Medical Studies - Fraudulent Errors

This is the third in a series of newsletters designed to help you understand and evaluate medical studies you may hear or read about in the news. In the first two we explained how medical studies are designed and how, even in the in the most well-intentioned studies, errors can creep in.

This month we look at outright fraud. Yes, sad to say, fraudulent studies have appeared in highly respected journals and been trumpeted in the news. Here are some examples.

Immunization Brouhaha

Cindy and Bob proudly showed me their newborn and said, a little shyly, that they did not believe in immunization and did not want to vaccinate little Rebecca. Bob was worried. He had heard that the MMR vaccine (which prevents measles, mumps, and rubella) could cause autism. I was able to give him the scientific background.

In 1998 a British investigator named Andrew Wakefield published an article in the prestigious medical journal The Lancet claiming to show that the MMR (measles, mumps and rubella) vaccine had caused autism in a number of cases. Newspapers picked up the story and vaccination rates plummeted. Subsequent investigations proved that Wakefield had received payments from lawyers seeking to sue vaccine manufacturers and had faked his data. Wakefield lost his medical license but the rumors about the vaccine still ripple on.

I told Cindy and Bob that while I was not in 100 percent agreement with national vaccination protocols, I did know that vaccination has saved millions of lives and will save millions more. They would be wise to reconsider their decision.

Scientific Gobbledygook

Ginger was considering buying a machine to alkalinize water. She asked me if alkalinized water would improve her health. The sales literature with its list of journal references and talk of free radicals, oxidation potential, millivolts, etc. seemed pretty scientific. On the exam room computer, we looked at the website and searched for double-blind controlled studies that actually applied to this kind of water. No such studies existed. The sales literature used some real scientific terms, but on close examination, the explanation of the chemistry of the water was gibberish. Sure they had some correct puzzle pieces, but didn't know how to put them together to make coherent logical assertions that matched anything in the real world.

The First Amendment to the United States Constitution protects your right to speak what you believe, even if it is gibberish. Some people use this to make a living—at your expense.

Ginger was happy she has spoken to me and saved herself the thousands of dollars the machine would have cost. You can read more about fraud in the alternative medicine field in the May 2008 Newsletter.

When Pharmaceuticals Compete

James' high blood pressure did not respond to several non-pharmaceutical measures I suggested. Since he'd recently developed diabetes, I knew a blood pressure medication in the ACEI class would have the side benefit of protecting his kidneys. In that class, on average, ramipril provides more lifespan extension than do most of the others, and is most effective when given in the evening, so he started taking one each bedtime. Recently he'd seen a news story of another medication that was supposed to be better. I had read that study. The commercial researchers who designed the study disingenuously gave their patients the ramipril in the morning. Surprise, their own favored drug did as well as did ramipril. They mentioned the time of ramipril administration on page three or so of the paper they published. Few readers got that far.

Suppression Bias

Mary felt pretty glum. She'd been caring for her ailing mother for two years in her home, and now that her mother had recently died, she couldn't get over her sadness. She was already in counseling, and her counselor had sent her in hoping that a prescription for an antidepressant would help.

I explained to Mary that grief normally results from the death of a loved one, that it's usually self-limited, and that anti-depressants have never been shown to ease that particular pain. In fact, I told her, many studies indicate that anti-depressants do not help true depression.

To repeat, independent studies often show as much benefit from placebo as from anti-depressant medication. Why don't we hear about this? The drug companies do many studies. However, they usually only publish those that show benefit, and put the rest in a file cabinet. This is called suppression bias – suppressing studies do not support a certain point of view or economic interest.

Pervasive Influence of Money

Pharmaceutical companies fund most medical studies, subsidize medical school buildings and professorships, provide the advertisements that keep the medical journal presses turning, and maintain a strong lobby in the government that regulates us all. The commercial influence on medicine goes much further than most people realize. You can learn more in a book by a retired editor of the New England Journal of Medicine: "On the Take: How Medicine's Complicity with Big Business Can Endanger Your Health"

Navigating These Waters

It's a good thing that we have access to the latest medical news. But it's easy to be swayed by reporting that misunderstands or exaggerates the results of a study. In addition, errors can creep into studies. These errors can be innocent, unconscious, subtly manipulative, or outright fraud.

Your best bet is the calm down, try to get full information about breaking medical news, and then critically evaluate it with your best scientific mind. Remember that most subjects of medical interest have many scientific studies. It's often useful to look at the full range of information available, not just the latest headlines.

I hope this article series has given you the tools you'll need.

For more information

September 2012 Medicine For People!

Too often, medical opinion leaders ignore the evidence, as you can learn from these previous issues of Medicine for People!