In this part we will cover Marik's claims about publishing which are mostly captured in the following statement (5m45s):
"I've discovered that the whole biomedical publishing system is fraudulent. It is completely based on fraud. It is completely controlled. The major medical journals dictate what is written. There is such things as ghost writers. They determine the outcome of the study, and then they write about the outcome of the study which can be completely made up by people who never participated in the study ... Big pharma is behind this. There's no question of doubt that if a paper, even if it's an [RCT] is financed by pharma, or supported by pharma, or looking at a pharmaceutical product,..... you can be guaranteed, 100%, in someway or another, it's fraudulent."
Boghossian is entertained by Marik for about 15 minutes before he lunges at his ultimate conclusion (18m15s): Doctors are informed by the medical literature and therefore: "Doctors have been misled; they have been brainwashed; mind games played with them, by this comglomerate; and they are providing false information to patients ... Most of what doctors tell you is based on fraud; doctors don't know this."
The claim elicits a laugh from Boghossian who seems equal parts amused and perturbed. When the podcast ends, and they have signed-off, Boghossian is heard to say off-mic: "Holy fuck. Jesus Christ." For nearly an hour he's been swallowing Marik's claims like an Englishman on his stag; and now he's reeling.
Watching an intoxicated and amused Boghossian override his characteristic style is intriguing; much more so than Marik's wild and unoriginal claims. But we said we would respond to Marik, so let's do that and return to Boghossian at the end of the post.
And let's merely flag that we are unlikely to hear any precise or vulnerable statements from Marik. His words will be opaque and scattershot, and because Boghossian has become impotent, we will be on our own in making sense of it. (Boghossian has around 200 thousand subscribers on youtube; this video has 13 thousand views since March 26. Presumably many tapped-out early.)
The crux of Marik's claim is that companies fix the outcome of their clinical trial. How is this possible when the study is pre-registered on clinicaltrials.gov which displays the principal investigator and study design: duration, outcome derivation, timing of analyses, etc? Marik hangs his assertion on the anonymous medical writers who "never participated in the study". (He uses the term ghost writers, either to denigrate them or out of ignorance.)
Ben Goldacre described Pharma's use of medical writers in his book Bad Pharma (throughout Chapter 6 on Marketing). Goldacre, like all the others who flog anti-pharma sentiment, has not worked in industry and his description was grotesque. But Marik, a fervent observer, is the type to be swayed by it, just like Bret Weinstein who started banging on about regulatory capture after reading Goldacre.
It was never true that medical writers "determine the outcome of the study" (see the full quote above). It is not possible to know what Marik could mean by this. The outcome of the study is an estimate of the pre-specified primary estimand calculated by the statistician - it is this estimate that determines whether the trial is a success or not. How can the medical writer affect this estimate when the statistician is the only person in the room who fully understands it?
Marik might claim that there is leeway in the Discussion section of the paper to amplify certain findings and formulate a narrative. However, a trial is a rigid tool and does not generate much ambiguity; and those who read medical journals are qualified and harbour scepticism about, e.g., the plethora of secondary endpoints (to some degree these outcomes are intended to distinguish between the company's product and a competitor's and scepticism may be warranted).
In any case, the medical writer does not draft the Discussion section: the authors do, and the journals require them to state their contribution and sign-off on it.
The medical writer performs administrative tasks, e.g., a literature search to aid the authors when drafting the Background section; proof-reading; collating feedback from co-authors; creating enhanced displays to meet the journal's standards; etc. These practices vary among companies and the larger companies are most likely to insist that authors make a genuine contribution. I.e., people like Marik are concerned about Big Pharma but they should be much more concerned about small and medium-sized Pharma, as seen recently here:
The most persuasive and accurate critique of pharma contradicts the argument Marik is making: far from enticing favourable results out of data, Pharma analyses lack flexibility and are straight-jacketed by excessive pre-specification (it is difficult to fully pre-specify an elaborate model and thus a crude model is favoured). Industry analyses exhibit tired habits, mostly for the sake of efficiency and to minimise the possibility of coding errors, and not for scientific reasons such as parsimony.
The problem for Marik is that it is the academics who are guilty of running ad hoc analyses and massaging results. Marik would know this and this makes him appear disingenuous.
Yet there is legitimate criticism that Marik skirts regarding the exaggerated contribution of the authors. Typically Pharma identifies key opinion leaders in the field, referred to as KOLs, who become the lead author and co-authors of the paper. These academic clinicians play a minor role in the design and conduct of the study (e.g. interim analyses); mostly they contribute to the interpretation of the results and putting them in context.
