Monday, April 19, 2010

"Unadjusted model." Why? [methods rant]

performing yet another manuscript review provokes a methodology rant:


technical note: why report an unadjusted analysis? if your study requires adjustment for confounders / covariates, then it simply makes no sense to report the results of your study BEFORE you have gone and adjusted for the fact that you know it has biases?

why?

i guess in an elliptical way, you could argue that the difference between the unadjusted and the adjusted analyses tells you the degree of prediction due to the adjusters / the covariates.
but if this is important, then just include them in your results table. report their weight, odds ratio, etc.

and give a "p" level if you feel like you need to.
if covariates, as a block, are interesting, then step them in on their own step in a hierarchical model.
step in demographic measures in one step.
step in comorbid conditions in the next.
step in psychosocial in another.
there. done. you have your info. done the proper way.

but reporting "unadjusted," and "adjusted," as if we are seeing things in various ways to round out our view? i don't get it. is it like when you get your eyes examined? which is better. this? ....or this (flip). this...(flip) or this?
we know which is better: the adjusted model. you would not run an adjusted model, otherwise. right? is it just me?

Tuesday, April 6, 2010

Pfizer: Feds encourage shell game to hide blame

Pfizer: Shell game to hide the blame. Read this recent CNN story - good job, CNN! We will miss this type of story when you go under!  Now, ask yourself: how much do you trust these drug companies? Has the level of shannanigans risen to the point where you no longer trust them? And consider: this con game worked by taking actual resaerch info, spinning it in the marketing blender, adding in some MD spokesmodels to clue in our overworked physicians, with the open basket of money coming from our tax dollars. In other words, worthless oversight at all levels, except maybe the poor grunts having to actually carry out the basic research.


http://www.cnn.com/2010/HEALTH/04/02/pfizer.bextra/index.html?iref=allsearch
"...any company convicted of a major health care fraud is automatically excluded from Medicare and Medicaid. Convicting Pfizer on Bextra would prevent the company from billing federal health programs for any of its products. It would be a corporate death sentence.
"Prosecutors said that excluding Pfizer would most likely lead to Pfizer's collapse, with collateral consequences: disrupting the flow of Pfizer products to Medicare and Medicaid recipients, causing the loss of jobs including those of Pfizer employees who were not involved in the fraud, and causing significant losses for Pfizer shareholders.

"We have to ask whether by excluding the company [from Medicare and Medicaid], are we harming our patients," said Lewis Morris of the Department of Health and Human Services.

"So Pfizer and the feds cut a deal. Instead of charging Pfizer with a crime, prosecutors would charge a Pfizer subsidiary, Pharmacia & Upjohn Co. Inc."