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	<title>Comments on: The Journal of the American Medical Association Does a Fine Impression of Vito Corleone (or is it Fredo?)</title>
	<atom:link href="http://crookedtimber.org/2009/03/23/the-journal-of-the-american-medical-association-crashes-and-burns/feed/" rel="self" type="application/rss+xml" />
	<link>http://crookedtimber.org/2009/03/23/the-journal-of-the-american-medical-association-crashes-and-burns/</link>
	<description>Out of the crooked timber of humanity, no straight thing was ever made</description>
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		<title>By: Danielle Day</title>
		<link>http://crookedtimber.org/2009/03/23/the-journal-of-the-american-medical-association-crashes-and-burns/comment-page-1/#comment-270485</link>
		<dc:creator>Danielle Day</dc:creator>
		<pubDate>Wed, 25 Mar 2009 19:28:00 +0000</pubDate>
		<guid isPermaLink="false">http://crookedtimber.org/?p=10176#comment-270485</guid>
		<description>My dad was a physician. He didn&#039;t have a lot of respect for JAMA. His main take, though, was &quot;Jesus. Who has time to write an article anyway?!&quot;</description>
		<content:encoded><![CDATA[	<p>My dad was a physician. He didn&#8217;t have a lot of respect for <span class="caps">JAMA</span>. His main take, though, was &#8220;Jesus. Who has time to write an article anyway?!&#8221; </p>
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		<title>By: Barry</title>
		<link>http://crookedtimber.org/2009/03/23/the-journal-of-the-american-medical-association-crashes-and-burns/comment-page-1/#comment-270483</link>
		<dc:creator>Barry</dc:creator>
		<pubDate>Wed, 25 Mar 2009 18:45:38 +0000</pubDate>
		<guid isPermaLink="false">http://crookedtimber.org/?p=10176#comment-270483</guid>
		<description>James, I didn&#039;t mean to poke fun at the U.K.; rather, I find the failure of democracy there to be an unfortunate and dismaying parallel to the failure here in the USA.</description>
		<content:encoded><![CDATA[	<p>James, I didn&#8217;t mean to poke fun at the U.K.; rather, I find the failure of democracy there to be an unfortunate and dismaying parallel to the failure here in the <span class="caps">USA</span>.</p>
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		<title>By: Mike</title>
		<link>http://crookedtimber.org/2009/03/23/the-journal-of-the-american-medical-association-crashes-and-burns/comment-page-1/#comment-270480</link>
		<dc:creator>Mike</dc:creator>
		<pubDate>Wed, 25 Mar 2009 18:30:22 +0000</pubDate>
		<guid isPermaLink="false">http://crookedtimber.org/?p=10176#comment-270480</guid>
		<description>Sounds more like Moe Greene than any of the Corleones.  And we all know what happened to Moe.</description>
		<content:encoded><![CDATA[	<p>Sounds more like Moe Greene than any of the Corleones.  And we all know what happened to Moe.</p>
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		<title>By: James Wimberley</title>
		<link>http://crookedtimber.org/2009/03/23/the-journal-of-the-american-medical-association-crashes-and-burns/comment-page-1/#comment-270425</link>
		<dc:creator>James Wimberley</dc:creator>
		<pubDate>Wed, 25 Mar 2009 13:48:35 +0000</pubDate>
		<guid isPermaLink="false">http://crookedtimber.org/?p=10176#comment-270425</guid>
		<description>Barry&#039;s reply to me in #23: I did say a &lt;i&gt;rare&lt;/i&gt; occasion for flagwaving. eudoxis (#21) is probably more to the point in suggesting that &quot;journals are all too happy to point out failures of rivals&quot;.</description>
		<content:encoded><![CDATA[	<p>Barry&#8217;s reply to me in #23: I did say a <i>rare</i> occasion for flagwaving. eudoxis (#21) is probably more to the point in suggesting that &#8220;journals are all too happy to point out failures of rivals&#8221;.</p>
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		<title>By: Ray Davis</title>
		<link>http://crookedtimber.org/2009/03/23/the-journal-of-the-american-medical-association-crashes-and-burns/comment-page-1/#comment-270422</link>
		<dc:creator>Ray Davis</dc:creator>
		<pubDate>Wed, 25 Mar 2009 13:32:48 +0000</pubDate>
		<guid isPermaLink="false">http://crookedtimber.org/?p=10176#comment-270422</guid>
		<description>Matt Brown&#039;s link to James Robert Brown&#039;s &lt;a href=&quot;http://www.journals.uchicago.edu/doi/full/10.1086/594521?cookieSet=1&quot; rel=&quot;nofollow&quot;&gt;&lt;i&gt;Philosophy of Science&lt;/i&gt; piece&lt;/a&gt; sheds light on the pragmatic ethics of Dr. DeAngelis:

