The Last Psychiatrist: Wakefield And The Autism Fraud-- The Other Part Of The Story

I get it: Wakefield's evil.  A Big Legal schill who faked the data to enhance his testimony and own profits.  He probably thought-- and this is in fact what happened-- that it would be a small enough study that no doctor would care about it, but he could use it in court to say "there is evidence to support the notion that..."  And, indeed, no one read that paper until 2 years later, when Wakefield pressed his luck by writing more articles citing that study.

We should "extradite him to Britain to face fraud charges," said some article somewhere.

Whatever.  If you want to be cattle and moo with the herd, fine: blame Wakefield.  But Wakefield didn't do this, Wakefield is a product of this.  It's like blaming Bernie Madoff for the banking crisis.  He's guilty, but he isn't the cause of the problem, he's the result of the problem.

You scientists have created a system that trusts, implicitly, the word of every scientist-- except if he is getting paid by Pharma, of course (as everyone knows, NIH and university funds do not influence results.)  If he says the patient had a -7 on a scale, then it was -7, end of story. "Well, we have to trust the researcher a little bit, otherwise the whole architecture falls apart."  Exactly.   Why then do you not trust bankers that way?  If a banker lies he goes to jail. Are there any penalties for making up a study?  Do you seriously believe that scientists have less reason to nudge the numbers than bankers do? 

Then, you'll engage in serious academic disputes about whether MMRM is better than LOCF for analyzing a double blind study-- you'll assert that double blind trials are the gold standard! when you all know that 75% of the time we can tell if it's placebo or drug.  When you title the paper, "A Double Blind, Placebo Controlled Trial of---" you are lying.

And why wouldn't you?  The system is set up for you to lie.

Why, in the internet age, is the primary data not part of the paper? 

Peer Review is a joke-- why do you call it that?  They're not my peers, they're my close friends or my mortal enemies depending on my/my department's relationship with the editor; and they're not reviewing it, they're writing asinine, self-important comments that will never be noted after publication.

Why doesn't it change?  The answer is precisely in what Wakefield did: he wrote a tiny paper that he hoped would not be scrutinized (or even read.)  He just wanted to be able to say he wrote it, he wrote it not for science but for himself.  Now pick up any journal.  How many articles within are not for clinicians to act on, they're to put on a CV, get a promotion, get a grant, establish a name.  That's why we have ten million journals, none of which anyone reads, ever.

Fortunately enough good science gets done, loudly, powerfully, that medicine moves forward.  But the amazement shouldn't be that Wakefield's study was a fraud, the amazement should be why we haven't discovered hundreds of studies that are frauds.

I'll save you the meta-analysis: it's because we don't have enough journalists.

via thelastpsychiatrist.com

Posted via email from Jack's posterous