The latest column looks off in places. E.g.,
“I’d submit to you that what we’re looking at is a little more nuanced than the breathless news coverage would suggest — though you’re certainly not wrong, Pressured, to cast a skeptical eye.”
What’s with “Pressured” dropped into the sentence?
(Also, it’s “et al.”, not “et al”. (Preferably italicized.) A minor thing.)
But as I continued reading it … I had a harder and harder time trying to parse sentences.
This column really needs some editing.
Pressured in Michigan asked the question.
E.g. = exampli gratia …since this is Latin, the abbreviation should be in italics … just a minor nitpick is all …
Ugh, that IS a poorly written answer. And not properly edited, either.
Et alia, Latin for “and the others”, is properly abbreviated et al.. And, of course, it should also be italicized, being a Latin phrase.
Or, yeah, like the OP said. :o
Mea culpa.
Well, if we’re nitpicking, it’s actually exempli gratia (ignoring macrons).
Beyond the use of italics et al, my take on the column includes:
sharing skepticism about any attempts to scare people about “hypertension” based on the new lower numbers, unless there are good medical indications to do so (as in accompanying conditions that put them at risk).
also being skeptical about dramatic announcements that researchers have “ties to Big Pharma”. All too often such claims are used to dismiss valid research because (for instance) someone’s publication record includes one or more studies partially funded by a drug company (you’d think from the lurid insinuations that all of the authors are on the company payroll and regularly vacation in the Caribbean on their ill-gotten gains). It’s helpful to know just what these purported links are.
Of course one needs to make an informed assessment of what the links are to vested interests before casting doubt on the credibility of research results. I don’t automatically fault a researcher just for having a commercial affiliation. But when that commercial entity is a direct beneficiary of the research results in question, and when the subject is legitimately controversial, to me that raises a red flag.
And there’s a good reason why it should raise a red flag. I have sometimes had occasion to look into some of these researchers who were cited in defense of some product or substance, and lo and behold, they turned out to be funded by a directly related commercial interest – and very often that was only the beginning. Very often if one dug deeper, that link turned out to be the metaphorical tip of the iceberg: it bore out the old maxim that where there is one cockroach, there is very probably an infestation of them; some of these folks had a whole network of lucrative connections to an entire industry, more and more turning up with every trail you followed.
Perhaps we differ on how many “purported links” is too many. Remember how safe tobacco was supposed to be, according to “actual” doctors and scientists? In general the best researchers doing the most credible research have no conflict of interest and make that honest declaration up front.
This is one of the most decrepit of the hoary old memes used to denigrate evidence-based medicine, along with “they laughed at Semmelweis for urging doctors to wash their hands”. What is not mentioned (besides how far back into history people have to delve to come up with this stuff) is that while good science may be resisted initially, the weight of evidence always triumphs.*
Any convincing counterargument to new standards for hypertension needs to be evidence-based, and not rely on unspecified allegations of conflict of interest.**
*note that while many physicians (along with everyone else) were slow to recognize the full dangers of smoking, it was physicians who conducted most of the research and epidemiologic studies establishing the links between cancer, heart disease and other ailments.
**also a favorite ploy of antivaxers, those who attack modern cancer therapy in order to push their quack remedies, anti-GMOers etc.
***The shill gambit.
No, it’s the opposite. I’m denigrating mercenary pseudo-science that undermines legitimate research. You would have a point if the tobacco example was an irrelevant anomaly being thrown out there to support a false narrative. But as I indicated in all the parts that you failed to quote, a link with vested interests is a serious red flag in scientific research where public policy is at stake, and moreover, where there is one link we often find a tangled web of many others. We’ve already discussed this in the matter of the defenders of the agribusiness and chemical industries and of course Big Pharma. The old maxim of “follow the money” remains as true today as it was when the tobacco industry was manipulating the science; today probably the biggest anti-science manipulator of all time is the fossil fuel industry, especially oil.