&lt;blockquote&gt;
Leveling sanctions against an author who fails to disclose financial interests by banning publication of his or her articles for some time period would only encourage that author to send his or her articles to another journal; it cleans our house by messing others. So what about all editors, or at least a group, such as the International Committee of Medical Journal Editors, agreeing to share the information and jointly to ban the offending authors? Those who suggest this approach have not considered the risk of antitrust suits.
&lt;/blockquote&gt;

Embarrassing external whistleblowers can be blacklisted, but ethically dubious research is Too Big to Fail.</description>
		<content:encoded><![CDATA[	<p>Matt Brown&#8217;s link to James Robert Brown&#8217;s <a href="http://www.journals.uchicago.edu/doi/full/10.1086/594521?cookieSet=1" rel="nofollow"><i>Philosophy of Science</i> piece</a> sheds light on the pragmatic ethics of Dr. DeAngelis:</p>

	<p><blockquote><br />
Leveling sanctions against an author who fails to disclose financial interests by banning publication of his or her articles for some time period would only encourage that author to send his or her articles to another journal; it cleans our house by messing others. So what about all editors, or at least a group, such as the International Committee of Medical Journal Editors, agreeing to share the information and jointly to ban the offending authors? Those who suggest this approach have not considered the risk of antitrust suits.<br />
</blockquote></p>

	<p>Embarrassing external whistleblowers can be blacklisted, but ethically dubious research is Too Big to Fail.</p>
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		<title>By: Barry</title>
		<link>http://crookedtimber.org/2009/03/23/the-journal-of-the-american-medical-association-crashes-and-burns/comment-page-1/#comment-270370</link>
		<dc:creator>Barry</dc:creator>
		<pubDate>Tue, 24 Mar 2009 19:24:03 +0000</pubDate>
		<guid isPermaLink="false">http://crookedtimber.org/?p=10176#comment-270370</guid>
		<description>Thanks, Rich!  Sweeeeet.</description>
		<content:encoded><![CDATA[	<p>Thanks, Rich!  Sweeeeet.</p>
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		<title>By: Rich B.</title>
		<link>http://crookedtimber.org/2009/03/23/the-journal-of-the-american-medical-association-crashes-and-burns/comment-page-1/#comment-270341</link>
		<dc:creator>Rich B.</dc:creator>
		<pubDate>Tue, 24 Mar 2009 17:49:53 +0000</pubDate>
		<guid isPermaLink="false">http://crookedtimber.org/?p=10176#comment-270341</guid>
		<description>Technical note regarding the WSJ Paywall:

It only exists on the WSJ page, or in direct links to the article.  It does not exist on Google.  

