Top cancer researcher fails to disclose corporate ties in major journals | Hacker News Reader

Top cancer researcher fails to disclose corporate ties in major journals

nytimes.com

74 pointsDrJaws26 comments

(I work in this field and have met the subject of the article.) There isn't much to say except he couldn't be bothered. The article tries to find some kind of angle to make this more interesting, but fails. It's sloppy for someone in such a high position, but that's about it.

If he had disclosed all his conflicts, the same research would have been published in the same places with the same people. Nothing would have changed. At conferences academic oncologists get up and flash a slide with many conflicts of interest at the start of their talk. Nobody really cares or pays much attention.

When it comes to clinical trials, there are many checks and balances that prevent a 'rogue' conflicted investigator from influencing the results. Not the least of these are the other investigators on the study which put their name on the paper, who are free thinking individuals. The data is also collected and analysed by an independent data monitoring committee, who will for example stop the study early if it is looking futile, whatever the drug company thinks should happen. Independent clinical trial staff will also send out teams to hospitals running the trial and inspect the data and talk to the staff. For trials going for regulatory approval of the drug, there is often a formal independent audit which goes even deeper, to the point of interviewing staff in a confidential setting and asking them if they have been coerced for example.

>If he had disclosed all his conflicts, the same research would have been published in the same places with the same people. Nothing would have changed.

Speculation.

> Nobody really cares or pays much attention.

Maybe they should.

>When it comes to clinical trials, there are many checks and balances that prevent a 'rogue' conflicted investigator from influencing the results.

And you think these checks and balances work good enough, most of the time?

He has to declare his conflicts annually to his institution, and has to provide updates with any new conflicts within 90 days. They would almost certainly have a conflict management plan in place for this situation

You seem to be ignoring the fact that preclinical trials are experiencing abysmal replication rates in studies geared towards that end. There's ongoing work on replication of clinical studies, but I would hypothesize that we are going to see the same problem there. The point here being that the systems in place do not seem be working as an effective system of checks and balances, and so bias in part of the individuals and organizations involved is rather important.

No, Baselga is primarily a clinical trialist, so it isn’t relevant to this discussion.

Clinical trials have standardised designs and procedures, the number of experimental subjects is large (compared to preclinical lab experiments), and orthogonal outcome measures are collected to enhance validity (like response rate and survival outcomes). Most doctors are trained and experienced in interpreting clinical trials, and are well aware of the limitations, which are constantly highlighted in conference discussions and the literature.

Finally, clinical trials are replicated all the time (surprised you would suggest otherwise?). A drug is tested in phase 1, phase 2 and phase 3 trials of increasing size, and drugs from the same class are also tested in competing trials.

We should take this with a grain of salt because your reputation is tied to his. This is the cascade effect that occurs when someone very powerful behaves inappropriately-the people below them must defend it to protect what they have.

Having come from acedemia, I disagree with just about everything in this post. People do care about conflicts of interest and when very powerful people are being reviewed, they get greater leeway because of the power of retribution.

More than 10 years ago, the NYT [0] and a Mt. Sinai researcher [1] published exposes of doctors being paid heavily by drug companies, after examining the paper records that companies were required to file in the state of Minnesota. That helped spur the creation of the federal Open Payments database (https://www.cms.gov/openpayments/), which, for a government web-facing database, is actually pretty good. That prominent doctors are still comfortable with flouting the disclosure rules is a nice example of how availability of data and records is still toothless without people (including journalists) being vigilant.

[0] https://www.nytimes.com/2007/06/03/health/03docs.html

[1] https://jamanetwork.com/journals/jama/fullarticle/206127

He's arguably done a better job at disclosure than many politicians and judges, at least. It's not so well known, but judges in the US are courted by monied interests as much as physicians and politicians are. Some decades ago, there was a public-interest site that reported on that, but it got nuked from orbit.

Do you happen to know the URL / if it was archived on internet archive?

No, sorry. The site had mainly focused on meta-policing stuff. Stories behind crime reporting. Almost police fandom. And then they started hosting FOIA data about financial reporting by judges. And investigative stories about conferences for judges, speaking fees, and so on. Basically the same stuff that's well known for the medical sector.

And then the site just disappeared.

Edit: Maybe https://www.judicialwatch.org/judicial-financial-disclosure/ is a descendant. But damn, they seem rather on the right-wing fringe.

Edit: Found it! It was APBnews.com.[0] And it seems that I was wrong. It apparently just disappeared during 2003-2004.[1] I don't have the patience to trawl through all that, to see what they actually said on their site.