It is amusing, then, when the lead author is seen discussing “their research” in major news outlets after you have described the results to them. It's a symbiotic relationship with the academics getting the attention they crave and the company borrowing the credibility of the researcher. The truth is: the academics are overconfident and request stupid analyses that leave them confused among a surplus of post hoc estimates. Perhaps they exert themselves because they are too keenly aware that they are superfluous. But that is quite a different criticism than the one Marik is making.
Marik's concern regarding peer-review of the submitted paper also misses the mark. Peer reviewers are an afterthought. They seek clarification and pine for faimiliar analyses. They are non-statisticians and one must do well to defend their analyses against them. For example, clinicians are inclined to demand conditional estimates of the treatment effect given change from baseline on a potential mediator. These are dubious estimates and the trial is not designed to answer them.
Frankly, the influence wielded by reviewers is excessive: authors are eager to appease them despite their requests for analyses lacking pre-specification and not being informed by an intimate knowledge of the study data (savoured only by the company's analyst). This is a criticism of the process, but it is not the one Marik his making. His claims of corruption are vague. He should, however, appreciate the limitations inherent in peer-review when his papers are scrutinised post-publication, including retraction.
Bearing in mind Marik's confusion about the publication process, it is interesting that he says he “discovered that the ... publishing system is fraudulent”. Discovered how? The lack of originality and specificity in his claims suggests he is merely invoking popular anti-Pharma books (the term ghost writers is straight out of Goldacre, and he says he was bowled over by Robert F. Kennedy Jr's book). If he had first-hand knowledge he would surely share it.
It is a shame whistle-blowing is restricted to those who have inside knowledge when others like Marik would like to decry Pharma too.
There is something familiar and tedious about his tone in this age of podcasting. E.g., the apparent contradiction whenever he refers to “published data” to support his views (e.g., 19m25s, and elsewhere) after claiming publishing is entirely fraudulent; the all-encompassing nature of the claims: “The major medical journals dictate what is written” (these journals are very different from one another); resentment that he and others like Kirsch are not taken serioulsy; the wayward scepticism: “Most of the vaccines they've developed simply don't work”; and he signs off with the usual plea for people to find more reliable sources of information.
Boghossian, on the other hand, is an interesting character: revealing and antagonistic, with an untenable blend of liberalism and hysteria. The following post refers to a book by Palahniuk:
We reached out to Boghossian and offered to add context and to clarify Marik's many dubious claims. In response he said this would not work because BasedScience are anonymous. (This was never an issue; we could have connected on Linkedin to confirm our credentials.) He then cancelled our subscription to his X account and blanked us. (We were an OG subscriber.) Incidentally, Boghossian's book is titled How to Have Impossible Conversations. Perhaps we were shooting too low.
Marik was never an impartial expert; he was a guest on the podcast. I.e., this is not an Andrew Neil grilling, it is more like Oprah chatting with Meghan.
Marik appeared on Bret Weinstein's podcast before appearing on Boghossian's (see Weinstein's podcast titled "Pharma: Not their first rodeo"). And Chris Martenson appeared on Boghossian's podcast in February after travelling with Weinstein to observe immigrants crossing the Darien. (Martenson does not pass the smell test; just visit his website.)
There is a mutual networking, recycling of guests, collaborating and promoting going on that the listener should take into account: Marik and Boghossian are in partnership. Soon after the podcast Boghossian appeared at Marik's institution where he spoke with employees who offered more guesswork. Perhaps these were some of the “more reliable sources” Marik was alluding to.
The enduring problem for the podcasters is that the real players would not be seen dead with them.
We witness, here, how in the era of podcasting wannabe best-sellers who flaunt their disapproval of Pharma can contaminate the minds of so many with their hackneyed criticism. Susceptible podcasters revived Goldacre's out-of-date review offering themselves as truth-tellers laying bare Pharma's secrets. It is shameful for Boghossian to allow Marik to persuade his listeners not to trust their doctor. Never mind the irony that some of these podcasters (not Boghossian) get rich selling dick pills and supplements to their listeners.
And, in a further irony, the same crowd who peddle cynicism and lies blame Pharma et al. for the rise of cynicism in public opinion.
In part 4 we will consider Marik's claims about Pharma rigging clinical trials (another accusation found in the Bad Pharma styled books, most notably Marcia Angell). We hope to persuade the reader that far from Marik's claims being true, it is industry, with its quality, who can restore the public trust lost by academia.