They want their articles indexes on Google News for advertising revenues.  Go to (almost) any article you want to read on WSJ, and type the headline into Google News, and you will get the full article, without a paywall.</description>
		<content:encoded><![CDATA[	<p>Technical note regarding the <span class="caps">WSJ </span>Paywall:</p>

	<p>It only exists on the <span class="caps">WSJ</span> page, or in direct links to the article.  It does not exist on Google.</p>

	<p>They want their articles indexes on Google News for advertising revenues.  Go to (almost) any article you want to read on <span class="caps">WSJ</span>, and type the headline into Google News, and you will get the full article, without a paywall.</p>
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		<title>By: Bill Gardner</title>
		<link>http://crookedtimber.org/2009/03/23/the-journal-of-the-american-medical-association-crashes-and-burns/comment-page-1/#comment-270313</link>
		<dc:creator>Bill Gardner</dc:creator>
		<pubDate>Tue, 24 Mar 2009 14:58:53 +0000</pubDate>
		<guid isPermaLink="false">http://crookedtimber.org/?p=10176#comment-270313</guid>
		<description>eudoxis @ 21:
It is possible that patients were hurt, even though SSRIs are not super-dangerous drugs. Without knowing the details of this case, I do think that it is important to protect the accused in ethics investigations until their cases have been investigated. If you believe &lt;a href=&quot;http://www.amazon.com/Baltimore-Case-Politics-Science-Character/dp/0393041034&quot; rel=&quot;nofollow&quot;&gt;Kevles&lt;/a&gt;, Imanishi-Kari and Baltimore were falsely accused of data fraud in their famous case.  I don&#039;t have a proposal for how best to balance the need to protect the public and the accused.

By the way, DeAngelis is a pediatrician.</description>
		<content:encoded><![CDATA[	<p>eudoxis @ 21:<br />
It is possible that patients were hurt, even though <span class="caps">SSR</span>Is are not super-dangerous drugs. Without knowing the details of this case, I do think that it is important to protect the accused in ethics investigations until their cases have been investigated. If you believe <a href="http://www.amazon.com/Baltimore-Case-Politics-Science-Character/dp/0393041034" rel="nofollow">Kevles</a>, Imanishi-Kari and Baltimore were falsely accused of data fraud in their famous case.  I don&#8217;t have a proposal for how best to balance the need to protect the public and the accused.</p>

	<p>By the way, DeAngelis is a pediatrician.</p>
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		<title>By: self exile</title>
		<link>http://crookedtimber.org/2009/03/23/the-journal-of-the-american-medical-association-crashes-and-burns/comment-page-1/#comment-270309</link>
		<dc:creator>self exile</dc:creator>
		<pubDate>Tue, 24 Mar 2009 14:34:42 +0000</pubDate>
		<guid isPermaLink="false">http://crookedtimber.org/?p=10176#comment-270309</guid>
		<description>JAMA has an interesting history in itself.  For the first 50 years it was run by and for the profit of a shakedown artist.  Forbes Magazine was run the same way under the founder. Rolling Stone did the same thing when they were in San Francisco.

I think that the New England Journal of Medicine is quite a bit better.</description>
		<content:encoded><![CDATA[	<p><span class="caps">JAMA</span> has an interesting history in itself.  For the first 50 years it was run by and for the profit of a shakedown artist.  Forbes Magazine was run the same way under the founder. Rolling Stone did the same thing when they were in San Francisco.</p>

	<p>I think that the New England Journal of Medicine is quite a bit better.</p>
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		<title>By: Barry</title>
		<link>http://crookedtimber.org/2009/03/23/the-journal-of-the-american-medical-association-crashes-and-burns/comment-page-1/#comment-270306</link>
		<dc:creator>Barry</dc:creator>
		<pubDate>Tue, 24 Mar 2009 14:18:24 +0000</pubDate>
		<guid isPermaLink="false">http://crookedtimber.org/?p=10176#comment-270306</guid>
		<description>James Wimberley 03.23.09 at 9:43 pm

&quot;Is the unexpected spine shown by the BMJ a rare occasion for justified British flag-waving, Britons never never never shall be slaves of Big Pharma?&quot;

