hits" per day, with a few more on the weekends. Today, suddenly, I have had 30 - and 2w of them from Moldova! If you can tell me instantly, without looking at a map, approximately where Moldova is located, I will buy you a beer. I sure wish I could determine which blogs are of interest to Moldovites.
Gnutz! I can't type and I can't be bothered to proofread! That's 22 hits from Moldova, not 2w.
DeleteOkay, here’s something I pass on to you in the spirit of – who the heck knows? It concerns diet and cancer prevention. It is unquestionably anecdotal evidence; Dr. Ioannidis would smile and role his eyes. True, less than 50% of women diagnosed with late-stage ovarian survive for five or more years, but some of them do. I would lay odds that a few of them subsist on things like gin, Twinkies and hot dogs. Still, diet is a serious concern in cancer studies. Maybe this woman is merely lucky, but maybe she’s on to something. Read it yourself: http://happyherbivore.com/2013/11/HOW-Sally-ovarian-cancer-plant-based-diet/?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+HappyHerbivore-Blog+%28Happy+Herbivore+-+Blog%29
ReplyDeleteThis item was brought to my attention by good Borrego friend Lou Bahar.
I completely agree with the idea that nutrition plays a huge part in fighting disease. It is one thing we do have an immense amount of control over what we consume. One of the difficulties is that a healthy diet can be different for different people. I think that there will be many changes in the way we view what we eat and hopefully doctors will start to prescribe more in the way of food related "cures" and not rely solely on medicines.
DeleteWell, as many of you know, I am skeptical about the role of diet in many aspects of life. For instance, I once said (tongue in cheek) that eating organic food is immoral. I got dumped on for that, predictably, but I still think it’s (a little bit) true. As for the role of diet in confronting disease, I am confidently agnostic. The medicines we take – aren’t they simply complex bio- molecules? What is food? Complex bio-molecules, that’s what. So why can’t eating a certain way help out with health? The answer is: in some well documented instances, it certainly does. So why do I doubt that eating herbivore-like can lengthen remission in ovarian cancer. I don’t, actually – but I think it’s far from a panacea. As Linda says here, what works for one person may not work for another. It is well known that “ovarian cancer” consists of many different diseases – that is, cancer of the ovaries (actually, most start in the fallopian tubes) arise from a variety of mutations and/or epigenetic changes. Thus one person may benefit from eating beets, whereas another can drown in beets and gain no advantage. Maybe gin and Twinkies would help someone, but I guess we shouldn’t recommend them.
DeleteThe problem is, of course, that most healthy foods taste crappy. At my age (80) I’m not about to give up red meat, butter, alcohol and sugar for a diet of sprouts, beans and tofu. So there.
The serious among my thousands of readers should really take the time to read the following article:
ReplyDeletehttp://www.theatlantic.com/magazine/print/2010/11/lies-damned-lies-and-medical-science/308269/
Here is an important commentary on the practices of drug companies, academic institutions, and the FDA. Important human consequences are involved.
ReplyDeletehttp://www.economist.com/news/science-and-technology/21659703-failure-publish-results-all-clinical-trials-skewing-medical
I may write a blog about this soon, but right now I am fully occupied enjoying Evelyn and Seamus, my less-than-two-year-old great grandchildren.
Also, I am cogitating on the value of an essay on why I don’t eat organic foodstuffs, and am in favor of labeling GMO products – so I can eat as many as possible. That should get some “comments.”