Also, it seems that the National Law Journal has been publishing redacted disclosure data.[2]

0) https://www.rcfp.org/browse-media-law-resources/news-media-l...

1) https://web.archive.org/web/20000101000000*/APBnews.com

2) https://www.rcfp.org/browse-media-law-resources/news/legal-s...

Nothing is ever as it seems with people. Public perception and our methods of assigning legitimacy to public figures is deeply flawed. How any public individuals are we incorrectly demonizing? How many bad ones do we think are good? Surely more than we are currently aware of.

To make it personal, consider that the general practitioner that you see has likely been bribed by the pharmaceutical industry throughout their career. Starting in med school, with free food and toys. But if pressed, they'd all say that gifts don't affect their professional judgment. But in fact, studies have shown that they do. For example:[0]

> For years, the evidence has suggested that even small gifts can influence physicians’ behavior, create a mindset of entitlement, and help to promote allegiance to companies and their products. Recently, with the availability of Open Payments data and research made possible by these data, the evidence has become stronger. Using Open Payments data, a 2016 study found that receipt of industry-sponsored meals, even just a single meal, was associated with an increase in the rate of prescribing the brand-name drug that was being promoted.

0) Steinbrook (2017) Physicians, Industry Payments for Food and Beverages, and Drug Prescribing. https://sci-hub.tw/10.1001/jama.2017.2477

Curious that there's a lot of downvoting of reasonable comments in this thread.

Sometimes I wonder if there is any place for monks in modern Western society.

We already know certain parts of society need specific protections from other parts of society: professors, journalists, judicial-administrators, etc.

Is it a legitimate extension of that concern that certain parts may, at least in part, need protection from other parts of society?

I mean... leading scientists from schools like Harvard have knowingly lied to the population about the dangers of things like lead, sugar, etc.

Sure, but "protections"? As they say, money doesn't talk, it swears.

> We already know certain parts of society need specific protections from other parts of society [...]

> Is it a legitimate extension of that concern that certain parts may, at least in part, need protection from other parts of society?

That's not an extension, it's just a restatement, and not even in different words.

Yea what I mean is in some sense it seems obviously logical. But I admit the use of the word other does change from one sentence to the other.

And people still wonder why it is taking so long to find a "cure". Everyone invovled is incentivized to never actually get to a point where "cancer" is a solved problem.

Of course, that is beside the point. One of the most effective treatments remains a series of prolonged dry or water fasts. ~10 and ~40 days respectively. But because no one can patent it or make $3M a year in kickbacks, I doubt it will ever be known to the mainstream in my lifetime.

There is no one “cure” to cancer. Each cancer requires its own set of treatments.

No. Absolutely not true. There are no 100 types of cancer. This is just the medical world concept of selling you on the equivalent to 100 types of morning cereal. There are of course different locations in the body where these damaged cells are located, but that's all there is to it. We turned a very very simple concept of damaged cells that the body cannot repair using the lymphatic system and flush out of the kidneys due to constant state of acidosis into a trillion dollar boogieman.

I am not a medical expert, but as far as I am aware there are different treatments for different cancers, all tailored to be the most effective for that particular type.

Could you provide some sources to back this claim?

> One of the most effective treatments remains a prolonged dry or water fast.

What are the best sources you have seen to support this? I have seen articles via Google, but I'd like to see more sources. (Writing this comment sitting next to a cancer fighter on a 48-hr chemo session.)

This sort of thing has been tested in animal models and it doesn't work. It is also completely implausible, but that's beside the point, you are unlikely to be convinced I suppose.

There are clinical trials of fasting in cancer patients. These have been designed by careful and ethical scientists and doctors. They are looking currently at whether fasting can improve the efficacy or tolerance of chemotherapy.

It is frankly stupid to take an already malnourished individual and make them fast for 40 days.

The reason I will not be convinced is that in the last 20 years I have seen first hand hundreds of people cure such diseases from Crohn's to many types of cancer by fasting.

The only times people have not been as successful as others is when fasting was preceded by chemotherapy/radiation which frankly destroy the body and for the most part is a death sentence one way or another.

And you are flat out wrong about your last point. Fasting is the biggest gift you can give your body, including and especially when it appears weaker due to a disease.

Are there any studies or support you can give behind your claims?

Just as you're skeptical of research in the area, I'm skeptical of people claiming to have seen "hundreds of people" cured of diseases by something as simple as fasting.

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