Friday, November 04, 2005

Is even MKSAP(13) vulnerable to drug company influence?

Recently, I received the MKSAP 13 update cd.In the section of migraine, the update contained a review of a RCT on the use of topiramate in migraine prophylaxis.OK, fair enough. A corresponding question regarding management of a patient with two or more migraine attacks per week had as the "correct" answer, topiramate. My concern is not that it may well be a reasonable approach, but that it is the correct approach and no mention was made, for example on the use of propanolol or other often used medications for that application.I wonder if the drug companies have made some docs-including the junior academics who often do the heavy lifting in such ACP educational endeavors-reason at some level that RCT equals evidence based medicine (let us all bow towards Canada) and results from a RCT ( in fairness, there are more than one for topiramate) gives us the correct answer without considering the context of prior evidence-what drugs worked for migraine prophylaxis in the past. It just seemed like short shift was given to reasonable alternatives.I may be making more of this that it deserves but given the insight of the fact of major influence of big pharma on physician thinking and education I seem to see it everywhere.(As an aside the MKSAP CD did not agree with my pentium D ,widows XP machine as soon after I loaded the software, my computer gave me a gosh awful error screen and screeched to halt and the fix-it software recommened de-installing any recent add ons.I did and now I afraid to try it again) So if some details of the above reproach are not quite factually correct,I did this from memory.Let me also say I have gone through all of the MKSAPs over the years and find them a great educational took, warts and all but now that the activities of drug companies in spinning medical research and research reports is common knowledge it is hard to read anything with the naive trust I had before.

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