Posted in bio ethics, Cardiology - Clinical, cardiology -Therapeutics, cardiology-ethics, Cardiology-Land mark studies, tagged accomplish, allhat, annals of internal medicine, bioethics, bmj, conflict of interest, diuretics, drsvenkatesan, drug trials, ethics, jama, jnc 7, lancet, nejm on December 10, 2008 |
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It is now mandatory for all journals to declare the conflict of interest by the authors who are involved in medical research .The purpose apparently is to make all transactions or links between the researchers and their funding agencies transparent .Even major journals do not go beyond this . Some ensure it , to appear in the first page of the article.
What does the the journals tend to convey to the reader by publishing the conflicts of interest ?
- Does it mean the article in question may have a bias or indeed have a bias ? and readers are warned hear by !
- Do they send across a message that the article may not be really a genuine one and the judgement is left to the the consumers of the articles ?
How often a journal article is rejected purely on the basis of conflicts of interest ?
Most of journal articles are rejected for poor methodology, statistical analysis and so forth .We don’t know how often a paper is rejected due to a conflict issue per se.If this could happen ,bulk of drug trials would face a torrid time from the editors.
Why , even the leading scientific journals never indulge in grading the significance of the conflict ?
Here is an example .
The much hyped drug trial on Hypertension “ACCOMPLISH” was published in the world’s most prestigious medical journal recently .It left it to the readers to have their own assessment on the conflict issue.
The consequence of not , grading and investigating about the conflicts could have serious global health implications both financially and academically .
This study was designed, formulated, completed and published with a single hidden aim of neutralising the land mark trial of ALLHAT which recommended diuretics as a first line drug in HT.Apparently diuretics are very cheap , effective generic drugs.
Is it a scientific rule that the latest evidence , should always prevail over the older evidence ?
No. Science can never have such a rule ! The question is how good and genuine is the evidence.
Just because an evidence is current , it does not attain a scientific sanctity !
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Posted in Cardiology - Clinical, Infrequently asked questions in cardiology (iFAQs), tagged acei, allhat, ARBS, diuretics, drsvenkatesan, hypertension, jnc7, lancet, loop of henle, reanl hypertension, salt sensitive, sodium, thiazide on September 8, 2008 |
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Diuretics are the most commonly prescribed anti hypertensive agents.Thiazide diuretics which was introduced many decades ago , lost popularity in recent years , again got a second life after the publication of ALLHAT trial recently. Now diuretics has become the the drug of first choice in almost any hypertension unless any specific contraindication.
The most commonly used thaizide is hydrochlorthiazide ,and chlorthalidone.The blood pressure reducing effect is so consistent and smooth , all the currently popular molecules like ACE inhibitors and ARBs come with a combination with thiazide. While every one is clear diuretics are effective anti hypertensive agent How it does is not clear.
How does a diuretic reduce blood pressure?
A. The exact mechanism is not clear. May not be uniformly effective in all patients with HT.
B . Salt sensitive HT respond well to diuretics.
C. Volume correction /free water clearance might be a factor
D. Direct effect on vascular smoth muscle documented.The sodium transporter is blocked and hence calcium : sodium exchange is prevented .This depletes intracellular calcium in vascular smooth muscle cells .Less calcium for actin myosin interaction and hence vasodilatation
E. Thiazides combine well with all other antihypertensive drugs (ACEI, ARB, Beata blockers, calcium blockers)
F. Loop diuretics like frusemide can never be a good antihypertensive agent.
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