Sunday, 14 July 2013

Antibiotics for back pain - the saga continues

A series of articles have appeared on the ESJ in response to the 'antibiotic for back pain' study by Albert et al.  There are three letters to the Editor, two of which are mine, and one of these points out the clear undeclared conflicts of interest of the authors.  There is also an editorial, it's worth reading yourself to reach an opinion of course, but it does appear to be a rather aggressive and blustering defence of the journal's stance and actions.  There are some sentences that simply don't make great sense:

"Against this background, it seems that a mass media launch in the United Kingdom, Europe, and North America with the story rapidly being taken up around the world, offering a ‘‘cure’’ for back pain propagated from a private clinic in London, should be considered unwise"

While the way in which the Editorial glosses over the conflict of interest issue is interesting, to say the least:

"One of the authors of the Southern Denmark papers has a commercial link with this organisation and addresses this conflict of interest elsewhere in this edition of the European Spine Journal."

This is factually wrong, actually 2 of the authors are named company directors of MAST Medical firms as I have stated on this blog.  The Editorial strangely doesn't  mention that one of the Albert/Manniche's business partners in the MAST MEDICAL companies, Peter Hamlyn, was directly involved in creating the media fanfare and mass hysteria:

"This is vast. We are talking about probably half of all spinal surgery for back pain being replaced by taking antibiotics" (Peter Hamlyn of MAST Medical in Guardian)

There is thus a complete failure of the Editorial to even notice that the massive media fanfare was instigated by the author/s and their very well rehearsed PR campaign, involving their business partners such as Peter Hamlyn.  The bizarre accusations levelled at bloggers like myself made me crack up:

"This mass media launch has led to a very widespread and negative feedback in the lay and specialist medical media. Obviously, this is an unregulated, opinionated repository for often extreme opinions, but there must be significant reputational risk both to the scientists, the commercial organisation in London and to the spinal community in general from some of these widely read internet resources (see ferret fancier, and the conversation). In addition, there has been a cynical response from the respected medical press [17]although a subsequent article gave a slightly more tempered response [18]."

The irony of the 'unregulated' and 'opinionated repository' is highly amusing given the completely unregulated freedom of peer reviewed journals to do precisely that!  Margaret McCartney is labelled 'cynical' for daring to question undeclared conflicts of interest!  I would like to personally thanks Margaret for her work on this as I feel without her pressure the Journal may well have buried a lot of this criticism. The Editorial simply tells us what is right near the end and again makes no mention of the authors' and MAST Medical's PR being the prime reason for the media fanfare that ensued:

"We believe that the surgical and scientific communities should have a tempered and objective response to these publications."

The overall point is simple.  Two authors were named company directors of firms that stood to directly profit from the results of research,and this was not declared when the articles were submitted, despite that fact that both authors were named company directors two years before the articles were even submitted!  The author/s have a lot of explaining to do and I struggle to see how they can dig their way out of this hole they have created for themselves.  The Journal also failed to pick up this undeclared conflict and appears to still be in denial on the issue.

The Journal has not behaved impressively either, this sort of aggressive defensive posturing doesn't do them any favours at all.  The Editorial contains basic factual errors and ignores the way in which the media fanfare was MAST Medical driven. The attempt to smear those, including myself, who have attempted to expose the truth is weak.  I suggest that the 'reputational risk' to the scientists is 100% self inflicted, the failure to declare serious conflicts of interest is a major professional failing that the Journal should be taking far more seriously.  The fact that these conflicting interests were undeclared had a major impact on the way in which the research was reported, and interpreted by doctors and patients alike.  This should be acknowledged at the very least.

ps I must also say that it is a remarkable coincidence that the Editorial is written by John O'Dowd and Adrian Casey, the latter of whom happens to work at the same private hospital at which Peter Hamlyn (MAST Medical Academy) also works!  Just chance I presume


Anonymous said...

My mother-in-law had the awful experience of being given back pain medication when she had a bladder infection, and so she should have been given an antibiotic rather than the anti-inflammatory she was prescribed. Research articles should not published by authors who do not clearly state their affiliation or if they have a conflict of interest with the topic in question, as is discussed in this blog. I do not know if the medical practitioner who attended my m-i-l had read such an article (gee I hope not), but it seemed quite incredible to me that he did not ascertain if she did in fact need an anti-inflammatory rather than an antibiotic. Simply testing her urine would have cleared up this issue. It is irresponsible to publish research articles, which may be read by medical practitioners, that might cause confusion or inappropriately influence decisions about patient care.

Rachel Matteson said...

They should be careful with how they provide their patient care. It is unbelievable to give antibiotic to people with back pains especially if they do not have infections.

Novak Jim said...

This anti-bionics is working but here I want to ask a question that is there any side effect of these medicines to use for a long time?
physiotherapist bergen county , physical therapy bergen county

Heather Monts said...

I search blogs all the time, as I blog myself. I have chronic back pain due to Digenerative Bone Disease at the age of 16, I am now 36 and I feel as though I am 90. Thanks for sharing the information.

Pain Management Doctors In NJ said...

Dr. Ajay Kumar promovierte to MEDIZIN der renommierten All India Institute of Medical Sciences, New Delhi, Indien. Er tat residencey Sein und für Physikalische MEDIZIN rehabiliatation der Temple University Hospital, Philadelphia.

Mark said...

Found your blog and enjoyed reading your material. I'm a blogger myself and suffer from back pain. I find I have very little faith in the modern day in medical professionals. Thanks for the info.

Contoured Pillows said...

Nice blog. Carry on .
Back Pain Treatments

Here! said...

This is so great! Love this! hahaha!

albina N muro said...

Anyone can do exercises for better posture but the problem is that they take way too long. Sometimes 20 to 30 mins per session, 3-4 times per week. There has to be a better way to get good posture fast!!? Click for bodyaline

Tara said...

@Albina - but you have to understand that if you don't PRACTICE good posture (which is what those exercises are) you'll never have good posture because it's a HABIT not just a switch you can flip!

generic ibuprofen said...

Thanks for giving nice information regarding back pain problems. It would be more helpful if it contains treatment tips.
generic ibuprofen

Cervical Spinal Stenosis Los Angeles said...

Spinal stenosis is one of the most common causes of neck and back pain, affecting an estimated 500,000 individuals in the U.S. The condition is characterized by a narrowing of the spinal canal that puts pressure on the spinal cord or exiting nerve roots. Spinal stenosis is often the result of degenerative changes within an aging spine and may lead to chronic pain or neurological deficit.

Mike Richards said...

One of the nice information about the back pain.Thanks for this information .I really appreciate your work, keep it up.

Physical Therapy said...

I think that the antibiotics can help us to get rid of the back pain but only for a short period of time and the pain will come back with more acuteness. So we should think about a proper treatment of this pain like the physical therapy sessions.

rekha said...

Good post....Pain is an unpleasant conscious experience that emerges from the brain when the sum of all the available information suggests that you need to protect a particular part of your body. When a health illness or condition is chronic it means it is long-lasting. visit our site for good tertments for Back Pain, Diabetes, Fibromyalgia, Thyroid.