I don&#039;t mean to be harsh, but if *I* were a Briton, I&#039;d still feel that we were slaves to the USA (e.g., policies allowing British citizens to be handed over to the CIA upon request).  I&#039;d also  feel that it&#039;d be reasonable to take Mr. Blair on an experiential tour through the old, unsavory, highly public forms of the British criminal justice system for that.</description>
		<content:encoded><![CDATA[	<p>James Wimberley 03.23.09 at 9:43 pm</p>

	<p>&#8220;Is the unexpected spine shown by the <span class="caps">BMJ</span> a rare occasion for justified British flag-waving, Britons never never never shall be slaves of Big Pharma?&#8221;</p>

	<p>I don&#8217;t mean to be harsh, but if <strong>I</strong> were a Briton, I&#8217;d still feel that we were slaves to the <span class="caps">USA </span>(e.g., policies allowing British citizens to be handed over to the <span class="caps">CIA</span> upon request).  I&#8217;d also  feel that it&#8217;d be reasonable to take Mr. Blair on an experiential tour through the old, unsavory, highly public forms of the British criminal justice system for that.</p>
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		<title>By: Barry</title>
		<link>http://crookedtimber.org/2009/03/23/the-journal-of-the-american-medical-association-crashes-and-burns/comment-page-1/#comment-270305</link>
		<dc:creator>Barry</dc:creator>
		<pubDate>Tue, 24 Mar 2009 14:15:31 +0000</pubDate>
		<guid isPermaLink="false">http://crookedtimber.org/?p=10176#comment-270305</guid>
		<description>Bill Gardner 03.24.09 at 12:13 pm

&quot;My point concerned De Angelis’s ( &amp; Fontarosa’s) motives, specifically that it was unlikely that they had been suborned by Forest, or by Pharma generally. I take it that you agree. I also agree strongly that it is wrong to blacklist a critic, or to attempt to silence him through a telephone call to his dean. That’s what I had in mind when I wrote “that is wrong”, but I could have made it clearer by spelling it out.&quot;

De Angelis might have been attempting to suppress the publicization of wrongdoing for purely egotistical reasons; however (a) that in itself is reason for her to &#039;seek career opportunities elsewhere&#039;; (b) after somebody successfully asserts that sort of control, it&#039;s childsplay for the next editor to continue that policy for money.</description>
		<content:encoded><![CDATA[	<p>Bill Gardner 03.24.09 at 12:13 pm</p>

	<p>&#8220;My point concerned De Angelis&#8217;s ( &#038; Fontarosa&#8217;s) motives, specifically that it was unlikely that they had been suborned by Forest, or by Pharma generally. I take it that you agree. I also agree strongly that it is wrong to blacklist a critic, or to attempt to silence him through a telephone call to his dean. That&#8217;s what I had in mind when I wrote &#8220;that is wrong&#8221;, but I could have made it clearer by spelling it out.&#8221;</p>

	<p>De Angelis might have been attempting to suppress the publicization of wrongdoing for purely egotistical reasons; however (a) that in itself is reason for her to &#8216;seek career opportunities elsewhere&#8217;; (b) after somebody successfully asserts that sort of control, it&#8217;s childsplay for the next editor to continue that policy for money.</p>
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		<title>By: eudoxis</title>
		<link>http://crookedtimber.org/2009/03/23/the-journal-of-the-american-medical-association-crashes-and-burns/comment-page-1/#comment-270301</link>
		<dc:creator>eudoxis</dc:creator>
		<pubDate>Tue, 24 Mar 2009 13:43:43 +0000</pubDate>
		<guid isPermaLink="false">http://crookedtimber.org/?p=10176#comment-270301</guid>
		<description>One has to wonder if patients were harmed because of this published study.  Doctors reading JAMA would notice that the original authors, Robinson et al., concluded that problem-solving therapy and antidepressants were  both effective at reducing depression in stroke patients.  In a letter to the editor by Lacasses and Leo,  the question was raised if there was a statistically significant difference between the two therapies, to which Robinson replied that there wasn&#039;t.  
 Robinson took his story on the road, and a flurry of media articles appeared, for example:

