Response: Dr Paul Marik on Conversations with Peter Boghossian
We are several medical researchers. We have worked in pharma, academia and drug regulation in five countries and three regulatory regions; we have all the degrees. We may be inclined to generalise.
We enjoy Boghossian's podcast and had no intention of drafting a response or even listening to this particular episode given the irritation it would likely cause. But Boghossian is searching for a guest capable of responding to Marik's claims and it seems unlikely he will find one. (He needs a current industry scientist if he wants an accurate picture; someone who has worked in publications and had interactions with, or worked in, the regulatory authority. These people will not speak publicly.)
There are too many false statements made by Marik that will mislead and trouble the public. We are compelled to respond.
Preamble: Important background regarding Academia pitted against Industry
The Bad Pharma caricature is enticing and touted by many academics; e.g., Angell, Goldacre, and Goetzche. To give a sense of their zeal consider this piece about the indefatigible Vinay Prasad who takes on pharma “with glee” (more about him below). Dr Paul Marik, Boghossian's podcast guest, is a retired professor and his cynicism regarding pharma puts him in good stead. But the listener is confronted with a paradox from the outset: to be a reliable critic of pharma it is essential that you have never spent time inside it.
We have read the anti-pharma books by the academics listed above and can say they often miss the mark; i.e. there is legitimate criticism that could be levelled at Big Pharma (BP) and they do not see it, for the most part. And a wonderful irony is that the dodgy stuff industry produces is presented at the academics' conferences because they are widely known to be susceptible and open, more so than the attentive experts at the regulatory agency.
The listener should detect this potential bias and pretence to authority without any commentary from Boghossian. Nevertheless, it is disappointing that Boghossian didn't approach the topic with more scpeticism given his other comments on virture signalling and contrived consensus in academia. Unfortunately, the podcasters are a single and tiresome voice on the topic of BP. Perhaps this is because academics seek the limelight while industry experts haven't the time or interest in public skirmishes. Or perhaps it is because there is a new and spurious belief that academics and Leftists are inclined to defend BP and the podcasters see themselves as necessary to counteract this trend?
Any regular listener of Jordan Peterson's podcast will know he has said, in multiple places, that he is perplexed by the Left's (Academia's) sudden apparent defence of BP. But this confuses the Left's confidence in the regulatory mechanism with trust in BP. Academics remain as dubious as ever about BP. They pit themselves against pharma in an attempt to retain talent who know they would be better treated elsewhere. This is the pitch they give, and it can be seen in the pages of their annual statements. The promise of the academics is this: unlike pharma we are scrupulous, so who do you want to align with? The ruse is in desperation because: people are leaving academia for industry in droves.
If the academics did not feel the need to advertise their opposition to BP they would celebrate the pronounced quality and reliability of the randomised controlled trial conducted by industry personnel, contrasted with their own feeble retrospective analyses of uncontrolled data. Quality is, at the end of the day, the paramount issue. In other words, the Big in Big Pharma is a good feature, and the smallness and lack of resources to be found in academic research organisations (AROs) is in no way advantageous. It is easier to behave badly when fewer people are watching, for example. Or: if you have a single statistician then independent validation of code is not even possible (nevermind that statisticians are not programmers). Many have forgotten that in 2004 when the EU tried to align standards for clinical trials with industry there was immediate push back from academics. The gap in standards remains today.
This irony makes the attacks on industry by academics especially tough to bear. There is an impulse to respond: Do you really want us to describe what we have seen in academic clinical trials? Do you really want to talk about ethics and fraud? You want to make that comparison explicit and in the open? Maybe a discussion about the lack of resources and nous in AROs is long overdue (fraud is easy in academia, you would not believe what we have seen). Maybe industry experts are sick of these error-prone status-chasers flinging muck at them. For a glimpse of their handywork take a look at this recently published trial:
To be honest, most people working in industry and drug regulation are preoccupied and these podcaster discussions do not cause a ripple in their world. They do not know who Bret Weinstein is, even though he claims to have all the answers; and if you listened to Alex Jones in the cafeteria of a regulatory agency and let his guttural voice loose not a single head would turn. The talk of censorship is exaggerated. In this crowd no one cares what the amateurs are saying. You will not find professionals on social media defending their work in pharma against attacks from outsiders; if they did it would seem unsightly. Hence the asymmetry of the attacks.
