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In reply to Lenzer, let me just note that she herself listed Newman’s evaluation of tPA as her source for the false meme that “ten of twelve clinical trials not only found no benefit for tPA, but did reveal significant increases in brain bleeds, a side effect of tPA.” That claim was in effect simply a carbon copy of what EM physician Jerome Hoffman has been saying for twenty years, often with Lenzer’s rhetorical help but with diminishing support from EM colleagues. I’d argue that Newman’s behavior, which resulted in a 2- year jail sentence, was relevant in that it would enter into any discussion concerning respect for what his patients need and not what he wants. As for “clear, unfettered facts,” Lenzer doesn’t cite any in her HNR blogpost because she doesn’t have any. Whether Gary Schwitzer and fellow editors at HNR were hoodwinked I cannot say. But for their assessment of Gina Kolata’s article, they clearly depended on tainted sources that eviscerate their own critical standards and review criteria. They should recognize that Jerome Hoffman, David H. Newman, and other perennial skeptics of tPA for stroke sound today the way Thomas Carlyle once described an elderly, anachronistic and querulous Florence Nightingale — like “a lost lamb bleating in the wilderness.”
I for one mourn the closing of HNR. It was a fantastic resource that helped to roll back the often fantastical claims of commercially driven medical and healthcare messaging. And it did so with a clear, objective set of measures. Their staff and board (I am neither, though I have contributed some reviews without pay) are meticulous, smart and careful and they have been the single most important source of media and medical analyses available anywhere – which is why luminaries in medicine love HNR and actually began emailing each other recently in the hopes of saving HNR.
Indeed the loss of HNR means we will be left with the typical industry-friendly critiques that are so utterly misleading (see Simmons piece above as one example). As is typical of the inflated claims of industry and their true believers, they exaggerate benefits, ignore or downplay harms, aren’t transparent about their conflicts of interest and play dirty in ways most of us wouldn’t.
I’ll take that critique point by point: Simmons supports tPA without pointing out that many studies indeed didn’t find a benefit, and rather than quibble over the number of studies, let it be clear that the vast majority found no benefit and only a couple found to the opposite. As for harms – it is undeniable that harms can be severe as even the single most-cited study of benefit noted a six-fold increase in brain bleeds. As for not being transparent about conflicts of interest, something most readers believe is important, the NY Times article Simmons cites failed to disclose that most of Kolata’s sources had financial ties to the manufacturer of tPA. Finally, as for playing dirty, many doctors who have brilliant reputations as leading methodologists have repeatedly cautioned about the overhyped claims regarding tPA for stroke. Yet Simmons chooses to claim that David Newman, whom Simmons claims is “the source” for the dissenting and critical view of tPA, was jailed for sexual abuse. Indeed it’s true that Newman was jailed for sexual assault, as well he should have been – but what in heaven’s name that has to do with a medical critique is well beyond me – yet Simmons claims this is “relevant.” to stoop that low just exposes that Simmons doesn’t have facts or statistics to back his claims, something HNR has been very careful to insist on: clear, unfettered facts.
Although many journalists and readers will lament the closing of Health News Review, I won’t so much. One recent critique of a New York Times story by Gina Kolata (March 26, 2018) concerning the use of tPA for acute ischemic stroke contested her reporting, citing “lingering uncertainty” about the drug and repeating the false meme that “ten of twelve clinical trials not only found no benefit for tPA, but did reveal significant increases in brain bleeds, a side effect of tPA.” The source cited for that specious claim was a personal evaluation by an emergency physician, David H. Newman, who was recently arrested for sexually assaulting a patient in the ER, convicted and sent to prison. (This relevant fact went unreported in HNR.) For the record, tPA for stroke is widely endorsed as standard of care and a key component of ongoing research to improve acute stroke care. A rump of contrarians contests its value today just as they have for 20 years. For the record, I’m co-author of tPA for Stroke: The Story of a Controversial Drug (Oxford University Press), and declare no conflict of interest and no relationship whatever to the drug’s manufacturer..