 http://www.usatoday.com/news/health/2008-05-27-stroke-depression_N.htm

There is possibility for harm.  Leo and Lacasses were right to raise the issue in BMJ after they were rebuffed by JAMA.   Journals are all to happy to point out failures of rivals.   Maybe,  JAMA is concerned that any osteopath or  social worker could destroy a medical researcher&#039;s career with letters to rival journals and ruin JAMA&#039;s reputation in the process.    The authors of the original study have publicly apologized for failure to disclose conflict of interest and have confirmed that drugs are not a superior treatment.  But the strong arming by JAMA continues.  Is there more to this story?  Note that DeAngelis is a psychiatrist.</description>
		<content:encoded><![CDATA[	<p>One has to wonder if patients were harmed because of this published study.  Doctors reading <span class="caps">JAMA</span> would notice that the original authors, Robinson et al., concluded that problem-solving therapy and antidepressants were  both effective at reducing depression in stroke patients.  In a letter to the editor by Lacasses and Leo,  the question was raised if there was a statistically significant difference between the two therapies, to which Robinson replied that there wasn&#8217;t.<br />
Robinson took his story on the road, and a flurry of media articles appeared, for example:</p>

	<p><a href="http://www.usatoday.com/news/health/2008-05-27-stroke-depression_N.htm" rel="nofollow">http://www.usatoday.com/news/health/2008-05-27-stroke-depression_N.htm</a></p>

	<p>There is possibility for harm.  Leo and Lacasses were right to raise the issue in <span class="caps">BMJ</span> after they were rebuffed by <span class="caps">JAMA</span>.   Journals are all to happy to point out failures of rivals.   Maybe,  <span class="caps">JAMA</span> is concerned that any osteopath or  social worker could destroy a medical researcher&#8217;s career with letters to rival journals and ruin <span class="caps">JAMA</span>&#8217;s reputation in the process.    The authors of the original study have publicly apologized for failure to disclose conflict of interest and have confirmed that drugs are not a superior treatment.  But the strong arming by <span class="caps">JAMA</span> continues.  Is there more to this story?  Note that DeAngelis is a psychiatrist.</p>
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		<title>By: mpowell</title>
		<link>http://crookedtimber.org/2009/03/23/the-journal-of-the-american-medical-association-crashes-and-burns/comment-page-1/#comment-270298</link>
		<dc:creator>mpowell</dc:creator>
		<pubDate>Tue, 24 Mar 2009 13:07:32 +0000</pubDate>
		<guid isPermaLink="false">http://crookedtimber.org/?p=10176#comment-270298</guid>
		<description>19:  Okay, I don&#039;t think I really have any disagreement with you regarding the issue at hand in that case.  I would like to point out that JAMA&#039;s proposed course of action, forbidding contributors who point out potential sources of conflict from speaking publicly on them until JAMA has conducted their own investigation (with no timeline attached), does privilege the parochial interests of JAMA above those of rooting out corruption in medical research publications.</description>
		<content:encoded><![CDATA[	<p>19:  Okay, I don&#8217;t think I really have any disagreement with you regarding the issue at hand in that case.  I would like to point out that <span class="caps">JAMA</span>&#8217;s proposed course of action, forbidding contributors who point out potential sources of conflict from speaking publicly on them until <span class="caps">JAMA</span> has conducted their own investigation (with no timeline attached), does privilege the parochial interests of <span class="caps">JAMA</span> above those of rooting out corruption in medical research publications.</p>
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		<title>By: Bill Gardner</title>
		<link>http://crookedtimber.org/2009/03/23/the-journal-of-the-american-medical-association-crashes-and-burns/comment-page-1/#comment-270291</link>
		<dc:creator>Bill Gardner</dc:creator>
		<pubDate>Tue, 24 Mar 2009 12:13:55 +0000</pubDate>
		<guid isPermaLink="false">http://crookedtimber.org/?p=10176#comment-270291</guid>
		<description>mpowell @18:
My point concerned De Angelis&#039;s ( &amp; Fontarosa&#039;s) motives, specifically that it was unlikely that they had been suborned by Forest, or by Pharma generally. I take it that you agree. I also agree strongly that it is wrong to blacklist a critic, or to attempt to silence him through a telephone call to his dean. That&#039;s what I had in mind when I wrote &quot;that is wrong&quot;, but I could have made it clearer by spelling it out.

