Clinical Trials and Scientific Articles: Read and Believe with Caution

A disclaimer should accompany every scientific article, “Read and Believe with Caution”. To say that weekly there is a study contradicting a prior clinical trial is probably an underestimation of the state of medical/scientific affairs. Hundreds of peer-reviewed journals now cross our desks and computer screens. How do we, the doctors and scientists, assimilate all these data? This is particularly difficult when one considers the complexity of statistical analyses that must be thrashed through in order to do justice to any single study. And then one must remember that we do not have every hour of every waking day to analyze trials. The result is far too often a leap to erroneous but easy conclusions. We saw this recently with a JAMA meta-analysis regarding fish oils (see the blog of my letter to JAMA) wherein standard statistical analysis was plainly deviated from. The result, an unfounded conclusion that no one on TV every mentioned. Perhaps they did not have the preparatory time necessary to dissect the statistics. Whatever the case, medical and lay opinions were unfairly and wrongly influenced by this trial.

And now we have another interesting study, this time in favor of supplements. On October 17th JAMA published on-line the results of a multivitamin analysis of Harvard’s famed Physicians’ Health Study. This trial revealed that simple (low dose) multivitamins could decrease cancer rates in men. Prior studies using high dose supplements have failed to demonstrate this. At the risk of being self-serving, over ten years ago I performed a small clinical trial (published in JANA – the Journal of the American Nutraceutical Association) demonstrating the possible downside of high-dose supplements. I responded to my own trial by forming a very conservative supplement company, VitalRemedyMD.  And my first products were two simple daily multiples with no more than 100% of the RDV of the essential vitamins and minerals (the Daily2Tab and DailyMultiple – innovative names, I know). No more than that. I based these formulations more upon my review of basic science literature, than our too-highly-revered RCT (Randomized Clinical Trials). A decade later, the clinical trial is “catching up” with something that science had already taught us. My point here is that we in the medical world have shunned our roots, basic science. And, we have cut ourselves off from our mentors, the basic scientists. In fact, just last week an article I wrote on this subject that was published online – A Survey of Internists and Cardiologists: Are Discoveries in Fatty Acids Truly being translated into Clinical Practice? Prostaglandins, Leukotrienes and Essential Fatty Acids (available online 25 October 2012). It tells this story. There is a disconnect between science and medicine. It is real, prevalent, and very disturbing. It undermines our ability to grow and limits our capacity to cure. The only way I see we can conquer this impediment is by opening a continual and non-confrontational dialogue among the diverse elements of science and medicine. Only then can we have true translational medicine, the application of what is learned in the lab to the patient in our offices or hospital wards. Short of dialogue we will continue to exist in a modern tower of babble, and we all know how well that worked out.

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