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The science of how we know: epidemiology and the ethical issues surrounding it

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The speaker says epidemiology is the science of how we know. Explain what he means. Epidemiology attempts to explain how we know something. We attempt to explain it by looking at facts, statistics and coming up with studies that can lead us to a better understanding of what we are studying. Epidemiology does not provide cut and dry answers because there are so many factors that can play a role in our health. Some of the main factors are social, economic and genetic. Studies performed and data analysis are trying to get us closer to the “how we know” what we believe we know.

What might be wrong with a clinical trial that compares a new medicine to a placebo rather than to a medicine that is the standard of care for treating the same illness? If a new drug were being tested and there was already treatment for that illness then testing against a placebo would be almost irrelevant. We already have a drug that is helping treat the illness. If you test it against the placebo you are testing it against no treatment, basically. The ideal test would be a comparison between the current drug and the new one. This would allow for a show of which is better at treating the illness. That should be the goal of these trials- to get the best care/treatment for the patients.

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What are some ways to ‘rig’ a particular study on a new drug? The question above gives a great example of rigging a new drug study. If the new drug works at all it can be called a success. It does not take into account that it may be much less effective than a current treatment. Sometimes drugs are compared- but the way they are compared can skew the data. The new drug gets proper dosage but the comparative drug either gets too low or too high of a dosage. This can lead to false information. It is not an apples to apples comparison. Another way of rigging a study would be to simply omit the negative information. If the negatives are left out then the study seems to have a more favorable outcome.

Give an example of publication bias. We can spot publication bias on a funnel plot if the left side of the plot of empty. It shows no negatives. Thinking back, I would say that evidence of the harm smoking causes was not published. It was kept from the public and. My uncle recently passed from lung cancer at 67 years old. Also, recently we are learning about the sugar industry pointing the spotlight on fats and cholesterol to shift the focus from the harm sugar causes. I believe those are examples of publication bias.

Another example of publication bias could be the studies claiming bilingual speakers are better at certain cognitive tasks. This study only published the information that supported their narrative. (Another example, 2014).

What does the speaker, Ben Goldacre, think is the single biggest ethical problem facing medicine today? Do you think you or anyone you know may have been affected by this personally? Why or why not? The speaker thinks that the omission of negative information from study results is the biggest ethical problem facing medicine. I feel like I have personally been the receiving end of this type of information. So, I have to take a medication daily. I have been taking it for years. I have always taken the name brand. A few years ago, my insurance company switched me to generic without my consent. I tried it. It did not work for me. I had an adverse reaction to it and actually made me regress. I ended up needing a higher dose of the name brand that I was previously on.

Ever since, I have to battle my insurance company and threaten them with lawsuits just to get the correct medication. This is every single time I get a refill. This is due to some studies that say generics are the same. I believe they are very similar but they are not the same. It is unfair to people that go through what I go through. I do not enjoy paying hundreds of dollars for the name brand when the generic is less than $12 for a 90-day supply. I would love to be able to take the generic. I feel the insurance companies encourage this “generics are the same” rhetoric so they will not have to foot the bill for name brand drugs. My well-being is put at risk to save big business some money.

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