Should we believe what we read in professional journals?

When I pick up a professional journal, I am already convinced that what I read is based on impartial research and evidence. But should I be?
My assumption that articles are being provided by professionals with the public interest as a priority is the wrong assumption. I was unaware until just recently that pharmaceutical companies and medical device companies can be very generous in order to receive positive press about their latest drug or gadget. While, as a health care professional, I would like to believe that other health care professionals can provide unbiased research despite the gifts, I am not that trusting of human nature.
To be fair, journals are taking steps to prevent this practice of padding their publications with articles favouring the “latest and greatest.” Until it becomes routine, and every journal checks the background of their authors, I would suggest a double-check on that research your case may depend on.

Toddlers at risk from codeine

The maternity world was turned upside down in the past few years with the realization that a common painkiller administered to mothers following childbirth was having disasterous results for newborns. Now it has been established by Canadian researchers that toddlers with the same genetic variation as those newborns have died from the same drug given directly to them following surgery.

According to research done at the University of Western Ontario in London and the Hospital for Sick Children in Toronto, the very common drug is acetaminophen and codeine (one familiar brand name of this combination is Tylenol 3). Unfortunately, there are very young children with a genetic variation who convert the codeine into morphine very rapidly. The morphine then slows breathing and a high enough dose will stop breathing resulting in death.

These findings are significant for cases where an otherwise “healthy” young child has undergone an uneventful procedure yet had complications such as respiratory arrest or death. If the child received codeine, that could be the root of the problem.

Avandia Increases Risk to Type 2 Diabetics

In a recent study by Toronto’s Clinical Evaluative Sciences, the drug Avandia (rosiglitazone) demonstrated an increased risk of heart failure and death when compared to the other drug for the treatment of Type 2 diabetes, Actos (pioglitazone).

As published in the British Medical Journal, the study examined the records of 40 000 patients treated with these drugs; 23% were less likely to be hospitalized for heart failure and 14% less likely to die when given Actos (pioglitazone) instead of Avandia (rosiglitazone). This has major implications for the millions of patients treated for Type 2 diabetes in the last several years. Based on the study, for every 120 people taking Avandia, one more was hospitalized and for every 269 people, one would die.

The makers of Avandia, GlaxoSmithKiline, have initiated their own study in response. The results will not be known for several years probably after the two drugs become available as generic formulas.

Dr. Juurlink, principal investigator, has dismissed criticisms from GlaxoSmithKline that the study may have only dealt with patients who were sicker. He points out that you would expect to see more heart attacks if the patients taking Avandia were sicker yet the study revealed that there was no difference in heart attack rates between the two groups.

As Dr. Steven Nissen, chair of cardiovascular medicine at the Cleveland Clinic, has said, “I guess the final word would be: Who would want to take the chance? Why would you? So from my perspective while you can argue that it may not end the story, in the meantime, what should physicians do? And I think the answer is they should use the safer of the two drugs.”