What happens when we don’t publish clinical trials

The last blog I posted emphasised the importance of publishing all clinical trials. The story of Lorcainide is a stark warning of what happens when we don’t.

In 1980 a cardiologist in Nottingham named Alan Cowley carried out a small clinical trial of a drug called Lorcainide. It was known at the time that heart attacks could cause irregular heartbeats in patients (known as arrhythmia), and these arrhythmias often lead to early death. Lorcainide had been shown to suppress arrhythmia, so it made sense that patients who came to hospital with a heart attack should be treated with the drug. Cowley and his colleagues carried out a small trial with 95 patients, and tested them to see whether they were getting more or fewer arrhythmias. The drug worked, lowering the frequency of serious arrhythmia.

The doctors noticed something else however. Of the 48 patients on the drug, 9 had died, compared to only 1 patient on the placebo. This was a very small trial, so the doctors weren’t overly alarmed. It’s not surprising that 10 patients died in the study; these are patients who are presenting with heart attacks after all. It was just worrying that there was such an imbalance between the groups. The doctors chalked it up to bad luck, and viewed their trial as a success.

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Problems with clinical trials

Clinical trials are at the heart of our progress in medicine. If we have a new therapy, clinical trials tell us whether it is better than the current one. They measure outcomes, but also look out for side effects and unexpected consequences of taking the therapy. They are absolutely essential to our progress, and it is vital that they are carried out properly and transparently. Continue reading

Correlation vs Causation

The following headline caught my eye recently:

“Migraines could be caused by gut bacteria, study suggests”

The Guardian – 18/10/16

To anybody who suffers from migraines, this is very interesting; at the moment, we really don’t understand what causes them. If a study has figured this out, then we may be able to help the estimated 15% of the population who are sufferers.

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Hot drinks and cancer

You may have seen a frankly terrifying headline this week:

“Hot drinks probably cause cancer, warns World Health Organisation”

Telegraph, 15th June 2016

Almost every news source carried this story, and the headlines were universally similar to the one above. This story comes from a report by the WHO, which looked at the association between coffee and mate (a South American herbal tea) and various forms of cancer. In short, they found that there was no association between coffee or mate and cancer, but that the temperature of the beverage may be linked to oesophageal cancer. Continue reading

Alternative medicine as a placebo

I recently wrote a post about the decision by NICE to no longer recommend acupuncture for lower back pain. This decision was made because, like most alternative medicine, acupuncture hasn’t been shown to work any better than a placebo. However, plenty of people use and get benefit from such treatments. This raises an interesting question: is there a place for complementary and alternative medicine (as a placebo) in the clinic? Continue reading

Royal College of Physicians recommends e-cigarettes for smokers

A few months ago I wrote here about the rise of e-cigarettes. In that post I pointed out that e-cigarettes are far less harmful than tobacco, and should be marketed as a safer alternative to smoking. There has been an interesting update on this topic today, with the Royal College of Physicians (RCP) recommending that all smokers be offered and encouraged to use e-cigarettes. Continue reading