[Cz-biology] [Cz-health-sci] Merck proposal is NOT A GOOD IDEA
Badgett, Robert G
Badgett at uthscsa.edu
Thu Nov 1 01:04:48 CDT 2007
Thanks for the opportunity to discuss this. I would not touch this offer either.
Aside from the Viox incident in which Merck is alleged to have withheld negative data from the NEJM (See Failing the Public Health - Rofecoxib, Merck, and the FDA - http://pmid.us/15470193 <http://pmid.us/15470193> ) (See Expression of Concern - http://pmid.us/16339408 <http://pmid.us/16339408> ) and publishing a deceptive meta-analysis (http://pmid.us/14564311 <http://pmid.us/14564311> ), there are numerous studies of the hazards of conflicts of interest.
In the CZ evidence-based medicine article, I started a summary of empiric studies on the problems with conflict of interest in medicine(http://en.citizendium.org/wiki/Evidence-based_medicine#Conflict_of_interest <http://en.citizendium.org/wiki/Evidence-based_medicine#Conflict_of_interest> ).
Perhaps a worse problem is that our relating with a conflicted entity may induce bad behavior on our part. See the start of a summary of this at http://en.citizendium.org/wiki/Medical_ethics#Effect_on_the_conduct_of_research_and_publishing <http://en.citizendium.org/wiki/Medical_ethics#Effect_on_the_conduct_of_research_and_publishing> . Most disturbing is the Stelfox NEJM study (http://pmid.us/9420342) listed at the preceding link.
Focusing now just on the quality of the Merck manual, there must be something good going on as it is in its 18th edition. However, in 1992, Antman showed the inaccuracies of traditionally edited textbooks that rely on the unaided expert (http://pmid.us/1535110 <http://pmid.us/1535110> ). Since then, medical texts have improved their methods to include things such as peer review, disclosing authors' conflicts of interest, attributing source evidence, frequent updating with literature searches supplied to authors from a central editorial office. The Merck Manuel does none of these and does not have an adequately transparent process.
So, there is theoretical risk that the Merck Manual is compromised and maybe biased. Let's look:
1. It is interesting that if you search rofexocib in the Merck manual you get 0 hits.
2. Another example: if you search Merck for "cox", you find this statement in the osteoarthritis chapter (http://www.merck.com/mmpe/sec04/ch034/ch034e.html), "NSAIDs, including cyclooxygenase-2 (COX-2) inhibitors or coxibs, may be considered if patients have refractory pain or signs of inflammation (eg, redness, warmth). NSAIDs may be used simultaneously with other analgesics (eg, tramadol, opioids) to provide better relief of symptoms." Does any MD on this list agree with this clinical recommendation by Merck? The Merck Manual omitted that the Cox-2 drugs might increase myocardial infarctions. It seems the Stelfox bias has occurred.
So even if we think the Manuel operates with editorial independence from the Merck company, we have to deal with the quality of the Merck Manual.
In summary, I believe the Merck Manual's methods are outdated and there is evidence of inconsistent quality of content. Given time, we can write better content. When this happens, it might be hard to jettison the Merck links.
Bob
-----Original Message-----
From: cz-health-sci-bounces at mail.citizendium.org on behalf of Diana Zuckerman
Sent: Tue 10/30/2007 9:04 PM
To: Kevin M. Kelly; mgrey at mfi.ku.dk; 'Larry Sanger'
Cc: 'Biology Workgroup List'; cz-health-sci at voltaire.citizendium.org
Subject: [Cz-health-sci] Merck proposal is NOT A GOOD IDEA
My email on this subject seems to have gotten lost, and I can't seem to send it to some of the mailng lists, so I am sending it again and ask that those of you with acces to all these list servs also send it for me.
Since Merck is a pharmaceutical company that sells medical products, and since it already offers an online version of the Merck manual for free on the Internet, anything they submit should be VERY CAREFULLY reviewed individually on a case by case basis, with the understanding that it can be edited like any other article.
Although the Merck manual has an excellent reputation, the company's reputation (particularly regarding disclosure of risks of Vioxx) is not so stellar. Please remember, the company's first loyalty MUST BE to their stockholders, not to the general public.
For the last few years I have participated in numerous conferences and discussions at the Institute of Medicine and other venues about how pharmaceutical companies control much of the content in medical journals, continuing medical education courses, and presentations at medical conferences and grand rounds. It is a terrible idea to have them take over Citzendium too.
