Avandia: publish or publish

O lema da academia americana: "publish or perish", está sendo agora focado para a imprensa médica. Questiona-se se o The New England Journal of Medicine deveria ou não publicar o artigo sobre o rosiglitasone. Eu não tenho dúvida do acerto em publicar. Agora, estou observando a reação ao estudo. Estou no aguardo das revistas semanais para ver quem ficará com o " ZecaPagodinho quesito diabetes" Ou seja, defender quem o paga, com pouco ou nenhum conteúdo, somente desqualificando o autor do artido ou projeto que contraria o seu patrocinador, tal como o cantor fez com o Ministro da Saúde.

Porém, ninguem chegará perto de Steven Haffner, de San Antonio, Texas. Ele se considera o dono da epidemiologia do diabetes e, adora o sensacionalismo quando a seu favor. Ele transformou o diabetes no paraíso da indústria, por forçar cada vez mais definição de diabetes, que um dia atingirá toda da população. Abaixo, a opinião de diabetólogos americanos, publicado no Heartwire, um noticiário do Medscape. Vejam a declaração de Haffner e, concluam. Destaquei também parte da declaração de David Natham sobre o papel da Glaxo Smith Kline nessa questão. Dr Steven Haffner (University of Texas Health Science Center, San Antonio), who was involved in the ADOPT study of rosiglitazone, said the paper needed to be published, but it should have undergone a more extensive review, and there should have been a different editorial with more emphasis on the flaws of the study. “The NEJM was irresponsible to go to [Drs Bruce] Psaty and [Curt] Furberg for the editorial--they were always going to emphasize concerns about drug safety; that’s what they do," he commented. “But I’m not surprised this paper was published like this. The three major medical journals are becoming more like British tabloid newspapers--all they lack is a bare-chested woman on page 3," he jibed. Dr Brian Strom (University of Pennsylvania, Philadelphia) agrees. “Drugs are given because they have benefits. Where there’s a scare, people stop taking them. So you can do more harm than good if the scare is not based on correct information. I do believe this meta-analysis should have been published, but a less sensational editorial would have been better," he told heartwire. Dr Robert Califf (Duke University, Durham, NC) made the point that news reporting should follow scientific discussion on drug-safety issues, not precede it. “It would be better if we had a system of postmarketing signal detection in which signals were vetted scientifically rather than splashed over TV and newspapers. I can't help but wonder if the NEJM is functioning more like the mainstream press than a scientific journal at this point, since many potential peer reviewers seem to feel that Dr Nissen's analyses are missing key elements that could have been added." Dr Darren McGuire (University of Texas Southwestern, Dallas) commented to heartwire: “All the sensationalism surrounding this observation has created unnecessary chaos and confusion at the patient level."

Dr David Nathan (Harvard Medical School, Boston, MA), who was one of the reviewers of the NEJM paper, is not so sure that people have overreacted. “Yes, this was an imperfect analysis. It can’t be looked at as definitive, but at the same time the findings shouldn’t be ignored," he told heartwire. “GlaxoSmithKline had the opportunity to collaborate, and they chose not to. They say they have more data, but why have they not published it? If they can produce convincing data, we can become more relaxed about this drug. But for the moment all we have is Nissen’s analysis," he added. “I’m advising patients to discuss this with their doctors--there are other choices for the treatment of diabetes. It certainly doesn’t make much sense to me to use a drug that is potentially cardiotoxic in a condition that causes heart disease. Given the choice of all the drugs available I would be very cautious about using this medicine," Nathan said.