This is a medical blog.  But if I envision myself to have a guiding philosophy, it’s this, from “On Physiognomy.”Screen Shot 2016-05-09 at 11.06.46 AM

A lot of what’s controversial in medicine, science, politics, ethics are debated by appeals to competing authorities.  It’s a mistake to say that science alone will resolve those debates.

A piece by Lisa Rosenbaum in the New England Journal  this week on bias and conflict of interest policies misses this point.

If a pharmaceutical company funds a trial for their drug and that trial is successful there are two different questions to be asked. The first is, based on the data presented, am I convinced that this successful trial implies my patients would experience similar success if I were to prescribe it to them? The second is, do I think this successful trial is true?

Here’s a quote from the Journal:Screen Shot 2016-05-09 at 11.26.01 AM

But you can’t judge a study solely on its merits; it will always be judged in the context of what is known.  To an extent, this is something that Bayes’ theorem can try to quantify. But trust is important.  If oseltamivir was made to look more effective than it is because Roche was selective in the data it published, that will not be evident from what is published.  If we know that drug companies have been selective and not-forthcoming about these things, then that should influence our interpretation of the data they give us.

The call for transparency on financial conflicts of interest is only part of the program of so-called “pharmascolds”.  Calls for data transparency & sharing, being open about outcome switching, strict adherence to clinical trial registries are equally, if not more important.

A published paper implicitly requests the reader take on faith that it includes everything needed for adequate interpretation of its meaning.  Conflict of interest statements don’t invalidate the data, but they do speak to how we should apportion our trust.