December 30, 2005

An Insider’s Assessment of Medical Journals and Peer Review

The author, Thomas Stossel, is American Cancer Society Professor at Harvard Medical School and co-director of the division of hematology at Brigham and Women’s Hospital. This is an excerpt of his column in the December 30 Wall Street Journal (requires subscription). It confirms the “passes the smell test (maybe)” perception that “peer review” deserves discussed at this previous post (“What Does ‘Peer Review’ Mean?”), and notes that the term does not deserve the high ground it currently holds:

The (media) message in all this is clear: Medical academics are saints — devoted selflessly to patient care — and corporate people are sinners, morally blinded by greed. But having worked in academic medicine for over 35 years and consulted for companies, this Manichean duality is inconsistent with my experience and a woeful distortion of reality. In a Sept. 8 article in the New England Journal of Medicine, I reported that no systematic evidence exists that corporate sponsorship of academic research contributes to misconduct, bias, public mistrust or poor research quality.

….. But unbeknownst to the media, the journals at the top got there because of herd behavior by researchers, not because they are better than lower-tier journals at vetting research quality. Here’s why: Researchers submit their best work to the top journals, which can therefore afford to maintain their prestige by rejecting, not publishing, many high quality papers. That’s brand creation — not science. Most of their editorial effort goes into deciding which submitted papers are sufficiently newsworthy. Anonymous peer review by jealous competitors has its merits, but it has a tendency to select for fashionable if relatively unoriginal and inoffensive papers. Top medical journals compete for papers describing large clinical trials reporting small effects of treatments for diseases affecting many people, although these reports often do not substantively advance scientific knowledge, and many subsequently are invalidated.

And no description of medical research in a medical journal comes close to the detail level or intense scrutiny imposed by the FDA on companies’ documentation of drug or device development before approval. Space constraints for readability and cost-savings preclude journals from publishing detailed information on the order of what companies file with the FDA, and unpaid journal peer reviewers, not to mention practicing doctors, would never read it anyway. The recent Korean cloning fiasco, in which the leading science journals published blatantly fraudulent papers, wasn’t the first such incident to afflict prestige journals, and it could never happen under conditions of FDA review. Indeed, doctors should take all studies published in “prominent medical journals” with “skeptical caution.”

The lower stringency of journals compared to the FDA is a good thing, because academic biomedical research would come to a screeching halt if subjected to anything even approximating FDA examination. Scientific knowledge advances reasonably efficiently, and new technologies emerge, despite the looseness of journals. And researchers’ craving for prestige goads them to greater efforts.

If reporters understood that journals are magazines, not Holy Scripture, we might not be witnessing ever more onerous regulations inhibiting interactions between academic and industry science. Prestigious biomedical journals are good for our health — provided they stick to their core business of facilitating imperfect communication between researchers. Leave drug and device monitoring to the FDA — and theology to theologians.

Quote of the Day: On the Threats of Obesity Regulations and Lawsuits

Filed under: Economy,Taxes & Government — Tom @ 12:22 pm

From (should be a free link):

Under normal circumstances, most grown-ups would resent the implication that they are morons. But there seems to be an appeal to blaming one’s ballooning weight on a corporate plot rather than on weak self-discipline.

….. Every few years we herald another FDA food pyramid or the news that some hitherto overlooked ingredient will be added to the labels on the back of our frozen dinners. (Starting next month, calorie counts must be printed in larger type.) But none of this matters: The poundage is still pachydermical. So tomorrow, when it comes time to make our New Year’s weight-loss resolutions, why don’t we resolve to leave Uncle Sam out of it?

Shameless Hustlers Preying on the Financially Troubled: Guess Who?

Filed under: Consumer Outrage,Economy — Tom @ 10:20 am

A few weeks ago, Al Sharpton (I was thinking of what to call him but couldn’t come up with anything nice) was hired to do commercials for LoanMax, an outfit thought by many to be an at least “opportunistic,” if not outright predatory, lender. LoanMax attempted to defend itself and Mr. Sharpton in a press release.

Two weeks later, Sharpton withdrew from the ad campaign, which was to have paid him $20,000 a month for a year.

History repeats itself:
This is not the first time a “respected African-American leader” supposedly representing “oppressed people” has gotten in bed with a questionable lender. Six years ago, there was this doozy:

August 30, 1999
Auto Dealer Has an Offer for Drivers With Bad Credit, but There’s a Catch

DETROIT — A car dealer here is making a big push into leasing used cars to poor people with no credit or bad credit. But the deals come with streetwise terms: Miss a payment and the car won’t start.

The dealer, Mel Farr, the former Detroit Lions football player, leases the cars to anyone who can come up with at least $50 a week. The catch is that a payment is due every Friday night, and customers must pay up each week to get the code they need to punch into a device attached to the dashboard. Otherwise, the car stays parked.

So, does that make Farr an angel for making cars available to those who otherwise couldn’t afford them, for giving people a reliable way to get to work and an opportunity to reestablish their credit? Doing business with him isn’t cheap: Car buyers who qualify for bank loans can borrow at about 9 percent, and Farr charges more than twice that on comparable leases to customers with the coded device. So, does that make him a vulture getting top dollar for old, beat-up cars by preying on those who have nowhere else to turn?

It depends on whom you talk to. Farr, the owner of the Mel Farr Automotive Group, said the unusual arrangement is a boon to inner-city residents who might otherwise have to rely on spotty public transportation — or their feet. Customers seem to be generally satisfied, though two have filed a lawsuit contending that their engines shut down as they were driving the cars.

Farr’s biggest supporters are the country’s political and economic elite. Prodded by the Rev. Jesse Jackson, Wall Street recently showered Farr’s company, the biggest African-American-owned business in the United States, with $36.5 million in new financing that enables him to expand in urban markets. And, in a public-relations coup last month, President Clinton publicly thanked him for bringing cars “to every community in this country.”

