Why results of most clinical trials are not published? (8)
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Let’s discuss the publication and dissemination of results of clinical trials in general. The pharmaceutical industry is the most profitable industry of all. Yet the results of only 40% of clinical trials are reported within the time prescribed by law, and 30% of clinical trial results never reported. And isn’t there an obligation to the public and to the patients who took part in clinical trials to properly analyze and report the results back to the public when the trial is completed? And what is the reason for the results of so many clinical trials not being reported to the public? This is a really important issue. And it isn’t only in relation to COVID-19. It’s in relation to all sorts of treatments and not only drug treatments. We have made major efforts to prevent this bias that we call publication bias by trying to make sure that randomized trials are registered prior to there being conducted. And then at least you can pursue those who registered the trials to find out what the answers are. Because the problem is that we all like headlines. We all like good news. Unless we’re a newspaper, or we’re somebody who is paid to look at adverse effects when you really like bad news. So the problem is that publication tends to occur preferentially for really good news or really bad news. And the indifferent news is not of interest to people. It isn’t what the editors like they can’t have a nice headline. And so the news that hydroxychloroquine doesn’t work is, in most instances, not a great interest whereas The idea that it does work is of greater interest. Now, because of our big concerns, even a study, which shows that something doesn’t work is of interest, and it will probably get published. But the general problem is there. The problem of publication bias is addressed to a degree by these registers. But even then, it’s still possible for people to manipulate their results. And cherry-pick the best results even when a trial has previously registered, that they’re going to look at a particular outcome. And that isn’t very interesting. It turns out, they will nevertheless have a headline, another outcome that is more interesting. And if you’re a statistician, you know that the variation in results is really quite concrete trouble. And you can nearly always find something interesting from your results. You will go searching for those results. Or as someone, once put it, you torture the data until you make it confess. The problem is that there is a tendency to like extreme results, whether they’re extremely good or extremely bad. We see that in newspaper headlines, good news or bad news can sell newspapers if it is made dramatic. And the results that are in between and indifferent are of less interest in the media in general. The problem is that science is really interested in those intermediate results, the ones that don’t show effects because if we To get a proper view of the entirety of the evidence, we need to be sure we see all of it. And having registration of trials goes a long way towards doing that. But even when we do that, we find that some investigators will change, cherry-pick their results, and produce the ones that show an effect, show something interesting. And by interesting, it may mean very good, or it may mean very bad. It’s interesting when there are adverse effects. And we find this in a number of areas of medicine, where the results that are published tend to be at one extreme or another, and the truth that lies between them may not be published.
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