People are now starting to catch on:
http://heartdisease.about.com/library/weekly/aa092000a.htm
"Heart Disease / Cardiology: Should calcium blockers be avoided in hypertension?
By DrRich
A recent meta-analysis strongly suggests that the use of calcium channel blockers in the treatment of high blood pressure significantly increases the risk of both heart attacks and heart failure. The report has engendered a firestorm of protest from the pharmaceutical industry and from several hypertension experts.
The report was presented in August, 2000 at the Congress of the European Society of Cardiology by Dr. Curt Furberg, Professor of Public Health Services at the Wake Forest University School of Medicine, and well-known expert on the effectiveness of cardiovascular drugs. Furberg’s study found that patients taking calcium blockers had a 27% increase in heart attacks, and a 26% increase in heart failure, as compared to patients taking other kinds of drugs for hypertension. Furberg concluded that, when treating hypertension, doctors should avoid calcium blockers whenever possible, using diuretics, beta blockers, and ACE inhibitors instead.
Responses to this report from hypertension experts and from the pharmaceutical industry was instantaneous. In press releases and in interviews with news services, various leading lights in the hypertension community described Furberg’s report as being “unbalanced,” “outrageous,” “unscientific,” “inflammatory,” and “inappropriate.” The terminology they used in private conversation, some say, was less complimentary.
The International Society of Hypertension released their own meta-analysis (the WHO-ISH study) on August 24, and found no problem with long-acting calcium blockers. [How could a sound statistical method produce two completely different answers? Answer: It can't. Meta-analysis is not sound.]
Pfizer, which sells amlodipine (the best selling calcium blocker), pointed out in a press release that only 190 of the 27,000 patients in Furberg’s study were taking their drug.
All critics agreed that the big problem with Furberg’s data was the meta-analysis he used.
What’s a meta analysis?
A meta-analysis is a relatively new statistical technique which combines the data from several clinical trials that all address a particular clinical question, in an attempt to estimate an overall answer to that question.
The reason meta-analyses are necessary is that similar clinical trials addressing a particular question frequently give different answers. The meta-analysis is a means of trying to come up with an overall best answer, given the available data from all the trials. When properly done, meta-analyses can give important insights to clinical questions, insights that can be gained in no other way.
There are many inherent problems with meta-analyses, however. By selecting which trials to include in the meta-analysis and which to exclude, by weighing which outcomes are the most appropriate to measure, and by making many other decisions in choosing the methodology for performing the meta-analysis, often (it is said), the one who performs that analysis gets to choose the outcome.
The difficulty in performing a legitimate meta-analysis has led some to remark that meta-analysis is to statistical analysis what meta-physics is to physics. [BINGO!]
As a result, when the results of the meta-analysis do not agree with a particular expert’s preconceived notion, it is always extremely easy for that expert to zero in on several aspects of the meta-analysis he/she disagrees with, and that, he/she can pronounce, completely invalidates the entire study. Better yet, critics can do their own meta-analysis to counter the one they don’t like.
Thus, if meta-analyses are to be used at all, they ought ideally to be (a) performed by individuals who do not have a particular prejudice as to the outcome, and (b) performed by experts who understand the field. Unfortunately, these two criteria are often mutually exclusive. [Especially in paranormal research.]
The political-economic dynamics of the calcium blocker meta-analyses
The world calcium blocker market is estimated to be about $6 billion. Drug companies potentially have a lot to lose if these drugs fall out of favor.
The WHO-ISH meta-analysis, presented by the International Society of Hypertension and suggesting no problem with long-acting calcium blockers, was paid for by the pharmaceutical industry. Notably, the WHO-ISH study did not include heart failure as an outcome, despite the fact that calcium blockers are known to cause this problem. Furthermore, one would be hard pressed to identify a “hypertension expert” who wasn’t significantly compromised by professional and/or financial relationships with pharmaceutical companies. Indeed, it is close relationships with drug companies that often determine who is recognized as an expert, since drug companies sponsor much of the research and many of the speaking engagements that give experts their visibility. One thus ought to attach at least a few grains of salt to the WHO-ISH meta-analysis, and to the opinions expressed by many of the experts’ complaining about the Furberg study.
In contrast, Furberg’s study had no external funding. Furberg himself is a highly regarded investigator, thought to be relatively independent of drug company money. However, Furberg has been at significant odds with prominent players in the hypertension community for at least 5 years for his attacks on calcium blockers, and, one might argue (and some have), has a reputation to protect. His latest study tends to vindicate his efforts for the past several years – another outcome, in other words, would not have vindicated those efforts. Hence the characterization of his study as “unbalanced,” “inflammatory,” etc."