I think we disagree only on details. I think De Angelis is wrong here, but that on the issue of medical-industrial corruption, she and the &lt;i&gt;JAMA&lt;/i&gt; editorial board have historically been on the right side. Also, I&#039;m skeptical whether &quot;the maintenance of [the parochial interests of JAMA] makes it easier for the pharmaceutical industry to exercise its clout hiding these kinds of things&quot;. Phama isn&#039;t that subtle. It&#039;s like what Susanna says to the Contessa in &lt;i&gt;Figaro&lt;/i&gt;: &quot;He [the Count] doesn&#039;t flatter women of my station. He offered to pay.&quot;</description>
		<content:encoded><![CDATA[	<p>mpowell @18:<br />
My point concerned De Angelis&#8217;s ( &#038; Fontarosa&#8217;s) motives, specifically that it was unlikely that they had been suborned by Forest, or by Pharma generally. I take it that you agree. I also agree strongly that it is wrong to blacklist a critic, or to attempt to silence him through a telephone call to his dean. That&#8217;s what I had in mind when I wrote &#8220;that is wrong&#8221;, but I could have made it clearer by spelling it out.</p>

	<p>I think we disagree only on details. I think De Angelis is wrong here, but that on the issue of medical-industrial corruption, she and the <i><span class="caps">JAMA</span></i> editorial board have historically been on the right side. Also, I&#8217;m skeptical whether &#8220;the maintenance of [the parochial interests of <span class="caps">JAMA</span>] makes it easier for the pharmaceutical industry to exercise its clout hiding these kinds of things&#8221;. Phama isn&#8217;t that subtle. It&#8217;s like what Susanna says to the Contessa in <i>Figaro</i>: &#8220;He [the Count] doesn&#8217;t flatter women of my station. He offered to pay.&#8221; </p>
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		<title>By: mpowell</title>
		<link>http://crookedtimber.org/2009/03/23/the-journal-of-the-american-medical-association-crashes-and-burns/comment-page-1/#comment-270288</link>
		<dc:creator>mpowell</dc:creator>
		<pubDate>Tue, 24 Mar 2009 11:32:11 +0000</pubDate>
		<guid isPermaLink="false">http://crookedtimber.org/?p=10176#comment-270288</guid>
		<description>17:  I&#039;m sorry, if you&#039;re willing to blacklist people because they call you out for failing to uphold your ethical duties regarding reporting conflicts of interest, you&#039;re not one of the good guys.  That&#039;s more than just arrogance.   She may not be protecting Forest Labs, but she is trying to protect the parochial interests of JAMA, the maintenance of which makes it easier for the pharmaceutical industry to exercise its clout hiding these kinds of things.  It&#039;s nice that she&#039;s trying to cleanup in house, but maintaining the perogative of a leading publication to blacklist it&#039;s critics has the same kind of perverting effect on the literature.</description>
		<content:encoded><![CDATA[	<p>17:  I&#8217;m sorry, if you&#8217;re willing to blacklist people because they call you out for failing to uphold your ethical duties regarding reporting conflicts of interest, you&#8217;re not one of the good guys.  That&#8217;s more than just arrogance.   She may not be protecting Forest Labs, but she is trying to protect the parochial interests of <span class="caps">JAMA</span>, the maintenance of which makes it easier for the pharmaceutical industry to exercise its clout hiding these kinds of things.  It&#8217;s nice that she&#8217;s trying to cleanup in house, but maintaining the perogative of a leading publication to blacklist it&#8217;s critics has the same kind of perverting effect on the literature.</p>
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