An article in the New York Times reminds us that, especially with the way people consume information today, a scientific, evidence-based recommendation is not sufficient to change a policy.  A well-constructed PR campaign is also required.

See:  Mammogram Math regarding the recent brouhaha that resulted from a recommendation to reduce mammogram screening frequency in not-at-risk populations.

Using the interlocking web of citations you can see how this happened. A small number of review papers funneled large amounts of traffic through the network, with 63% of all citation paths flowing through one review paper, and 95% of all citation paths flowed through just 4 review papers by the same research group. These papers acted like a lens, collecting and focusing citations on the papers supporting the hypothesis, in testament to the power of a well received review paper.

But Greenberg goes beyond just documenting bias in what research was referenced in each review paper. By studying the network, in which review papers are themselves cited by future research papers, he showed how these reviews exerted influence beyond their own individual readerships, and distorted the subsequent discourse, by setting a frame around only some papers.

via How myths are made – Bad Science.

A post related to this one:
Published Scientific Articles Not Written By Scientists and referencing the study How citation distortions create unfounded authority: analysis of a citation network.

I knew that the proper methodology is not to rely on review articles, except maybe to find references, but I had not realized how much influence they seem to have. This is astonishing and hopefully will encourage a more cautious approach to using review articles.

Sometime in 2003, a DesignWrite employee wrote a 14-page outline of the article; the author was listed as “TBD” — to be decided. In July 2003, DesignWrite sent the outline to Dr. Gloria Bachmann, a professor of obstetrics and gynecology at the Robert Wood Johnson Medical School in New Brunswick, N.J.

Dr. Bachmann responded in an e-mail message to DesignWrite: “Outline is excellent as written.” In September 2003, DesignWrite e-mailed Dr. Bachmann the first draft of the article. She also pronounced that “excellent” and added, “I only had one correction which I highlighted in red.”

The article, a nearly verbatim copy of the DesignWrite draft, appeared in 2005 in The Journal of Reproductive Medicine, with Dr. Bachmann listed as the primary author. It described hormone drugs as the “gold standard” for treating hot flashes and was less enthusiastic about other therapies.

The acknowledgments thanked several medical writers for their “editorial assistance,” not disclosing that those writers worked for DesignWrite, which charged Wyeth $25,000 to generate the article.

Dr. Bachmann, who has 30 years of research and clinical experience in menopause, said she played a major role in the publication by lending her expertise. Her e-mail messages do not reflect contributions she may have made during phone calls and in-person meetings, she said.

“There was a need for a review article and I said ‘Yes, I will review the draft and make sure it is accurate,’ ” Dr. Bachmann said in an interview Tuesday. “This is my work, this is what I believe, this is reflective of my view.”

via Ghostwriters Paid by Wyeth Aided Its Drugs – NYTimes.com.

This bears some similarities to laws written by lobbying firms to politicians.  However, it isn’t clear that Dr. Bachmann, in this case, is being lobbied in any way, but merely that she is signing off on a paper she did not entirely write, but that she did agree with and have input on.

Though the idea of someone not writing the article their name appears one is particularly disturbing when industry links are not made explicit, it does not necessarily mean that the article itself does not reflect a valid scientific viewpoint. The fact that it is tainted by industry effort, does not mean the science cannot be good.

It is not uncommon for a Principal Investigator’s name to appear on a paper written by a graduate student or post-doc in their laboratory. Admittedly, though, this is quite different when the paper is written on behalf of the business whom the paper benefits.

To my mind, industry links to research do not automatically negate the scientific validity of it, but they must be clearly demonstrated.

An improvement on this article would be an investigation into whether the science in these industry-sponsored articles was unsound.

Additionally, review papers are generally seen as a problematic to rely on as they do not often meet the rigorous standards original research is held to. Nonetheless, too many people do rely on them, and hence, the problem with biased articles.

