The Gold Standard? - Part 2

C.F. Rehnborg Chair in Disease Prevention at Stanford University, Professor of Medicine, Professor of Health Research and Policy, and Professor (by courtesy) of Biomedical Data Science at the School of Medicine; Professor (by courtesy) of Statistics at the School of Humanities and Sciences; co-Director, Meta-Research Innovation Center at Stanford; Director of the PhD program in Epidemiology and Clinical Research
Dr. John Ioanidis. C.F. Rehnborg Chair in Disease Prevention at Stanford University, Professor of Medicine, Professor of Health Research and Policy, and Professor of Biomedical Data Science at the School of Medicine; Professor of Statistics at the School of Humanities and Sciences; co-Director, Meta-Research Innovation Center at Stanford; Director of the PhD program in Epidemiology and Clinical Research

The FOX is Guarding the Chicken Coop.

Dr. Ioannidis, MD is highly credible. His credentials are just partly stated under his image.

As you browse his list of publications and qualifications, ask yourself the following question. If he is wrong, why is he still employed by Stanford University - one of the most prestigious medical schools on the planet?

Dr. Ioannidis is the major critic of Gold Standard #2 - Randomized Controlled Studies. These are the studies the put pharmaceutical drugs in your medicine cabinet. Below is a short list of his publications with key statements from each.

1. Ioannidis: Most Research Is Flawed; Let's Fix It – Medscape. You estimated that 90% of medical research is flawed.

2. A user's guide to inflated and manipulated impact factors. This article may not seem to belong here, but if the journal owners are lying about the influence of their journal, than can we trust what they are publishing?

3. Why most published research findings are false. Simulations show that for most study designs and settings, it is more likely for a research claim to be false than true. Moreover, for many current scientific fields, claimed research findings may often be simply accurate measures of the prevailing bias.

TJL Comment: That's fine as long as your health isn't at stake - but it is!

4. Power failure: why small sample size undermines the reliability of neuroscience. Improving reproducibility in neuroscience is a key priority and requires attention to well-established but often ignored methodological principles.

5. Contradicted and initially stronger effects in highly cited clinical research. Controversies are most common with highly cited nonrandomized studies, but even the most highly cited randomized trials may be challenged and refuted over time, especially small ones.

6. Systematic review of the empirical evidence of study publication bias and outcome reporting bias. Studies that report positive or significant results are more likely to be published and outcomes that are statistically significant have higher odds of being fully reported.

TJL Comment: Do you learn more from mistakes or successes?

Shouldn't we publish both?

7. Better reporting of harms in randomized trials: an extension of the CONSORT statement. In response to overwhelming evidence and the consequences of poor-quality reporting of randomized, controlled trials (RCTs), especially regarding the safety of drugs, many medical journals and editorial groups have now endorsed the Consolidated Standards of Reporting Trials.

8. Why most discovered true associations are inflated. Newly discovered true associations often have inflated effects compared with the true effect sizes.

9. Summing up evidence: one answer is not always enough. Neither individual trials nor meta-analyses, reporting as they do on population effects, tell how to treat the individual patient.

10. Statin treatment for primary prevention of vascular disease: whom to treat? Cost-effectiveness analysis. Conclusions In daily practice, statin treatment seemed not to be cost-effective for primary prevention in populations at low risk of vascular disease, despite low costs of generic drug pills.

TJL Comment: 99% of the publications on statins say they ARE cost effective

- but you now know they are biased.

This report tells the truth.

11. Completeness of safety reporting in randomized trials: an evaluation of 7 medical areas. Conclusions The quality and quantity of safety reporting vary across medical areas, study designs, and settings but they are largely inadequate. Current standards for safety reporting in randomized trials should be revised to address this inadequacy.

TJL Comment: Do you watch network TV and listen to the side effects of the drugs that are advertised. They are under-reporting the true side effects.

Consequences - You Are Getting BIASED Health Advice

"Where did you learn that?"

For most of us, we learn what to do, for our health, from our doctors.

Where did our doctors learn that?

