There is occult medicine amongst us. I’m not talking about witchdoctors, faith healers, crystals or miracle cures. I’m talking about Big Pharma.
The definition of occult from the OED is occultare ‘secrete’, frequentative of occulere ‘conceal’, based on celare ‘to hide'; the adjective and noun from occult- ‘covered over’, from the verb occulere. Occult is also used in medicine to describe conditions not readily diagnosed by manifest symptoms meaning that other options will have to be used e.g. blood tests.
Big Pharma regularly occults data, refusing to let the biomedical community access its full store of information. Select information is released, mostly putting positive spins on trials. Negative results are occulted. It is hard to determine how much information revealed to Big Pharma is occult. Is it a bigger percentage than the percentage Big Pharma have published? Who can say. What is known though that governments down to individuals have practiced unknown or secret medicine.
The AllTrials campaign is trying to turn the situation around by forcing Big Pharma to register and report the results of all trials, past, present and future. The Declaration of Helsinki recognised the ethical importance of releasing all clinical trial data but Big Pharma (and other research groups) still resist or ignore it. Efforts such as that of Peter Doshi and Tom Jefferson in wresting information about Tamiflu demonstrate the extent to which Big Pharma resist releasing information.
All results from any sort of clinical trial must be released, be it negative, indifferent or positive. Otherwise, clinicians practice occult medicine and lose the scientific and moral upper-hand when it comes to fighting quack medicine.
Last year, I gave an introductory talk about a collabrative health literacy program the RMH Health Services Library initiated with public library systems in our catchment area. The basic outline of this program: ask libraries what health topics are of interest to their communities and then find staff to volunteer time to deliver a talk. This is an update on this program. I am happy to say that the hospital executive have given their support and it is now part of the official partnerships program. The talks this year will be arranged in a less ad hoc fashion. There will be 6 given by staff from the HARP program and the SubAcute Ambulatory Care program on topics around successful aging through to managing chronic disease such as heart failure and diabetes. The talks will be at the branches of one public library system to start with and will possibly expand from there. The health literacy initiative has also expanded to include training public librarians about free health resources they can use in the event of questions from patrons around health, nutrition, exercise, drugs and tests. I was invited to speak at two of the Moreland Libraries staff forums late last year, and it was an excellent opportunity to talk to librarians working with the public about free resources that they may not know of. The future of this program may also include developing a free educate-as-you-go training resource for public librarians – a very interesting and exciting possibilty that I will keep you all informed of.
Do you search for studies for potential inclusion in qualitative systematic reviews? If you do, you might be interested in this quality assessment tool developed by Dr Christopher Carroll and Dr Andrew Booth. QuaRT aims to assist reviewers with decisions about inclusion and exclusion of qualitative studies by asking questions in 4 domains: question and study design, selection of participants, method of data collection and method of data analysis. This is still a new tool and as it has been developed during writing of a health technology assessment, it has not gone through metholdological development, testing and evaluation. If you plan to use this tool, Drs Carroll and Booth would be interested to hear from you. http://quart.pbworks.com