Epidemiological ievirzes rakstinji neskaitaas. Kur ir RCTs?


"..meta-analyses evaluating the effects of red meat intake have generated mixed findings and do not formally assess evidence strength. "

https://www.nature.com/articles/s41591-022-01968-z

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The analysis of experimental studies in rats with chemically-induced colon cancer showed that dietary hemoglobin and red meat consistently promote aberrant crypt foci, a putative precancer lesion. The mechanism is not known, but heme iron has a catalytic effect on (i) the endogenous formation of carcinogenic N-nitroso compounds and (ii) the formation of cytotoxic and genotoxic aldehydes by lipoperoxidation. A review of evidence supporting these hypotheses suggests that both pathways are involved in heme iron toxicity. Cancer Prev Res; 4(2); 177–84. ©️2011 AACR.

eksperimentāli pētījumi tiek uzskatīti par spēcīgāko kauzalitātes evidenci.

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no kādas RCT nāk šie dati, ko tu prezentē?: "..15% to 35% of heme iron is absorbed..... non-heme - 2% to 20%"

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76% pēdējo pāris gadu laikā publicēto RCT ir farmokoloģijas industrijas finansēti pētījumi ar būtiski pozitīvākiem rezultātiem nekā industrijas nefinansētie RCT (publication bias). neredzu pamatojumu dot priekšroku RCT kā pētījumu formai, kaut vai skatoties uz SSRI pētījumu fiasko.


Background: There has been substantial interest from the pharmaceutical industry to study and develop new biologic agents. Previous studies outside of the biologics field have demonstrated that industry funding has the potential to impact the design and findings of clinical trials. The objective of this study was to evaluate the impact of industry funding on randomized controlled trials (RCTs) that investigated the efficacy of biologic therapies. Methods: A review of all RCTs involving biologic therapies in top impact factor medical journals from January 2018 to December 2020 was performed. The relationship between industry funding and the presence of statistically significant primary outcomes and the use of active comparators were analyzed. Results: Among the 157 RCTs included, 120 (76%) were industry funded and 37 (24%) declared no industry funding. Industry-funded studies were significantly more likely to report a statistically significant positive primary outcome compared to studies without industry funding (85% vs. 67%, χ2 = 5.867, p = 0.015) and were significantly more likely to utilize placebo or no comparator than non-industry-funded trials (78% vs. 49%, χ2 = 4.430, p = 0.035). Conclusions: Industry-funded trials investigating biologic therapies are more likely to yield statistically significant positive outcomes and use placebo comparators when compared to non-industry-funded biologic therapy trials in high-impact medical journals.

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Gazendam, A.M., Slawaska-Eng, D., Nucci, N., Bhatt, O. and Ghert, M., 2022. The impact of industry funding on randomized controlled trials of biologic therapies. Medicines, 9(3), p.18.

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>> neredzu pamatojumu dot priekšroku RCT kā pētījumu formai, kaut vai skatoties uz SSRI pētījumu fiasko.

Neiesaistoties pārējā diskusijā, šis ir aplams secinājums. Par antidepresantu vājajiem rezultātiem jau mēs zinām, tikai pateicoties RCT. Nekādus citus pierādījums regulatori jau vispār neņems vērā, jo salīdzinājumā viss pārējais ir fufelis. Protams, big pharma centīsies šmaukties arī ar RCT, bet nu tāpēc jau ir vajadzīga kritiska izvērtēšana, nevis vienkārši citēšana – “lūk, šis (ārkārtīgi zemās kvalitātes) RCT saka to un to, tāpēc tā ir vienīgā patiesība”.

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