What's inside the box.: the future of clinical trials

Last week I reported for a newspaper on a huge trial on different approaches to diabetes screening published in the Lancet. It looked at 8 different ways of screening for type 2 diabetes in a population of 325,000 people over 50 years.
Except it didn’t really. It used a computer model, the Archimedes model, built up over many years. The model has had in the past, some fantastic successes, predicting the results of the CARDS trial with great accuracy, for example.
But there are times when for all the hundreds of thousands of data points, and the most sophisticated algorithms in the model, it gets things wrong. The model did not predict the results from the Illuminate trial that resulted in Pfizer stopping development on torcetrapib, its drug to reduce HDL levels, because of unexpected adverse results.
There is still a lot about the complex interaction of treatments and human physiology that we don’t understand and where we have to use empirical evidence.
Developing computer models of human physiology and the likely effects of medicines (or screening strategies) is likely only to increase as computing power grows. The Lancet trial would have been impossible to do in real life. It would have had to have begun before I was born and would have cost tens of millions of pounds to carry out. It came up with some results which should inform public policy on managing the diabetes epidemic.
But there will be fewer and fewer people who can understand what is going on inside the box. What are the assumptions made, what is the integrity of the data? Today a reasonably informed person can, with a little work, read published clinical trials and come to a sensible conclusion about their quality. If the findings come as the result of the workings of arcane formulae, and manipulation of complex datasets, there is much less opportunity for a non-specialist to be able to make any kind of judgement. I have seen the future of clinical trials, and it worries me.

This stuff shouldn't irritate me, but it does

Things reporters get wrong but shouldn't part45...

This report on abdominal obesity on the BBC health news website says 'Excess weight around the middle generates oestrogen and excess chemicals in the stomach, which put people at higher risk of killer diseases.'

I haven't checked the source materials, but I'm pretty sure the excess chemicals they are talking about are inflammatory cytokines. Which would be hydrolysed and destroyed if they were in the stomach, and so not in a position to do any damage. It's when the cytokines produced by the metabolically active fat gets into the blood that the trouble starts (and it's fair enough not to go into too much detail on the immunology...)

The BBC would not let a political or sport story containing such a howler to get through. Its reporters and editors are complete geeks about the different stages of a parliamentary bill or the Liverpool back four from 1974.

Didn't an editor somewhere along the line, wonder how chemicals in abdominal fat cells were transported to the stomach, and how they would then be in a position to increase the risk of heart disease, diabetes and cancer? Did no one in the news room have A level understanding of digestion?

Just looked up the source for the story. It's a churnalism classic: amplifying a badly written and ambiguous phrase in the press release and turning it into an error.

Lazy, careless and ignorant.

Rock markings

I've recently returned from a short break in Northumberland where there are huge numbers of cup and ring rock markings. I looked at the Ordnance Survey map (Berwick on Tweed, can't remember the number) and there were hundreds within a few miles of where we were staying near Wooler.
Like a lot of low-key prehistory they tend to be in wild and wonderful places. There doesn't seem to be a consensus view on their purpose (it seems improbable that they are the results of idle doodling, given how long they must have taken). I quite like the idea of a kind of neolithic graffiti artist, leaving his (probably) tag in the local area, buidling up respect, notoriety and kudos. I doubt if there's any evidence to support this.
There are some fab photos at Julian Cope''s brilliant Modern Antiquarian site.