Wednesday, June 13, 2007

Avandia and the "New-Media Man"

In all honesty, I don't give a @$#@ (that's French for rat's ass) about the diabetes drug Avandia. While this article in the New York Times is ostensibly about the recent news that Avandia has been associated with an elevated risk of heart disease, the author spends much of his time discussing his research for the article. He refers* to himself as a "new-media man", meaning that rather than trust the headlines, he utilizes the "entire niche of blogs and digital news sources on relevant subjects — drug risks, Big Pharma, diabetes". I was pretty impressed. This guy was going to do a little digging and come up with a nice take-home message, empowering his reader to use the internet to look past the headlines and scrutinize what they are reading. So what was his take-home message?

"And here is what I found: everything, except insight."

What a disappointment! Maybe I should have guessed as much, after all the title of the article is "Call the Doctor". But this was a gimme! The take-home message is so simple, yet the author got caught up trying to weigh opinions of others when he would have been far better off just reading the study and forming his own. To me, the value of so-called "new-media" is unprecedented access to primary sources, allowing the people (as in "we the") to form their own opinions rather than simply selecting between those of politicians and journalists. (The Durham-In-Wonderland blog is a fantastic example, to which I've linked to multiple times before.)

A quick skim of the actual study in the New England Journal of Medicine given a pretty simple take-home message:

There is a 95% that the increase in risk of heart attack due to the use of Avandia for 24 months is between 3% and 98%, the best estimate being 43%. In other words, Avandia does seem to increase the risk of heart disease, but the studies have been small so the precise magnitude is unknown until larger studies are conducted. This result should be taken very seriously because Diabetics are at higher risk for heart disease to begin with, so even a relatively small percent increase in risk is significant, in the same way that doubling your chances of getting in a car accident is more significant than doubling your chances of being hit by lightning.

* in reference to Jaideep's comment, formerly "refferse"


jaideep said...

wow, even i tried, i don't think i could misspell "refers" worse than that...incidentally google wasn't able to figure it out.

rey said...

ben mathews has a blog. i did not know this. Now I have something new to add to my list of daily reads. I look forward to reading all about his zany adventures riding down the PCH!

About Avandia, Ben Mathews makes an interesting point, which is that in the society we live in we do have unprecedented access to primary sources. However, I think the point must also be made that simply reading the primary sources does not also make you well informed. While the news media often raises my ire by their (seemingly deliberate) misrepresentation of stories, such as when they warn us of new "dangers", does not necessarily lead to better conclusions. In particular, the medical literature is not completely objective. While the facts and statistics are generally factual, papers are written in such a way that they will get published. This means that they must somehow distinguish themselves, and the best way to do this is by trying to raise controversy.
While the topic of the paper is deserving of study, I would have doubts about changing my clinical practice based upon this article alone. meta-analysis is inherently flawed, for many of the reasons that the article itself provides. For this and other reasons, the article must be read critically. I think Ben illustrates this himself when he says "the take home message is that there is a 95% chance...". The true take home message is "this article comes to the conclusion that there is a 95% chance...". The difference is subtle but significant.

rey said...

i just realized this is alan's blog, not mathews. i guess that makes me retarded.

rey said...

hi alan!

Alan Rosenwinkel said...

ha ha. Hi Rey :-) I agree that everything should be read critically, even peer-reviewed literature. I've read some really horrible papers, especially in the medical literature.

dave hiller said...

Alan's blog, huh? I guess I deserve that since it's been a while since I've posted. Coming soon - my 3-year argument with John Rice in blog format.

It seems we're largely coming to the conclusion that you can't know anything. You can't trust what reporters say because they're generally uneducated in specific areas. You can't trust primary literature because you're generally uneducated in that specific area. You can't necessarily trust experts because they took a long time to become educated in that specific area, and with their investment comes bias.

Happily we can use all of these sources of information together. Read whatever news sources you find trustworthy, but be willing to check what experts actually said. For topics that particularly interest you, or if you question someone's conclusion, try to read the primary literature. A good news source should even make it easy by linking to its sources. This can then be an iterative process; if you check the source and it supports a statement, then you're more likely to trust the person who made that statement.

Hopefully by sharing some of our observations here we can speed that process - if one of you finds a source reliable that's a pretty good indication that I can also. I've already invested the time to find out which of you are idiots, so it's all application now.

jaideep said...

who is John Rice and what did he(?) put in your spanish rice to piss you off so much?

Daina said...

Rey, you are very funny.

It drives me nuts that most Americans seem to think they know something just because they heard a brief summary of a news report on TV. Haven't they ever heard of something called due diligence, checking multiple sources, etc? Or perhaps it's just SoCal that suffers from this.

I generally agree that you can't know anything for certain. I liked Feynman's model of doubting everything until he could explain it himself. I think it takes constant re-evaluation of your hypothesis, and actively doubting what you know and seeking out new sources of information, as well as a keen eye for assessing the quality of those sources, in order to get to the truth. Unfortunately doing this for the hundreds of current event topics that are of interest to us can be a bit difficult to juggle with a full time job, so anyone who isn't careful is left indentured to the full-time professionals and Group Think.

dave hiller said...

In a book I read recently, it was speculated that groupthink is selected for, not against. For instance, if you moved to a new area you'd be better off following the practices of the people who were already surviving there, rather than starve while you try to learn your own way.

The three major problems to me would be if 1) you had an easy way to check and didn't bother 2) you refused to adapt to another source of information or 3) you were sure based on this one source that it was absolutely correct. After all, as JR's math teacher says, there are four states of knowledge, and the only really dangerous one is to not know that you don't know something.

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