FRSM
18.01.2008, 15:17
Коллеги! Ежели кто-то пропустил ето письмо в прошлом БМЖ, вызвавшее много дискуссий:
BMJ 2008;336:59 (12 January), doi:10.1136/bmj.39450.691169.3A
Letters
Financial ties that might bind
Consider palliative coronary intervention
The recommendation by Yank et al, that pharma sponsored drug trials should be interpreted with caution, is well made.1 Most percutaneous coronary intervention (PCI) procedures entail the implantation of a coronary stent. Most stent studies are funded by equipment manufacturers and are designed and conducted by researchers who believe in coronary intervention despite the lack of hard evidence of cost effectiveness or clinical superiority over optimal medical therapy.2 3
Therapists’ irrational faith in intuitive based practice adds an extra dimension to the "positive spin" effect described in the paper. Given the paucity of independently funded coronary stent studies and the total lack of a placebo controlled study of this palliative therapy, healthcare commissioners have a hard time unravelling spin, especially when professional bodies weigh in with their spin on the evidence.
The RITA-2 study showed that, although palliative PCI was associated with a small and transient improvement in symptoms, it increased the incidence of myocardial infarction or death by nearly 80% and was £2684 more costly than medical therapy.4 5 Despite these worrying results the British Cardiovascular Intervention Society (BCIS) strongly lobbied for an expansion of PCI. What grounds did BCIS have for supporting the rapid expansion of palliative PCI despite its poor showing in RITA-2?
The study reported by Yank et al implies that it would be prudent to take account of the relation between BCIS and industry when assessing BCIS’s recommendations. A search through UK professional bodies’ websites shows that BCIS seems to be the only UK professional body to admit to having two industry representatives on council ([Ссылки могут видеть только зарегистрированные и активированные пользователи]).
Michael R Chester, director
1 National Refractory Angina Centre, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool L14 3PE
[Ссылки могут видеть только зарегистрированные и активированные пользователи]
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Competing interests: MRC provides advice to PCT/PBC Commissioners on patient centred angina service redesign.
References
Yank V, Rennie D, Bero LA. Financial ties and concordance between results and conclusions in meta-analyses: retrospective cohort study. BMJ 2007;335:1202-5. (8 December.)[Abstract/Free Full Text]
Griffin SC, Barber JA, Manca A, Sculpher MJ, Thompson SG, Buxton MJ, et al. Cost effectiveness of clinically appropriate decisions on alternative treatments for angina pectoris: prospective observational study. BMJ 2007;334:624.[Abstract/Free Full Text]
Boden WE, O’Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, et al; COURAGE Trial Research Group. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 2007;356:1503-16.[Abstract/Free Full Text]
RITA-2 Trial Participants. Coronary angioplasty versus medical therapy for angina: the second Randomised Intervention Treatment of Angina (RITA-2) trial. Lancet 1997;350:461-8.[CrossRef][ISI][Medline]
Sculpher M, Smith D, Clayton T, Henderson R, Buxton M, Pocock S, et al. Coronary angioplasty versus medical therapy for angina. Health service costs based on the second randomized intervention treatment of angina (RITA-2) trial. Eur Heart J 2002;23:1291-300.
BMJ 2008;336:59 (12 January), doi:10.1136/bmj.39450.691169.3A
Letters
Financial ties that might bind
Consider palliative coronary intervention
The recommendation by Yank et al, that pharma sponsored drug trials should be interpreted with caution, is well made.1 Most percutaneous coronary intervention (PCI) procedures entail the implantation of a coronary stent. Most stent studies are funded by equipment manufacturers and are designed and conducted by researchers who believe in coronary intervention despite the lack of hard evidence of cost effectiveness or clinical superiority over optimal medical therapy.2 3
Therapists’ irrational faith in intuitive based practice adds an extra dimension to the "positive spin" effect described in the paper. Given the paucity of independently funded coronary stent studies and the total lack of a placebo controlled study of this palliative therapy, healthcare commissioners have a hard time unravelling spin, especially when professional bodies weigh in with their spin on the evidence.
The RITA-2 study showed that, although palliative PCI was associated with a small and transient improvement in symptoms, it increased the incidence of myocardial infarction or death by nearly 80% and was £2684 more costly than medical therapy.4 5 Despite these worrying results the British Cardiovascular Intervention Society (BCIS) strongly lobbied for an expansion of PCI. What grounds did BCIS have for supporting the rapid expansion of palliative PCI despite its poor showing in RITA-2?
The study reported by Yank et al implies that it would be prudent to take account of the relation between BCIS and industry when assessing BCIS’s recommendations. A search through UK professional bodies’ websites shows that BCIS seems to be the only UK professional body to admit to having two industry representatives on council ([Ссылки могут видеть только зарегистрированные и активированные пользователи]).
Michael R Chester, director
1 National Refractory Angina Centre, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool L14 3PE
[Ссылки могут видеть только зарегистрированные и активированные пользователи]
--------------------------------------------------------------------------------
Competing interests: MRC provides advice to PCT/PBC Commissioners on patient centred angina service redesign.
References
Yank V, Rennie D, Bero LA. Financial ties and concordance between results and conclusions in meta-analyses: retrospective cohort study. BMJ 2007;335:1202-5. (8 December.)[Abstract/Free Full Text]
Griffin SC, Barber JA, Manca A, Sculpher MJ, Thompson SG, Buxton MJ, et al. Cost effectiveness of clinically appropriate decisions on alternative treatments for angina pectoris: prospective observational study. BMJ 2007;334:624.[Abstract/Free Full Text]
Boden WE, O’Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, et al; COURAGE Trial Research Group. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 2007;356:1503-16.[Abstract/Free Full Text]
RITA-2 Trial Participants. Coronary angioplasty versus medical therapy for angina: the second Randomised Intervention Treatment of Angina (RITA-2) trial. Lancet 1997;350:461-8.[CrossRef][ISI][Medline]
Sculpher M, Smith D, Clayton T, Henderson R, Buxton M, Pocock S, et al. Coronary angioplasty versus medical therapy for angina. Health service costs based on the second randomized intervention treatment of angina (RITA-2) trial. Eur Heart J 2002;23:1291-300.