Dr. RW and then DB's Medical Rants correctly point out that the absence of recognized ties with or support by drug companies does not insure a conflict of interest free argument or medical publication.
Dr.RW discusses what on the surface might appear to be an evidence based analysis of the end results of the US system of medical care and the single-tier,single payer system found in Canada. Several of the authors of this article which proudly announces that there are no conflicts of interest actually are quite active in the politics and lobbying efforts for a single payer system in the U.S and supporting the current system in Canada while arguing for more funding.
The lead author is the Dr. Gordon Guyatt,who could accurately be described as one of the founding guru of evidence based medicine as well as a politician.
What better form of evidence based medicine could there be for a propaganda piece than a meta-analysis? A meta-analysis is basically an observational design with the "subjects" being published studies.The authors are free to decide which studies are included and which are rejected.In the instance highlighted by Dr.RW the authors do not even tell the reader how that selection-deselection process was done.(You have to contact them to get the details.) Even when the authors disclose the process-as is typically the case- the reader must suspend concerns about possible bias -or ulterior motives-to accept the article at any approximating face value. There is more faith in the acceptance of a meta-analysis than in a randomized trial.
Dr. Steve Goodman's Annals of Internal Medicine editorial expands on the issue of what a meta-analysis really is and illustrates how two meta-analyses done by reputable researchers can reach opposite results because the authors believed or did not believe that certain studies should be included in their analysis.
Criticisms of meta-analyses aside, the major point excellently made by DR. RW is that authors who have strongly held views on social-medical issues and are actively promoting a given social or political agenda should be considered as much of a source of a conflict of interest as someone who fronts for a drug promoting article.
