Denialism

The message and the messenger

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by

MarkH
in

ResearchBlogging.orgI’m not sure what to make of this. An article in the latest Journal of the American Medical Association (JAMA) reports some potentially good news for type II diabetics. Type II diabetes has been extensively studied (detailed post to follow), and one area of difficulty has been reducing the incidence of macrovascular disease (heart attack and stroke, primarily). Treating blood pressure and cholesterol aggressively in diabetics helps, but controlling blood sugars closely doesn’t seem to help with these particular sequelae of diabetes.

Further complicating the picture was some data released last year about rosigitizone (Avandia), an oral diabetic drug. This showed possible increased cardiac mortality with the use of this medication, although the numbers weren’t too convincing.

So, the new article reports on pioglitizone (Actos), a close relative of Avandia. The data seem to indicate that, versus another type of oral diabetes medication, Actos reduced incidence of death, heart attack, and stroke.

Hmmm. Dr. Steve Nissen, who has always been out front in denouncing potentially dangerous drugs was a lead author on this study. He was also very noisy about the harm of Avandia.

It just seems like an odd coincidence that he should be out front decrying the (possible) harm of one drug, and then be the lead author of a study supporting the use of its main competitor. Nissen has an excellent reputation, so nefarious motives are probably out. But it does show that who says something can be almost as important as what is said.

Nissen, S.E., Nicholls, S.J., Wolski, K., Nesto, R., Kupfer, S., Perez, A., Jure, H., De Larochelliere, R., Staniloae, C.S., Mavromatis, K., Saw, J., Hu, B., Lincoff, A.M., Tuzcu, E.M. (2008). Comparison of Pioglitazone vs Glimepiride on Progression of Coronary Atherosclerosis in Patients With Type 2 Diabetes: The PERISCOPE Randomized Controlled Trial. JAMA: The Journal of the American Medical Association, 299(13), 1561-1573. DOI: 10.1001/jama.299.13.1561

Comments

  1. Steve Schonfeld

    So, the new article reports on pioglitizone (Actos), a close relative of Avandia. The data seem to indicate that, versus another type of oral diabetes medication, Avandia reduced incidence of death, heart attack, and stroke.

    Did you mean that Actos reduced incidence of death, heart attack and stroke?

    Reply
  2. Anonymous

    So, the new article reports on pioglitizone (Actos), a close relative of Avandia. The data seem to indicate that, versus another type of oral diabetes medication, Avandia reduced incidence of death, heart attack, and stroke.

    Did you instead mean to say that Actos reduced incidence of death, heart attack, and stroke?

    Otherwise, I don’t understand it at all.

    Reply
  3. PalMD

    d’oh!

    It took you guys almost an hour to find my error, so I blame you.

    Reply
  4. Dianne

    Also notable: the trial was sponsored by the company that makes actos and the sponsor had a role in both collecting and evaluating the data. It might be interesting to do a head to head comparison of the two drugs and see how they perform when directly compared, if such a trial could still be ethically conducted.

    Reply
  5. metabopharm

    You are incorrect. They did not measure death heart attack or stroke. They found a few microns difference in the thickness of aterial plaques. The difference was found using a device Nissen patented. He has been a paid consultant to Takeda, makers of Actos, for some time. His meta-analysis implicating Avandia was deeply flawed. Go to Medscape and you can view a vidotaped lecture of a real epidemiologist from UT San Antonio, Steven Haffner, demolish Nissen’s analysis in NEJM. See URL above.

    Reply

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