The 100 Trillion Dollar Prize for Medicine

(OMNS April 19, 2012) Here is your chance to impress your colleagues holding mere Nobel Prizes: the Newlyn Research Group announces the Cargo-Cult Prize for Medical Informatics. At 100 Trillion Zimbabwe dollars (Z$100,000,000,000,000), the prize value is nominally greater than that of all Nobel Prizes ever awarded. The value of the award was chosen to reflect the inflated worth of large-scale clinical trials.

Pic: One Hundred Trillion Dollars

1. To receive this award, all one has to do is explain the validity of the selection of the “best” evidence in the “systematic” reviews of the Cochrane Library [1]. That is, you will “prove” how non-random selection of the “best” data can be achieved without censorship, without bias, and without having determined the answer in advance.

2. In addition, the competition asks you to provide a mechanism whereby the results of Cochrane reviews can determine the “best” treatment for an individual patient who wants to make a rational decision. It is important to “prove” how a Cochrane review provides unbiased and realistic data for a doctor treating an individual patient, or for individuals rationallyconsidering decisions about their own health.

3. We also ask you to demonstrate how you would apply your suggestions to an individual. We will look for a demonstration of how the results of significant large-scale clinical studies can be applied validly to specify treatment for an individual. In so doing, you will answer the following question: how do you remove the gray area from the graph below, which shows the overlap between two highly significantly different large groups (p < 0.01 n=1000). (Using an eraser, or burying one’s head, is not considered a solution.)

Graph: Normal Distribution

The gray area, as the term suggests, illustrates the uncertainty in the decision. The larger the study, the greater is the area of uncertainty.

The winning submission will explain how a Cochrane review provides anything other than background data for rational patients and their doctors.

Winning the prize should be easy if, as claimed, Cochrane reviews and large-scale randomised placebo controlled double-blind clinical trials are a “gold standard” for medical decision making.

The inspiration for this award came from a pair of Cochrane reviews, namely, that of Bjelakovic et al. “Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases” [2] and that of Hemila et al. “Vitamin C for preventing and treating the common cold.” [3] Both reviews disparage nutritional supplements and each appears to represent the biased viewpoint of its authors, presented as impartial analysis. We have objected to these reviews on the grounds that the scientific method precludes such data selection. So far, the review authors, the Journal of the American Medical Association (JAMA), and the Cochrane Library have failed to answer these questions adequately.

Applications for the Cargo-Cult Prize for Medical Informatics are invited in the format for papers for the Journal of Orthomolecular Medicine [4], where they may be submitted for editorial and peer review. A short summary of the paper should be provided, suitable for peer review and publication in the Orthomolecular Medicine News Service. Prior to peer review, the paper will be subject to an initial screening, to remove papers that lack basic rationality. In pre-screening, we follow the (irrational) example of the Cochrane reviewers, who screen papers and remove those that 1) use high nutrient doses and 2) demonstrate that supplements are safe and effective.

We suggest that, until we make the award, all Cochrane, JAMA, and similar meta-analysis reviews are issued with the following warning:

“CAUTION: This review is a selective interpretation of the available data and incorporates the bias and prejudice of the reviewers. The effects it describes are only valid as aggregate statistics of large groups and should not be used by doctors or members of the public for making decisions about individuals.”

References:

1. http://www.thecochranelibrary.com/view/0/index.html

2. Bjelakovic G. Nikolova D. Gluud L.L. Simonetti R.G. Gluud C. (2012) Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases, Cochrane Database Syst Rev., Mar 14, 3, CD007176.

3. Douglas R.M. Hemilä H. Chalker E. Treacy B. (2007) Vitamin C for preventing and treating the common cold, Cochrane Database Syst Rev., Jul 18, (3), CD000980.

4. http://www.orthomed.org/jom/jom.html

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2 Responses to The 100 Trillion Dollar Prize for Medicine

  1. Pingback: Linkblogging For 22/04/12 « Sci-Ence! Justice Leak!

  2. Andrew says:

    I just can’t understand how this farce has gone on so long. Can’t we open an official debate with those making medical policy? They must be somewhat rational (at least in public) unless they have completely sold out to Big Pharma. And I know Ben Goldacre and Edzard Ernst bang on about the importance of randomized large-scale double-blind trials… would love to see them in a debate on this specific topic.

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