Doug Bremner has a blog. That blog stinks.

Bremner is an apparently well-regarded psychiatrist, and takes a refreshing look at the influence of industry not just on pharmaceuticals but on the conduct of science itself. His outspoken views have led to attempts to squelch his academic freedoms. But his sometimes-heroic record does not excuse dangerous idiocy.

I can understand how wading into the cesspool that is conflict of interest can leave one cynical. But cynicism and suspicion turned up to “11” is no longer bravery—it’s crankery. It’s not his snarkiness that burns—it’s his inability to separate his biases from the facts.

It’s not like the pharmaceutical industry doesn’t deserve to be taken to the wood shed. Examples of unethical and downright immoral practices abound, such as ghost-writing, fake journals, and a host of other sins. But the industry has also helped develop a most remarkable pharmacopeia which saves and improves countless lives. There is good, and there is bad. And telling the two apart, well, that makes all the difference.

He tends to go for headlines that hit hard, but miss the point entirely. Examples:

  • Angioplasty Found to be Useless Waste of Money: he cites a journal article which he says concluded that “not useful for patients with stable coronary artery disease (CAD). ” His title would be accurate if angioplasty were used only in stable CAD—it is not.
  • Should I Take Aspirin or Put a Gun To My Head?: here, he sort of gets the difference between primary and secondary prevention, but not really. He also likes to admit that the data contradict his conclusion but he’s nice enough to say, “screw the data”:

    Although technically the risk of stomach bleeding is outweighed by the heart benefits of aspirin (which can only be shown when large numbers of patients are studied), in terms of what that means to you the differences are clinically meaningless.

  • This Just In: Breast Cancer Screening Essentially Useless: yes, Doug, breast cancer screening doesn’t benefit everyone equally. For example, the prevalence of breast cancers in men is low enough that recommending it for you would be stupid—like your article.

This type of consistent inconsistency is why a headline like this is hard to take seriously: Flu shots are [still] for idiots. It’s always good to re-examine the evidence behind our practices. Influenza vaccination uses tremendous resources, and it’s important to know what benefit, if any, we get from this expenditure. But Doug hates evidence that contradicts his pre-formed conclusions, so conveniently ignores it.

First, though, his “facts” are wrong. For example:

The problem is that there are many strains of flu and the vaccine targets only one, and you need the shots every year cuz the viruses keep changing.

No. Each year’s flu vaccine is a mixture of various strains that are circulating or that are likely to become the next season’s prevalent strains. I’m not sure why he sees this as a weakness. It is a weakness. If flu were more like pertussis, for example, we would only need one vaccine with occasional boosters. Flu does not comply with my wishes, and that’s sad, but that’s the way it is.

Moving on to graver sins of ill reasoning:

And that oft quoted figure of 30,000 deaths per year? Half of those cases of the “flu” are actually flu-related illness that is not actually caused by an influenza virus (and not prevented by flu shots). And most of the rest are in the elderly who often have impaired immunity so the flu shot wouldn’t work for them anyway.

The figures on flu mortality are derived from a complex model that is not without flaws. We need to estimate because we don’t test everyone. If anything, though, they underestimate flu mortality. As for the elderly having impaired immunity leading to the shot “not working”—well, that’s poppycock. This begs the question quite ferociously. His brief statement has several unfounded assertions: all elderly who get the flu have impaired immune systems; these same people would not derive sufficient immunity from the vaccine; and that half of the 30K are in this group. This many assertions in one sentence makes my head spin, but not in a good way. Whether and how much flu vaccines benefit the elderly is a difficult question, but there is significant data that the elderly benefit from these vaccines.

This of course ignored the fact that for swine flu, it it the young, not the elderly who are the primary target group for immunization. You see, all flus are not created equal. Every season is different, and broad, unsupported conclusions such as Bremner’s are usually unwise.

But back to the cherry picking: he relies strongly on a single study from the British Medical Journal by Tom Jefferson. He didn’t bother giving the actual citation, which is good for him. If he had, the reader would see that the “study” is actually an editorial, and that subsequent letters effectively eviscerated the argument. He of course does not bother to mention data that do not support his conclusions.

The reason Bremner’s blog sucks is that he’s essentially a one-trick pony. Every article is about a vast conspiracy. Without what is sometimes known as the Pharma Shill Gambit, he’s got nothing. And given the quality of his pieces, perhaps “nothing” is what he should be doing more of.


Posted by Peter Lipson

Peter A. Lipson, MD is a practicing internist and teaching physician in Southeast Michigan.  After graduating from Rush Medical College in Chicago, he completed his Internal Medicine residency at Northwestern Memorial Hospital. He currently maintains a private practice, and serves as a teaching physician at a large community hospital He also maintains appointments as a Clinical Assistant Professor of Medicine at Wayne State University School of Medicine and at Oakland University William Beaumont School of Medicine, the first being a large, established medical school, the latter being a newly-formed medical school which will soon be accepting its first class of students.  He blogs at White Coat Underground at the Scientopia blog network. A primary goal of his writing is to illuminate the differences between science-based medicine and everything else.  His perspective as a primary care physician and his daily interaction with real patients gives him what he hopes is special insight into the current "De-lightenment" in medicine.  As new media evolve, pseudo-scientific, deceptive, and immoral health practices become more and more available to patients, making his job all that much more difficult---and all that much more interesting. Disclaimer: The views in all of of Dr. Lipson's writing are his alone.  They do not represent in any way his practice, hospital, employers, or anyone else. Any medical information is general and should not be applied to specific personal medical decisions.  Any medical questions should be directed to your personal physician.  Dr. Lipson will not answer any specific medical questions, and any emails and comments should be assumed public. Dr. Lipson receives no compensation for his writing. Dr. Lipson's posts for Science-Based Medicine are archived here.