Re: Conflicts of interest

Issue: BCMJ, vol. 47, No. 2, March 2005, Pages 79-80 Letters

In his editorial “Conflicts of interest,” Dr James A. Wilson writes, “I have no faith in the reported results of these treatments/devices, and will continue to disregard them until properly designed studies are conducted and reported in mainstream journals by non-conflicted investigators.” (BCMJ 2004;46(10):492).

Demonstrated facility in critical thinking is a prerequisite for neither medical school nor for the House of Commons. If it were then the Department of Fisheries and Oceans would run the Gun Registry and vice versa, thereby ensuring an abundance of fish and elimination of illegal firearms. A good example of flawed thinking is the law pertaining to new reproductive technology which, after several false starts, was finally enacted last year. It was based upon the multimillion dollar commission chaired by Dr Patricia Baird, OC, whose report Proceed with Care admirably demonstrates the biblical observation, “a house built on sand cannot stand.” It has had some beneficial effects: the Assisted Reproduction clinic located in the tiny town of Bellingham is flourishing.

One need not reflect too deeply to find other glaring examples of fallacious thinking. Post-menopausal hormone replacement was until recently de rigeur: we now learn it was a false dawn. Until the Australian gastroenterologist Dr Barry Marshall demonstrated the presence of helicobacter we knew that bacteria were destroyed by gastric acid and peptic ulceration was caused by nitrates, spices, smoked foods, and stress. After ingesting the gastric aspirate of one of his patients Dr Marshall in 1984 was able to prove his premise and it appears that the tens of millions of dollars expended on proton pump inhibitors and H2 receptor blockers, with only transient benefit, were wasted. Not as egregious perhaps, as the treatment prescribed by the physicians of King George III, whose head was shaved and a poultice of hot pigeon dung applied.

With the dearth of new drugs under development the pharmaceutical industry is tapping the lucrative medication of the worried well. If only the populace would take a daily statin pill for its hypercholesterolemia and an ASA and a dietary pill and a tablet for sexual dysfunction their troubles would be at an end and all would live happily to decrepit senility. We are bombarded by junk science and it is good that we should heed the wise advice of Dr Wilson and develop a healthy skepticism. How is this to be attained? It is necessary that these qualities be inculcated into our medical students and resident staff in their formative stage, for as the twig is bent so grows the bough.

—H.E. Woolley, MD

H. Ewart Woolley, MD. Re: Conflicts of interest. BCMJ, Vol. 47, No. 2, March, 2005, Page(s) 79-80 - Letters.

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Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

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