I’ll repeat what I said before: the best researchers doing the most credible research have no conflict of interest and make that honest declaration up front. This is indisputably true. And while it’s true that the weight of evidence always triumphs, mercenary interests undermine this process, and are directly responsible for blocking and dragging out the evidence-based process at every turn and delaying vital public policies, costing us time that we may not have. Where is your “triumph of evidence” on climate change? The preponderance of evidence is absolutely overwhelming. And where are we? The US withdrew from the Paris accord and declared the whole thing a hoax. Where’s your triumph of evidence now? Follow the money, you can’t go wrong in determining motivations. And bad science, done for mercenary reasons, has polluted the public consciousness and bears a significant responsibility for the FUD surrounding this issue.
Sorry for the digression. That should probably be the end of it. My point being, if a particular industry is funding research, don’t be surprised if the research results are favorable to that industry’s interests. Science must be impartial and rigorously objective, and having no conflict of interest is an essential prerequisite. And this view does not constitute a “shill gambit” or support for antivaxers or any of the other gratuitous invectives you’ve thrown at it.
Really?
*"One of the most common unifying themes of the anti-science movement is the notion that large corporations and governments are concealing the truth for the sake of monetary gain. These conspiracy theories pervade blogs against GMOs, vaccines, modern medicine, global warming, etc., and they have led to the common trope, “follow the money.” This is a challenge that I repeatedly see anti-scientists make, and the idea is that if we simply follow the money trail, we will find that climate scientists are being bought off, the food supply is being controlled by the evil overlords at Monsanto, vaccine researchers are being paid by pharmaceutical companies, etc. This challenge is designed to quickly silence all opposition by establishing that all opposing research is biased and the scientists are only in it for the money.
There are, however, several obvious problems with this challenge. First, it is an ad hominem fallacy. For example, the fact that a vaccine researcher works for a pharmaceutical company does not automatically mean that he/she fudges their results. This leads to the second problem: for this argument to work, you need to show that researchers are actually being paid to be dishonest, not simply that their job is doing research. This places the burden of proof on the person telling you to “follow the money.” In other words, they must provide evidence of widespread corruption and dishonesty to support their claim. Finally, this challenge is applied inconsistently, and the people who issue it completely ignore the fact that many of their “experts” have financial conflicts of interest.
So ultimately, this challenge is a bad one because it has a logical fallacy as its core and places the onus on the person issuing the challenge."*
Chanting “follow the money” without regard to the quality of evidence puts one on the side of pseudoscience supporters and fatally damages one’s credibility. It’s your choice if you want to put yourself in that position.
It is of course legitimate to note the source of funding of a study if it appears germane, in the course of analyzing its legitimacy.
In this example, Orac points out who paid for a study purporting to show harm from vaccination, but doesn’t stop there.
“A study must rise or fall on its own, however, regardless of who funded it or what obnoxious antivaxer is promoting it. So let’s dig in.”
And he does, to devastating effect. His criticism would’ve been worthless if he’d stopped at “Follow the money”.
I agree. To claim that I said otherwise is to put a simplistic and disingenuously literal interpretation on what I’m saying. Any statement of broad basic principle can be shown to lead to idiotically incorrect conclusions if applied stupidly, without knowledge or with bad assumptions. That doesn’t mean the principle is not generally correct and useful.
It’s like saying “You can’t trust a habitual liar”. Yet even a habitual liar will tell the truth when the truth serves his self-interest. It doesn’t make the principle stupid or invalid. It simply means that the source should be red-flagged and subject to extra scrutiny and not accepted on the same basis as a known reliable source. We see this in your favorite debating topic, GMOs, where in the matter of food safety the science and the interests of agribusiness and the food industry happen to be aligned. But it’s independent science that validates it, and history being what it is, I wouldn’t trust these profiteering slimeballs to unilaterally and voluntarily make safety determinations in the future without legal mandates and rigorous federal oversight.
Furthermore, the article you cited purports to show that “follow the money” is the mantra of anti-science, yet the argument and the article are deeply flawed. The flaw actually begins in the very first sentence (emphasis mine): “One of the most common unifying themes of the anti-science movement is the notion that large corporations and governments are concealing the truth for the sake of monetary gain.” This may be the belief of conspiracy theorists but it isn’t mine. I’ve never lumped governments into the same bucket, and I regard governments – in the form of consumer protection laws, regulatory agencies, and funding of independent scientific research – as our best and only line of defense against the potentially abusive behaviors of private corporations. To the extent that governments may fail to do this adequately, it’s usually because they’ve been overrun by corporate lobbyists and the malignant influence of corporate money in politics, which is rampant in the US as nowhere else. Nor do I regard all corporations as necessarily worthy of deep suspicion, but only those whose self-interest is at odds with the public interest, such as those whose products or activities pose risks to public health or safety or to the environment.