More recently, researchers determined that the spleen is like an elaborate wetlands, a Mississippi bayou for filtering and freshening the blood. In other organs, blood flows through an interconnected mesh of increasingly narrow arteries, veins and capillaries. The spleen, by contrast, has a so-called noncapillary circulatory system: as the blood flows in, it is dumped into puddle-like sinusoids, and to get back out it must squeeze between cells. That dumping and squeezing help filter out blood-borne parasites, aging blood cells too brittle for compression and the little oxidized pellets, the BB’s, with which red blood cells are often pocked. The spleen has often been called a graveyard for red blood cells, but it is more of a recycling center, for the iron and other components are plucked out of the cells and used to stock new hemoglobin cages.

Filtration, cannibalization, and now — serious monocyte cultivation. In the new study, the researchers began by looking at monocytes, the largest of the body’s white blood cells. “It was recognized that these cells are the major repair workers after a heart attack,” Dr. Nahrendorf said. “They remove dead muscle cells, they start rebuilding stable scar tissue, they stimulate the generation of new blood vessels.”

via Basics – Finally, the Spleen Gets Some Respect – NYTimes.com.

Not just for black bile anymore…

More than 20 years after medical expert systems were first developed, the USPTO issued two patents simply on the concept of using a computer to help physicians choose medical treatments. A company that purchased these patents claims that “the diagnosis and treatment of most chronic diseases will fall under the claims of these patents.” Already it has filed patent infringement suits against seven companies in three years and it threatened to sue a university for hosting a freely available HIV database. Perhaps most startling of all, that same university — where much of the seminal research on expert systems took place — entered into a licensing agreement intended to limit the use of the HIV database, which had been created by one of its own faculty.

via harmfulpatents.org.

Received the link via my AMIA listserv.  They refer to this as “patent trolling”.  It is a good example of how patents should be used to protect intellectual property rather than scientific methods, especially ones already in the public domain.  I half-seriously ask:  could Dr. Shafer have licensed his methods with a GNU Affero Public Liscence?

If you think it’s a worthy cause, there is a donation link. He has already put some fair amount of personal capital into it.

The typical human is home to a vast array of microbes. If you were to count them, you’d find that microbial cells outnumber your own by a factor of 10. On a cell-by-cell basis, then, you are only 10 percent human. For the rest, you are microbial. (Why don’t you see this when you look in the mirror? Because most of the microbes are bacteria, and bacterial cells are generally much smaller than animal cells. They may make up 90 percent of the cells, but they’re not 90 percent of your bulk.)

This much has been known for a long time. Yet it’s only now, with the revolution in biotechnology, that we’re able to do detailed studies of which microbes are there, which genes they have, and what they’re doing. We’re just at the start, and there are far more questions than answers. But already, the results are astonishing, and the implications profound.

Even on your skin, the diversity of bacteria is prodigious. If you were to have your hands sampled, you’d probably find that each fingertip has a distinct set of residents; your palms probably also differ markedly from each other, each home to more than 150 species, but with fewer than 20 percent of the species the same. And if you’re a woman, odds are you’ll have more species than the man next to you. Why should this be? So far, no one knows.

via Microbes ‘R’ Us – Olivia Judson Blog – NYTimes.com.

An interesting article on the continuing discoveries of the inner life of the human body.  Of particular interest:

Moreover, whereas humans are extremely similar to one another at the level of the genome, the microbiome appears to differ markedly from one person to the next.

and

Diet has some effect: a diet rich in sugars and fats reduces the diversity of gut bacteria, and shifts the balance towards those that are more efficient at extracting energy. Start eating more plants and you can shift the balance back, and increase the diversity of your gut microbes.

and

First, during your lifetime, your bacteria can change their genes even though you cannot change yours….It may be that gut bacteria evolve in response to short-term changes in the environment, especially exposure to food-borne diseases. They may thus act as an evolving supplement to the immune system.

…Because bacteria can evolve so fast, it may be that some of what we think of as human evolution — like the ability to digest new diets that accompanied the invention of agriculture — is actually bacterial evolution.