The current issue of JAMA (subscription needed to access on-line) features a commentary by Drs. Philip Greenland and Donald Lloyd-Jones of Northwestern U. on the ENHANCE trial (about which see my post, http://brodyhooked.blogspot.com/2008/01/now-that-weve-been-enhanced-whats.html).
The result is sort of like Dick Cheney going quail hunting. You fire away with a shotgun, you shoot some things you wanted to, and maybe some things you shouldn't have.
On target: Two major conclusions about ENHANCE. First, the two docs are prepared to mince no words, and to declare flatly that there was no justification for ENHANCE at all except for company marketing. They argue that such studies simply should not be done, and their academic investigator colleagues should refuse to participate. Second, they point out that major organizations that tried to comment on ENHANCE, to help clarify the issues for the public, became tarred with the conflict-of-interest brush, and such organizations should take this seriously and divest themselves of such conflicts to be trustworthy in the future.
Drs. Greenland and Lloyd-Jones do not say if they are adopting their own good advice. The end of the article lists several significant conflicts of interest for each, with regard to statin manufacturers--which may be pertinent to what follows.
Off target: Here I have my own conflict of interest as I am under personal attack as it were. Drs. Greenland and Lloyd-Jones take great umbrage at the media response to ENHANCE, especially with regard to the suggestion that statins may not be all that they are cracked up to be in preventing heart disease. They regard this assertion as ridiculous and irresponsible and argue that physicians quoted in these "erroneous" media articles (like me) should really get out facts straight before shooting off our mouths. One of the two villainous articles they cite is the one by John Carey in Business Week: http://www.businessweek.com/magazine/content/08_04/b4068052092994.htm?chan=search
As I have tried to explain in this blog previously (http://brodyhooked.blogspot.com/2007/12/new-cholesterol-controversies-regaining.html), there is very good reason to doubt that statins are all that good especially for the primary prevention of heart disease (as opposed to secondary prevention, preventing future events in people who have already had hearty vattacks or strokes). Many of my colleagues whose work I rely on in reaching that conclusion were also interviewed by John Carey, and in my view he has a blockbuster lineup of experts that were all quoted in that article (not counting myself of course). Carey also did a fantastic job of explaining for the general public the difficult concept of "number needed to treat," which is the only intelligent way to make sense of most clinical trials research on drugs, so he deserves a gold star for great reporting, not the skunk cabbage that Greenland and Lloyd-Jones shove in his direction.
Greenland P, Lloyd-Jones D. Commentary: critical lessons from the ENHANCE trial. JAMA 299:953-55, Feb. 27, 2008.