Money or fame. I used to work for one such corrupt PI.

@@DylanYoung ughhh I hate to hear that. When I worked on site they would have research meetings to get input from different departments and with other oncologists.

Yes, that's what he's saying. Not sure if it's a criminal level or just malpractice (a civil suit). The uncle of a good friend of mine stroked out and died because they took him off his blood pressure meds and put him on placebo, I believe the family was able to get a civil judgment. Might be tough to get an involuntary manslaughter or negligent homicide conviction against someone with the cultural prestige of a physician-researcher, though. But I'd love to see it! Not only the researchers, but anyone else knowledgeable about what the usual standard of care should be but who officially signed off on conducting that study anyway.

You understand completely

Yes - and no. The problem (as I understand it) is that they didn't control for post-relapse treatment in the placebo arm. So the set-up is this: You have kidney cancer, it is operated on, and no cancer can be detected (let's say 3-8 weeks post-op. At this time you are randomised to either X) the drug or Y) placebo. THIS IS WHAT ADJUVANT TREATMENT MEANS. (Shouting because people misunderstand what "adjuvant" means in this context.) Then we follow over time. How many in each group a) has the cancer recurr, and b) how long do they live. This study shows that people in the X - adjuvant group lived longer/less cancer recurred. BUT a) Some people in the X group would not have had recurring disease/died regardless. They are not correcting for that. b) When cancer recurrs you treat it, optimally in this case - at this time, but not _everywhere_ on the planet_ - with the same drug given to group X. It is (probably) not that they actively withheld the drug in question from those in group Y whose cancer came back. It is that in group Y there was also people who live somewhere where they don't give that drug as first-line treatment (or at all) when a relapse happens (too expensive, other treatments favored, whatever the reason). There might also have been people in the placebo group Y that for some reason can't tolerate the drug they were investigating - hope not, that would border on research fraud (but there probably isn't easy clear contra-indications, but group Y got placebo, so any treatment-stopping side-effects wouldn't have occurred for them, for group X they would have been out of the study immediately.) The problem here, even if every single patient was treated optimally _for their circumstances_ (is drug in question available or not), is that you are not comparing "give drug as adjuvant" with "best _possible_ care if relapse", you are comparing "give very expensive drug to everyone" with "a grab-bag of treatments from all over the globe". Which means that your benefit of "expensive drug to everyone" will look much greater.

Giving the placebo in first line was fine because there was no alternative treatment. But afterr relapse, half of the people in the control arm received bad treatment, and that was unethical. If you or one of your loved ones has cancer, it is really absolutely mandatory to be an informed patient. Read and understand clinical guideline recommendations and engage with your doctor. Ask questions. If they're a good doctor, they will try to answer them honestly.

Agreed. I think the TRANSFORM trial on Lisocabtagene in DLBCL was a good trial. It did everything right that the ZUMA-7 trial on Axi in the same setting did wrong. It would be very interesting to see a head to head comparison of these two trials and to hear what that means for the treatments - is Liso really better than Axi, or was Axi just unlucky to have a shitty trial?

I think the issue is not exactly the methods, but it's that they are using the incorrect treatment on the control arm. If one was to read the study without knowing the standard of care in the field, they would not know that these studies are so bad. Unfortunately that means any scientist can't just read it and know it's bad. Though some of the things Dr. Prasad points out, like data presentation and missing information may be noticeable (but not guaranteed)

The IRBs should be a check and balance, but they are failing. Better would be to not have the manufacturer involved in stidy design. We need truly independent researchers

But good point that these boards should also be accountable. One idea would be required information on the standard of care as a separate part of the IRB submission. Maybe worth some independent doctors. Though we know if the manufacturer pays them they will be corrupt

What's worse is that there may very well be no benefit at all, and an increase in harms.

*oncology

I know two people recently diagnosed. One sadly passed away, the other a father barely 50. It’s a horrible cancer. Both males .

You can use same logic to explain all "diets" too. People have never heard of calorie restriction and its effects on health. Keto,vegan,carnivore,vegetarian,pizza+beer,all "work" in aleviating your symptoms or curing your disease AS LONG AS YOU'RE LOOSING WEIGHT. Things change if you aren't. And "ketones" are a God particle of nutrition.

What?

Citation needed

​@@nugsin4 look into how it works. It's basically a circular argument and doesn't match up to other dating methods we know match up to known history.

@@lokidarkbeard2647 Take a cross-section of a tree, C14 date the rings. Repeat this until you are satisfied that C14 dating is accurate. There are other methods, but the tree example is sufficient to dispel your confirmation bias toward young earth creationism.

@@Coolinteresting876 If you radiometric date anything we know the actual date of (like a historical pot for instance) you'll get a random date that is way off like 10,000 years off. When you radiometric date anything you give them a range of acceptable dates and they break your sample into parts and test each part and each part gives a different date. They then eliminate any dates outside the range you gave. They then take the top and bottom dates that are left and give you that as a range.