Relative efficacy assesment with mixed treatment comparison

Assessing the relative efficacy of new drugs: an emerging opportunity

"For the majority of new drugs, critical realtive efficacy information is lacking". A strong statement from an article written by EMA officials and a Harvard professor. The article makes two proposals to solve this conundrum:

• One is observational studies, which are comparatively low cost and reflect routine care, as they often involve retrospectively analysing existing data from patient registries, electronic health records or claims databases. By definition, however, they lack randomization and rely on data that are generated in routine care to assess patients’ health states, and on clinical end points that are prone to misclassification or incompleteness

• Mixed treatment comparison (MTC) indirectly assess the relative efficacy of two treatments, A and B, by using existing data from two or more RCTs that have compared each of the treatments to a common comparator (for example, one study comparing A versus placebo and another comparing B versus placebo, although there are more-complex MTC designs, including any available head-to-head RCTs). MTCs are fast and inexpensive as they rely on existing RCT data, some of which is produced even before a drug is marketed

A key requirement for successful mixed treatment comparison should be common end point definitions across RCTs. The article explains the promising COMET initiative, and I wonder why this wasn't created before.

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Caravan Palace à la salle Barts

Efficient health systems

The five principles behind the world’s most efficient health systems

I was reading The Guardian this morning and I found this article. Forget for a while if there are five principles or more, its an op-ed. These are the key principles:

1. Integrated care
2. Hospitals as Health Systems
3. Standardise and  simplify
4. Take social care seriously
5. Payer power

You may agree or not, but it is worth checking it out.

PS. If you want to know our research contributions on integrated care, I suggest you attend this workshop.

Caring for humanity

An ambitious agenda for humanity
One Humanity: a shared responsibility

The World Humanitarian summit will take place next May in Istambul. The Lancet  alerts its readers this week:

Worldwide, 60 million people have been forced from their homes by conflict and violence. Additionally, 218 million people are affected by disasters every year. What can be done to prevent and ameliorate this large-scale human suffering and improve our global response?

The UN report sets out five core responsibilities for the international community: political leadership to prevent and end conflicts; strengthen compliance to international law; ensure no one is left behind; move from aid delivery to ending need; and political, institutional, and financial investment into this agenda.
My personal impression is that more should be done, but unfortunately my hope over the impact of UN conferences is really very negligible.

Genome editing: a potential weapon of mass destruction

The Patent Dispute Over Gene Editing Technologies: The Broad Institute, Inc. vs. The Regents of the University of California

Nobody could imagine two decades ago that a small part of wide range of bacteria's immune system could represent so much for genome editing. Known as CRISPR, clustered regularly interspaced short palindromic repeats, such mechanism can recognise and defend against viruses. The other part of the defense mechanism is a set of enzymes called Cas that can cut DNA and avoid the invasion of viruses. Mostly, these research was originated in Les Salines d'Alacant by Francisco Mojica a microbiologist.
As far as this is a natural process Dr. Mojica didn't show interest in patenting it. Now the row over patents is hot between UC Berkeley and the Broad Institute. I will skip details, you may find it in The Economist.
It seems that the fight is only to determine who was the first, and the Court will have to decide on March 9th. However, my question is: why is it still possible to file a patent over human nature?.
Meanwhile the public debate may be moved towards the use of such CRISPR technology for genome editing, and Science was publishing an article about the threat that misuse represents for human beings. Are we facing a new weapon of mass destruction?
Both issues, patents and bioethical implications are crucial at the moment. Former examples provide clear guidance of outcomes that should be avoided. Unfortunately, the race for the biggest size of the pie (billions of $) seems to be a priority over health and humanity.

The failure of replication in economics (and health economics)

Is Economics Research Replicable? Sixty Published Papers from Thirteen Journals Say “Usually Not”

One of the main principles of scientific method is reproducibility. Wikipedia says:

Reproducibility is the ability of an entire experiment or study to be duplicated, either by the same researcher or by someone else working independently. Reproducing an experiment is called replicating it.
The values obtained from distinct experimental trials are said to be commensurate if they are obtained according to the same reproducible experimental description and procedure. The basic idea can be seen in Aristotle's dictum that there is no scientific knowledge of the individual, where the word used for individual in Greek had the connotation of the idiosyncratic, or wholly isolated occurrence. Thus all knowledge, all science, necessarily involves the formation of general concepts and the invocation of their corresponding symbols in language (cf. Turner). Aristotle′s conception about the knowledge of the individual being considered unscientific is due to lack of the field of statistics in his time, so he could not appeal to statistical averaging by the individual.
A particular experimentally obtained value is said to be reproducible if there is a high degree of agreement between measurements or observations conducted on replicate specimens in different locations by different people—that is, if the experimental value is found to have a high precision

If this is so, then somebody could test any specific article and its results. That's precisely what two researchers have done with sixty published papers. The conclusion is specially annoying:

We successfully replicate the key qualitative result of 22 of 67 papers (33%) without contacting the authors. Excluding the 6 papers that use confidential data and the 2 papers that use software we do not possess, we replicate 29 of 59 papers (49%) with assistance from the authors. Because we are able to replicate less than half of the papers in our sample even with help from the authors, we assert that economics research is usually not replicable.

If economics research is usually not replicable, then what about health economics?

PS. Somebody should change immediately the peer review process or othewise close the journal.

PS.  Experience Ai Weiwei at the Royal Academy of Arts online with Ai Weiwei 360.

A taxonomy of health behaviors

Mapping health behaviors: Constructing and validating a commonsense taxonomy of health behaviors