What PPIs and the Kardashians have in common

The science we conduct often reflects the society we live in. One phenomenon of current society is the rise of the reality television show. Participants are promised instant media fame without having to struggle through acting school. I worry that this has rubbed off on some of the studies we now conduct. Sir Richard Doll and Austin Hill, the architects of modern epidemiology, realized that it was hard for epidemiology to prove or disprove anything. Their studies were driven by clear hypotheses as some took five to 10 years to complete. Furthermore, their landmark paper on smoking and lung cancer devoted over a page of discussion as to why the observed association of an odds ratio greater than 10 of lung cancer in smokers may not be causal. This scientific version of the reality TV show is exemplified by some studies linking proton pump inhibitors (PPIs), commonly prescribed for gastroesophageal reflux disease (GERD), to a variety of diseases. PPIs have been associated with GI infections (including Clostridium difficile), pneumonia, bone fractures, pernicious anemia, interactions with clopidogrel, and heart disease. To this list we can now add chronic kidney disease and dementia. When a drug is associated with a long list of unrelated bad consequences it usually turns out that most, if not all, of these associations are not causal. This phenomenon was noted over 50 years ago but seems to have been forgotten by modern epidemiologists in the pursuit of the quick high-impact p...
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Conditions GI Source Type: blogs