Furthermore, the article contradicts its original premise in the very first example, global warming. The example begins with the following statement:
When following the money, it’s important to look at what each group stands to gain from their position (this is a task that anti-scientists tend to utterly fail at).
It then later states the following:
Now, having established a complete lack of incentive for starting this supposed conspiracy, I want to flip things around and look at the people who would benefit from denying climate change. This time, we have a very clear and obvious group that benefits enormously from denying global warming. I am, of course, referring to fossil fuel companies.
Both statements are of course absolutely correct, but you see the problem here. This has nothing to do with “follow the money” being an invalid principle, because the author is asserting precisely how valid it really is. It has to do with complete morons and conspiracy-theory lunatics having no clue as to where the money really is: it’s not in the grant money of climate scientists, it’s in the trillion-dollar fossil fuel industry as well as much of their major industrial customer base. The problem isn’t in the principle of “follow the money”, the problem is in the defective brains of climate deniers.
Remember what I clearly said in summing up: “My point being, if a particular industry is funding research, don’t be surprised if the research results are favorable to that industry’s interests.” Do you disagree? If not, stop trying to put a ridiculous spin on my words.
Apparently, using the shill gambit is permissible if you think your cause is just; others doing the same thing on behalf of less virtuous goals are “conspiracy theorists”. :dubious:
To be “disingenuously literal” :), if you (or anyone) want to argue that research specifying a lower threshold for “normal” blood pressure is flawed/compromised, you need to point out the alleged inadequacies and only then attempt to correlate them with the researchers’ supposedly being on the take from Big Pharma.
Here’s an analysis from a physician in the public health field, which manages to raise questions about the new guidelines without going into full-on shill mode:
By contrast, here’s a response from a popular “natural health” website using the shill gambit.
Who comes off as sounding informative and rational?
By the way, the new blood pressure guidelines are largely the result of a huge multi-center clinical study that was (wait for it) federally funded - the 2015 SPRINT trial.*
Oops.
*apologies if this is behind a paywall for others. Results are summarized elsewhere online.
Hmmm… after I asked you to kindly stop trying to put a ridiculous spin on my words. you appear to have taken a new tack and gone full non sequitur. My initial response up in post #8 was, you will note, a general caution about the influence of special interests on scientific research (which also includes, BTW, a significant concern about the influence of special interests on how the results of scientific research are re-interpreted and communicated to the public). It was in response to your casual handwaving dismissal of such. At no point did I say anything at all about this specific announcement of revised high blood pressure criteria, as I’m in no way qualified on the subject matter.
But I’m happy to answer your question anyway, if you’ll answer mine, even though it’s hard to see the relevance of your question.
I read both the articles you linked. I wholeheartedly agree with the NYT piece, specifically on the points that (a) an apparently large reduction in the incidence of cardiovascular events has to be seen in the perspective of such events being very rare to begin with, (b) the numbers were biased by including only high-risk patients, and © blood pressure is one of those peculiar things that vary greatly with the conditions under which they’re measured, and indeed tend to become elevated just by the very fact of being measured (I know this from experience).
I also see the problems with the “natural health” piece, such as the parts I highlighted here: “And don’t you just know that this change will mean billions more in earnings for pharmaceutical companies as the newly designated hypertensive patients will no doubt have to be placed on BP-lowering medications.”
But so what? We have a well-reasoned article and apparently quite a badly reasoned one. This will always be the case. So what? It doesn’t change the principle I articulated, as did Cecil’s article. Here’s the pertinent quote:
A 2017 sample of PAOs found that 67 percent received at least some cash from for-profit companies, and 12 percent got more than half their budget that way. This study was part of a series of JAMA Internal Medicine articles on the growing problem of industry influence on things like medical guidelines; it was noted elsewhere, for instance, that the industry-funded National Osteoporosis Foundation “continues to promote the idea of a widespread ‘disease’” while “others point to concern about the condition’s overdiagnosis and overtreatment.”