These outsiders have no bearings when confronting the literature. E.g., they will not know that some of the disagreements between academia and industry can be understood as a feature of their varying circumstances. Why do the academics place meta-analysis atop the heirarchy of evidence while industry decisions are dictated by the large and costly RCTs? (Recall the ivermectin meta-analysis run by academics which had Weinstein terribly excited. Regulators gave it little heed; they knew better.) Ponder why the academics, who have a terrible time acquiring funding, have decided that analysing other researchers' data in the form of a meta-analysis is the route to the truth. (Goldacre is especially idiotic in this regard, but he has recently pivoted from evidence-based medicine to data science. What exactly data science is and why the academics are now pushing it is a post for another time. Suffice to say, if the podcasters knew anything about what was going on in BP they would put all their attention here. But of course they seem only to think that data science is a new word for statistics.)
Thus, the reader needs to do some work if they are to avoid being caught in the rip. We would like to encourage you to read between the lines: why do the academic authors listed above target non-experts? The huge font in Angell's book and the language she uses gives this away; and Goldacre's reckless book reads like a British tabloid newspaper. Bret Weinstein held it aloft on his podcast and declared it "a terrifying book" and subsequently reiterated how common the regulatory capture inferred by Goldacre is. Experts who reviewed the book when it landed saw it as biased and uninformed. The uninitiated are easily incited, unlike seasoned professionals; this provides a useful tell.
If academics like Angell and Goldacre had a legitimate concern then why not engage industry instead of courting the public with claims of corruption? (The regulatory authority seeks input when drafting guidelines.) Consider Prof Prasad who sounds more like a football fan in the away section than a Professor announcing some deficit in an analysis. On X the Prof has called Rob Califf (head of the FDA) names that we have been careful to forget. In doing so he distances himself from industry and makes cosy with those observers who savour distrust. (Prasad has deleted all his posts on X before 2023 that mentioned Califf, e.g. those declaring him corrupt, and has blocked us on the platform.)
Further, note that Prasad is a Professor of Biostatistics and Epidemiology* and does not hold a degree in either field (he has an MPH, a common degree among MDs who find mathematics tough going). Unlike industry, in academia titles are nominal. Maybe the reader noticed, for example, academics from peripheral fields such as engineering offering their views on vaccine safety during COVID. Or, the substack maintained by Prasad on pharmaceutical drug development, despite Prasad never having worked in pharmaceutical drug development. It is absurd to everyone aside from the academic who apparently regards it as their duty to stray outside their competence.
To appreciate the audacity on display, note that when the regulatory authority received the submission from the drug company various distinct experts were required to review: clinicians, regulatory experts, statisticians, safety experts, and a pharmacologist (post-approval studies required an epidemiologist). We were involved in these discussions and can say not one of these experts believes they can stand in for a colleague if they are absent. Transposing disciplines is a characteristic of the academic only. It was fun to watch academic epidemiologists on X calling themselves biostatisticians until COVID hit, then they were epidemiologists again. (There is more clout in being a biostatistican, but the degree is more difficult to get through.)
Only the industry scientist is expected to suffer the egregious stupidity of miscellaneous pundits. Imagine Bret Weinstein, when he is walking his cat, pausing at a construction site and shouting: "Gentlemen! You're doing it all wrong!" He'd be arse over tits in a dumpster in seconds. We have started to wonder: maybe something like this is needed to give people on the outskirts reason to pause before they serve us their guesswork. Otherwise Weinstein encourages the listener to interpret our silence in his favour (from Michael Shermer's podcast):
"[I]f i'm wrong ... there should be a flood of biologists ready to expalin what I got wrong, and when that flood of biologists doesn't show up you should ask yourself the question: Why is that?"
As noted above, if pronouncements on a podcast do not elicit a reaction it is not censorship or suppression of ideas or a conspiracy or google's algorithm. It is because the experts are too consumed with work to listen to some useless agitator.
So that is what we will offer here: a lack of silence. If it sounds harsh please recognise how generous the experts have been with their silence to this point. A response to Marik’s specific claims will follow in some days’ time.
*Since this post was published Prasad changed his title to Professor of Epidemiology, Biostatistics and Medicine, i.e. to include ‘Medicine’.