If we want the Citizendium to have any credibility at all, we need to avoid any collaborations like the one proposed by Merck. That being said, it would be ok to check individual articles and decide on a case-by-case basis whether to use them.
Sincerely,
Diana Zuckerman, Ph.D.
President
National Research Center for Women & Families
1701 K Street, NW, Suite 700
Washington, DC 20006
(202) 223-4000
----- Original Message -----
From: Kevin M. Kelly
To: mgrey at mfi.ku.dk ; 'Larry Sanger'
Cc: 'Biology Workgroup List' ; cz-health-sci at mail.citizendium.org
Sent: Tuesday, October 30, 2007 8:43 PM
Subject: Re: [Cz-health-sci] [5] Merck proposal
I agree!
'We' need to associate the compendium with authorative sources. Association
with Merck is a no brainer.
Now a belated hello. I am digging out from under my wave of obligations.
Best regards,
Kevin
<--
www.Toksave.com
www.KellyWebworks.com
www.MySignatureFile.com
-->
-----Original Message-----
From: cz-health-sci-bounces at mail.citizendium.org
[mailto:cz-health-sci-bounces at mail.citizendium.org <mailto:cz-health-sci-bounces at mail.citizendium.org> ] On Behalf Of Michael J
Grey
Sent: Tuesday, October 30, 2007 6:41 PM
To: Larry Sanger
Cc: 'Biology Workgroup List'; cz-health-sci at mail.citizendium.org
Subject: Re: [Cz-health-sci] [5] Merck proposal
Dear All,
I think this is an excellent idea. I have used the Merck Manual for many
years. I frequently refer my students to this source.
Best regards,
Michael.
MJ Grey, PhD
Associate Professor
Department of Neuroscience and Pharmacology & Department of Exercise and
Sport Science University of Copenhagen, Denmark
http://www.cph-ncm.ku.dk/mgrey/ <http://www.cph-ncm.ku.dk/mgrey/>
Larry Sanger wrote:
> All,
>
> The following is a proposal we received. I have some comments after it.
>
> ========
> First, let me applaud your effort to provide a wiki with content from
> expert contributors. There is a great deal of information available
> free online, though not all of it is reliable.
>
> Second, I propose a collaboration between Citizendium and the Merck
> Manuals department at Merck & Co., Inc. This department, of which I'm
> a staff member (Executive Editor, Electronic Publications), publishes
> The Merck Manual, a print and online textbook created by expert
contributors.
>
> We are prepared to place links in your External Links section of
> Citizendium topics to related material in our online version of The
> Merck Manual. Two
> examples:
>
> Subject: Guillain Barre Syndrome.
> Your page: http://en.citizendium.org/wiki/Guillain-Barre_syndrome <http://en.citizendium.org/wiki/Guillain-Barre_syndrome>
> The link in External Links would go to:
> http://www.merck.com/mmpe/sec16/ch223/ch223d.html <http://www.merck.com/mmpe/sec16/ch223/ch223d.html>
>
> Subject: Otitis Externa.
> Your page: http://en.citizendium.org/wiki/Otitis_externa <http://en.citizendium.org/wiki/Otitis_externa>
> The link in External Links would go to:
> http://www.merck.com/mmpe/sec08/ch088/ch088c.html <http://www.merck.com/mmpe/sec08/ch088/ch088c.html>
>
> Unfortunately, we are not in a position to author material for you,
> but we'd be delighted to add value to your pages with links to our
> material. We invite you to visit The Manual at
> http://www.merck.com/mmpe/index.html <http://www.merck.com/mmpe/index.html> to determine for yourself whether
> links to this content is acceptable and desirable. In a preliminary
> review, I found 40 to 50 Citizendium topics to which we could contribute.
>
> Please let me know if you are interested in such a collaboration.
> ========
>
> I can say (publicly on this list) that this would be welcome to me.
> Merck has an excellent reputation, and it seems unlikely that there
> would be anything in their manuals that we should not send users to.
>
> More important, perhaps, is that this very small request (it's
> basically just a request to add 50 links to CZ) might be the beginning
> of a useful collaboration.
>
> I'm inclined to say "yes," but I wanted to get your feedback first.
>
> --Larry
>
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>
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