The problem was described a bit more heatedly in a 2009 article in the New York Review of Books by Marcia Angell — longtime editor at a little pamphlet out of the northeast called the New England Journal of Medicine — about the infiltration of industry money into things like “expert panels” on health issues.
So here are my questions:
Do you disagree with the above?
What about my statement that if a particular industry is funding research, don’t be surprised if the research results are favorable to that industry’s interests?
Do you think that the vast sums being spent by special interests on lobbying and on both overt and covert advocacy organizations are affecting legislation and skewing public perspectives on important issues? Think oil and coal companies and climate change policy, or the AHIP lobby and health care policy.
Finally, I’m perplexed by your crowing about the fact that the BP recommendations were largely based on the government-funded SPRINT trial. I don’t think anyone claimed that this particular recommendation was a Big Pharma conspiracy. But the general comments above and reflected in my questions are still valid.
In fairness, though, I should say that despite all the reasons we have to justifiably criticize Big Pharma, many BP medications are dirt cheap. Know what’s really expensive? Drugs like platelet aggregation inhibitors – the things you may have to take after a cardiac event, assuming you survive. So I’m not going to get too upset by increased attention being paid to high BP, including medication to manage it.
The shill gambit does not become more respectable with repetition.
Recall that you initially dived into this thread to share the following sentiment:
Eloquent. Then we get this protestation:
Of course not (nudge nudge wink wink).
We await your evidence that new hypertension guidelines are “motivated” by monetary greed.
(crickets)
By the way, it’s obvious you badly need to research basic medical information before sharing your insights. Heart attacks, strokes, heart failure and cardiovascular deaths in general (assessed by the SPRINT trial) are not “very rare” events. Heart disease and stroke are among the top five causes of death in the U.S. (heart disease is #1). The SPRINT trial did not limit itself to an exotic group of people teetering on the edge of the grave; its “high risk” participants are widely represented in the population, as this group included those over 50 with moderate systolic hypertension and who had subclinical cardiovascular disease. And while so-called “white coat hypertension” (higher BP readings at the doctor’s office) can be a real phenomenon, it may also be risky to ignore (some experts think that if anxiety/stress at the MD’s office causes blood pressure to spike, it may be shooting up at other stressful times and constitute a genuine risk factor. Depending on the circumstance, it might be wise to monitor BP over the course of the day to see what’s going on.
That would be a terrific zinger if I had ever made such a claim. But I did not, and in fact I pointed out that in this specific instance most blood pressure medications are dirt-cheap anyway. Also, BTW, many of them are now generics.
Before sharing your own medical insights, you should know that you’re talking to someone who, almost exactly one year ago, returned from hospital after cardiac surgery following a heart attack, and I assure you that I need no tutoring from you on the facts of heart disease, its risk factors and prevalence, or its treatment or prognosis.
If you’re going to criticize my statement then you must also criticize the original article I was paraphrasing, the one that you cited as being “informative and rational”. My wording may have been a bit sloppy, but in the context of the article I was discussing it’s hard to imagine you couldn’t fathom what I was saying, to wit: that the group with the higher BP target had an 8% rate of cardiac events, while the one with the lower target had a 6% rate. That’s a 25% reduction, but it’s a reduction on a (relatively) very small cohort. Again, if you think this is stupid, take up your argument with the physician who wrote the article that you had just finished praising. If you’re now going to argue with your own cite because I agree with it, that would be one of the more spectacular turnarounds in the service of argumentative one-upmanship that I’ve witnessed in recent memory.
I also note that you continue to evade my repeated questions (last summarized in post #15), all of which leads me to believe that you’re more interested in arguing than in actually having a constructive discussion.
I think you should make an effort to read the NEJM article on the SPRINT trial before making any more whoppers (the latest being the one about a “very small cohort”. I’m afraid your experience with cardiac surgery did not make you informed with respect to cardiovascular disease, though perhaps it goes a way towards explaining your fondness for the pharma shill gambit.
If you didn’t mean to insinuate that the new blood pressure guidelines were motivated by pharma greed, then it’s difficult to understand why you felt the need to charge into this thread to emote on the subject.
Oh, and if you want to debate about any other area of research supposedly being hopelessly contaminated by $hillbucks, then feel free to start a new thread. Based on your related flailings on the subject of GMO foods, your comments should be entertaining, if not terribly informative.