Seth's Blog

New York University professor of obstetrics and gynecology Lila Nachtigall, whom I mentioned recently, said nice things about estrogen replacement therapy to a Newsday reporter. The story fails to say that she gets money and ghostwriting from Wyeth, which makes the pill used in that therapy.

In a previous post I said that the Nobel Prize to Barry Marshall and Robin Warren — for supposedly showing that H. pylori causes stomach ulcers — was a mistake. Because half the world has the bug in their stomach, and only a tiny fraction of them get ulcers, the true cause of those ulcers lies elsewhere, probably with an impaired immune system. Marshall famously drank a flask full of H. pylori and didn’t get an ulcer, yet took this to support his theory. A classic example of self-deception.

Recently Lam Shiu-kum, a former dean of medicine at the University of Hong Kong, was convicted of a giant fraud. He siphoning millions of dollars of medical fees into his own pocket:

Dr Lam, 66, brought a 39 year association with the university, his alma mater, to an abrupt end in March 2007 when the investigation into billing irregularities began. He is a distinguished gastroenterologist who conducted pioneering research into chemoprevention of stomach cancer through the eradication of Helicobacter pylori. His team also conducted the first double blind, controlled study into curing peptic ulcers by H pylori eradication.

I suppose this supports my case. As far as I know, almost all doctors and med school professors believe H. pylori causes stomach ulcers; I have never heard dissent about this.

More. What goes unsaid, and maybe unnoticed, in the debate about health care, is that it is hard to have decent health care (that is, decent health) when those in charge don’t know what they’re doing. The stomach-ulcer-etiology problem is a small example of a big thing. In case I’m not being blunt enough, let me be even more blunt: This example illustrates that the average doctor, the average med school professor, and at least two Nobel-Prize-winning med school professors (not to mention those who award Nobel Prizes) have a lot of room for improvement in their interpretation of simple facts. My previous example of the infectious-disease expert (a med school professor) who overlooked the immune system is another example of vast room for improvement. It’s hard to get good health care from people whose understanding of health is terribly incomplete yet don’t realize this.

What a cesspool. I mean the dirty work medical school professors do for drug companies. The profs make the drugs appear better than they are. Let me count the ways:

1. I blogged earlier about Duke professor Charles “Disgraced” Nemeroff taking huge amounts of money — which he then failed to disclose — to encourage doctors to give dangerous poorly-tested drugs to children. Nemeroff is (or at least was) considered a top psychiatry professor!

2. When the practice of drug companies ghostwriting articles for professors was revealed, New York University professor of obstetrics and gynecology Lila Nachtigall, the nominal author of a ghostwritten article, told a reporter (contrary to evidence supplied by Wyeth) that she had written all of her 1000 articles and 3 books. And she said this:

If they [Wyeth] came up with the idea or gave me an outline or something, I don’t remember that at all. It kind of makes me laugh that with what goes on in the Senate, the senator’s worried that something’s ghostwritten. I mean, give me a break.

It made her laugh. Yes, why should anyone care about the dishonesty of med school professors? What cave has Nachtigall been living in?

3. About half of published clinical trials were not properly registered, a new study showed (abstract here). A large fraction of these studies were drug-company-funded, I’m sure. (More than half were “industry” funded.) And the authors were often med school professors. Failure to register your study means you can distort the results to make them closer to the outcome you prefer by changing the “endpoint” (the dimension you use to measure whether the drug worked). Even among the registered studies, one-third used a different endpoint than the registration said. It is hard to avoid the conclusion that a lot of misleading results — making drugs look better than they really are — are being published. The level of cheating appears to be incredibly high — perhaps more than half of published papers.

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I once read a Briefly Noted review in The New Yorker that revealed that the reviewer had only read a quarter of the book. A friend told me that reviewers got about $100 for those reviews so there was a certain inevitability to this deception. This abstract, of Calvin Trillin’s best-ever article, about an American student who goes to China, blossoms, gets sick, and dies, is another example of the same thing. The abstracter clearly didn’t read the article — but you should.