Saturday, June 28, 2008

Stacking the deck

Concerning my post about Rivaroxaban, Retired Doc said:

Good point about the dose of enoxaparin.I need to say more about that having made points about stacking the deck in randomized trials. Is that what we have here?

Both trials were sponsored by Bayer, which will participate and benefit from the marketing of the product. So, this may be a case of stacking the deck. It's a variant of the straw man fallacy in which the drug is tested against a "claim" that no one in the real world would make for the comparison drug. This has been seen in many other sponsored trials.

There's a larger point: I didn't look at the disclosures until I read the comment. I identified the flaw in these trials without knowledge of the funding source. I make it a practice to do this---to examine a paper critically before looking at disclosures. It’s a useful exercise in that it encourages critical examination of studies on their own scientific merits.

If authors are open in reporting their methods one can spot flaws without knowledge of financial conflicts. Disclosures create a type of bias on the part of readers. There was a time when scientific papers were evaluated primarily on their own merits. Some industry sponsored papers are scientifically rigorous, some are not. Some nonsponsored papers are rigorous and some are not. Is today's inquisition about conflicts of interest promoting intellectual laziness?

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