They learned it from medical school and annual continuing education sponsored by pharmaceutical companies.

Industry Funding of Clinical Trials: Benefit or Bias? (from the Journal of the American Medical Association). Furthermore, the scientists who design, conduct, analyze, and report clinical trials often receive monetary compensation from drug companies, in the form of either salaries or consulting fees.

It's time to question the advice from your doctor - because he/she has been deceived by the system - with

Evidence BIASED Medicine.

(Thank you Dr. Richard Laudon for being the first to call medical data what it all too often is - biased)

Drs. Malcolm Kendrick, Arnold Relman, and David Diamond also write profusely on bias and medical misinformation.

Dr. Malcolm Kendrick is a GP in Scotland and a best selling author who dares question cholesterol-lowering drugs.

Here are quotes from some of his publications:

The case against science and medicine is straightforward: much of the scientific and medical literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness.’

- Richard Horton (Editor of the Lancet - one of the top global medical journals),

The mistake, of course, is to have thought that peer review was any more than a crude means of discovering the acceptability — not the validity — of a new finding.

Basically, many researchers are claiming that they have proved something to be true, but all they have actually done is to manipulate their research in order to confirm what they already ‘knew’ to be true.

Dr. Arnold Relman was an American internist and professor of medicine and social medicine. He was editor of The New England Journal of Medicine (NEJM) from 1977 to 1991, where he instituted two important policies: one asking the popular press not to report on articles before publication and another requiring authors to disclose conflicts of interest.

In 2012, Dr. Relman said medical profiteering had become even worse than he could have imagined.

The medical profession is being bought by the pharmaceutical industry, not only in terms of the practice of medicine, but also in terms of teaching and research, says Arnold Relman, a Harvard professor and former editor of the New England Journal of Medicine, whose recent critique of the industry's influence in health care, published in the New Republic, won him and his co-author one of the top awards for magazine journalism in the United States. The academic institutions of this country are allowing themselves to be the paid agents of the pharmaceutical industry. I think it's disgraceful.

Reference: Moynihan, Ray. "Who pays for the pizza? Redefining the relationships between doctors and drug companies. 1: Entanglement." Bmj 326.7400 (2003): 1189-1192.

Drs. Uffe Ravnskov and David Diamond study the way medical journals report benefit and harm.

Here is an example of their findings regarding the deceiving way medical research presents its results.

We have provided a critical assessment of research on the reduction of cholesterol levels by statin treatment to reduce cardiovascular disease. Our opinion is that although statins are effective at reducing cholesterol levels, they have failed to substantially improve cardiovascular outcomes. We have described the deceptive approach statin advocates have deployed to create the appearance that cholesterol reduction results in an impressive reduction in cardiovascular disease outcomes through their use of a statistical tool called relative risk reduction (RRR), a method which amplifies the trivial beneficial effects of statins. We have also described how the directors of the clinical trials have succeeded in minimizing the significance of the numerous adverse effects of statin treatment by reporting harm using absolute statistics. When harm and benefit is reported side-by-side but using different statistical tools, it gives the illusion of benefit that does not exist.

Dr. Trempe, my mentor at Harvard Medical School, subscribed to the New England Journal of Medicine since 1968 - and he read every article that journal published. Every year, the NEJM wrote to Dr. Trempe and asked him what the journal could do to improve. Every year he gave the same response:

Do NOT publish any relative statistics.

DO publish only absolute statistics.

NEJM is the #1 medical journal in the world. They did NOT listen to Dr. Trempe. Thus doctors are led to believe that drug benefits are far better than reality (that is, in your body)


Don't believe everything your doctor tells you because some of their information is from "evidence-biased" studies. Even the most vaunted "gold standard" randomized controlled studies have significant bias - even by simply reporting benefit in relative (meaningless) statistics and harm in absolute (meaningful) statistics.

Do try to understand "root-cause" medicine, that is, mechanisms of disease. With that knowledge, you cannot be fooled by the "evidence." Where did you learn that?

Be Well...