Monday, January 21, 2008

More Conflicts of Interest--This Time, Not Pharma

See David Armstrong on the WSJ blog:

Just to make clear that the pharmaceutical industry does not have a corner on the conflict-of-interest market, Armstrong notes that two of the major authors of recent research studies advocating CT scans as a screen for lung cancer have undisclosed commercial ties, including patents held on the software that interprets the scans. The vast majority of journal articles that they have written do not disclose these ties, and some of the major journals in which the articles have appeared are investigating.

By way of background, I will simply note that lung cancer has historically been a disease for which no screening tests have been recommended--because there is no evidence that detecting the cancer at the point in which any screening test can see it, changes the actual outcome of the disease, which is generally pretty dismal. (Of course, prevention of lung cancer is relatively easy--don't smoke.) More recently, these gung-ho screening types have tried to persuade us that super-sensitive CT scans are the breakthrough that will detect smaller cancers at a point when they are still treatable, and so any patients at high risk (smokers, for the most part) ought to have annual CT scans. The data to date are underwhelming and seem to rely on flaky statistics to "prove" some survival benefit.

It's typical for the average joe, who hears that medical experts are against CT scanning as a routine screen for lung cancer, to imagine that it's all just an insurance company conspiracy to save money. What A.J. doesn't seem to grasp is that there are two obvious and serious personal harms that can result directly from a CT scan that is not really needed or helpful. First, these scans will have a huge false positive rate, meaning that many people will get their lungs cut open to get tissue for biopsy, just to find out that they do not have cancer. Second, we are waking up to the fact that a CT scan of the chest is no small deal when it comes to radiation exposure; so a few annuals scans and you could have been exposed to enough radiation to cause a new cancer if you did not have one already.

Nothing like knocking public trust in academic medicine and medical research down a few more notches.

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