Monday, 1 October 2018

Killing the messenger

There's a story in Surely, you're joking Mr Feynman about Dick Feynman's hobby interest in safe-cracking while working at Los Alamos. With the fate of the free world riding on the development of the atomic bomb, security was cranked up the paranoia. With his restless curiosity and questioning of authority, Feynman took to using sleight of hand to 'lift' the combination of various 'secure' filing cabinets. When his inventory of compromised cabinets was submitted, the management sent a memo round requiring those responsible to be more careful about cabinet security. The way this instruction was implemented was to exclude Feynman from offices - that being far easier that addressing the underlying security problem. That may remind you of demonizing whistle-blowing Gardai who pointed out ethical breaches in the actions and inactions of their colleagues. It's not always bad for whistleblowers: Pfizer employee John Kopchinski netted $50 million for grassing up his company for their mis-marketing of  epilepsy drug Lyrica

There's a whiff of that this week. In my piece about Lyrica, I cited the definitive study by the Cochrane Index which showed that it was of no effect in one of the treatments that Pfizer was instructing its sales force to push Lyrica at. tsk!

Finally after a 7 year gestation, the Cochrane Library published its analysis of the efficacy and adverse effects of Gardasil anti-HPV vaccination of teenage girls: Prophylactic vaccination against human papillomaviruses to prevent cervical cancer and its precursors. Their conclusion was that a) vaccination reduces later indicators of cervical cancer b) is mostly harmless. This was an important milestone in The Blob's story about HPV vaccination. Two years ago I set out the evidence (as far as I could understand / interpret it) in a three-parter: I - II - III. I my tenative conclusion was that, if it had been available I would have had Dau.I and Dau.II vaccinated to reduce their chance of developing cervical cancer 20-30 years down the pike. I wasn't super-convinced, though, that there was no possibility of adverse side-effects 20-30 days after the jab.

Within a couple of months, Jørgensen Gøtzsche & Jefferson had published in the BMJ a comprehensive critique of the Cochrane cervical cancer review. They suggested that, whatever the actual findings of the review, it was methodologically flawed: many eligible studies had been excluded from the analysis and all the big studies had been funded by the manufacturers. They furthermore suggested several obvious examples of conflict of interest among the authors of the review. Their quick agressive turn-around may have been because they had published an epidemiological study of HPV in Jan 2018 before the Cochrane review came out.

One problem is that Jørgensen Gøtzsche & Jefferson work for Cochrane! In their Nordic Centre in Copehhagen and Gøtzsche is on the Cochrane Board. The response of the Cochrane Board was not to re-evaluate their [definitive] investigation of HPV vaccination; rather it was to call for Gøtzsche's resignation from the Board for disloyalty, conduct-unbecoming and causing Cochrane reputational damage. A report of the internecine shenanigans, in Nature,  has caused so much reputational damage that half the Board has resigned and the anti-Gøtzsche faction looks likely to be replaced.
To do right? 
It is hard!

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