Some critics, though, portray Farr less as a do-gooder than an exploiter. “It is a no-fault system of consumer oppression by an auto dealer who should know better,” said Ralph Nader, the consumer advocate. “It is an electronic form of consumer servitude.”

Follow-up on Farr:
What happened to Farr shouldn’t surprise anyone who has followed stories like these (about halfway through link; notice the generally positive tone of article):

….. he inked an impressive $36.5 million expansion deal on Wall Street, only to default on it within months. In a fatal blow to Farr’s auto superstore empire, the very strategy of his business relied on – offering loans to sub-prime borrowers with sketchy credit ratings – had backfired with brutal consequences. His business faced an uncertain future with a high loan-default rate, huge unpaid balances to creditors and a strained relationship with his largest partner, Ford. By the end of 2000, he had shut down a large number of his dealerships, including expansion sites in Baltimore and Houston and some of his largest outlets in Ohio and Michigan. In 2002 his last two dealerships closed and Ford began to auction out his fixture and equipment stores amid pleas (and threats) from Farr’s friends and admirers, including the Rev. Jesse Jackson. At that point, his slow but certain downward spiral had reached rock bottom.

I guess we should be thankful Mr. Sharpton severed his relationship with LoanMax before he tried to raise capital for them.

It’s astounding how people like Sharpton and Jackson seem to suffer no negative long-term consequences to their standing as alleged heroes for financial relationships like these.

If you’re curious: Car-shutoff arrangements like these have withstood legal challenges (about halfway through article at link) and are in use in some parts of the country. In May 2004, Mel Farr married Linda Johnson Rice, president and CEO of Johnson Publishing Co., publisher of Jet and Ebony Magazines. He is now President of a company called Triple M Acceptance, about which little information is available online. The couple is definitely High Society.

UPDATE, Jan. 11, 2006: Based on this item about a Bill Clinton “New Markets Tour” of East St. Louis, IL in July 1999, Triple M Acceptance appears to have been the financing arm of Farr’s operation while he was a car dealer. I haven’t been able to learn what it does now that he is, from all appearances, not a car dealer.

Bizzy’s AM Coffee Biz-Econ Links (123005)

Biz Weak: “A Rough New Year for Consumers”

At MSNBC’s web site, Business Week (or Biz Weak, as I prefer to call it) paints a gloomy picture of all the things that are going up in price this year. It names consumer staples (including toilet paper-I kid you not), credit, health care, and utility bills, and attempts to portray rises in these items as reasons why the consumer confidence numbers, and consumer spending itself, may contract.

Most of the items they noted were already known by consumers when the confidence surveys were taken. Sorry, Biz Weak, you ‘re going to have to make a stronger case than that–just stay out of the way if you’re going to be a bunch of mopes.

City of Springfield, Mass. Near Bankruptcy

Now to a legitimate crisis which could go by the name “Win a lawsuit, lose your jobs”–The Bay State city appears to be near financial ruin:

SPRINGFIELD, Mass. –Springfield officials say bankruptcy and more than 1,000 layoffs are likely if the state refuses to give the city more money to avoid a deficit that could balloon to $70 million in the next six years.
“Does the state want us to lay off people and let the city collapse, or do they want to give us the money and the chance to fix the problems?” said city councilor Timothy Rooke.
Rooke’s year-long term on the control board overseeing Springfield’s finances expires next week. He said the city could be forced to hand pink slips to as many as 500 teachers and another 800 city employees during the next several years.
He and other officials say the layoffs could be necessary to pay city employees what they’re owed in frozen raises.
A recent ruling by Superior Court Judge Constance Sweeney found that Springfield illegally withheld raises for teachers three years ago. Sweeney is expected to decide next month exactly how much the city owes its teachers, who say they’re entitled to all negotiated raises that have been frozen since the 2004 fiscal year.
City officials fear that her ruling could entitle firefighters and police officers — who have also had their wages frozen — to millions of dollars in back pay.
“If that worst-case scenario goes through, it would collapse the system,” Rooke said.
Lawmakers have repeatedly said the city is not likely to receive more state aid.
If it doesn’t, “bankruptcy is inevitable,” Ryan said. The mayor met Thursday with Thomas Trimarco, Gov. Mitt Romney’s budget chief and a former member of the city’s financial control board.

Given the number of layoffs proposed for a city with a population of about 150,000, and besides the obvious back pay problem, this looks like the result of having way too many people on the payroll for way too many years.

The Rodney Dangerfield “No Respect” Economy has a Weak Spot in Washington (this article requires free registration) the litany of good news chronicled here and elsewhere on jobs, consumer spending, growth in real incomes, and the like. The article serves as a ready resource for reciting how well things are going.

There is an exception to the good news–out-of-control federal spending:

The most conspicuous blemish on the 2005 economic scorecard was frenetic federal spending, estimated to be up another $180 billion, or 8%. If Congress were to cut that spending growth rate in half, and if the economy continues to spin off tax revenue dividends as in 2005, the budget deficit would fall in half by this time next year. And, then, who knows, the pessimists may run out of things to complain about and this expansion might finally get the respect it deserves.

I happen to think that an allegedly Republican Congress facing the voters this year, coupled with a bit of newfound vigilance in the blogosphere, might actually bring some sanity back to fiscal policy in Washington. It’s always easy be an optimist as the New Year approaches–unless you write for Biz Weak.

Positivity: 10 Deacons Ordained as Priests in Basra, Iraq

Filed under: Positivity — Tom @ 6:12 am

Even though this is a three week-old story, I’m posting it because it is a sign of the country’s religious pluralism: