John,
“The poster child for the AllTrials campaign” – thank you for this.
There’s another well-informed commentary which provides more wood to your fire with some interesting links to reviews of the data that are a little less ~ahem~ ‘focussed’ than Jefferson, Doshi et al:
http://www.socialsciencespace.com/2014/04/tamiflu-and-the-ethics-of-the-british-medical-journal/

I’ll try to stick to the microbiology; current neuraminidase inhibitors aren’t perfect. We all know that. How imperfect? A pandemic would be the ultimate test but I agree a proper estimate can only come if ALL the available data is now properly analysed by someone untainted by all this – and then published in a high-impact journal other than BMJ. And using a methodology without the huge gaps that even a simple microbiologist such as I can drive a coach and horses through.

And other commentators have also noted BMJ has been digging itself deeper into a hole on this issue – one wonders when they might stop.

Anyway, the data (linked to in the link above and elsewhere) shows that people will die unnecessarily in a pandemic if neuraminidase inhibitors are not readily available. (Unless something better turns up in the meantime or the then current seasonal vaccine is effective against the pandemic strain and available in abundance – which is incredibly unlikely for many self-evident reasons.)

So one wonders not just how on earth an academic journal such as BMJ could allow itself to get so mired in this. The aspect that really beggars belief is adopting a position where an increase in preventable morbidity and mortality from a pandemic – inevitable without rapid access to neuraminidase inhibitors – is a price worth paying because winning a war of words with Roche is apparently just too important.

Having made Tamiflu the poster child for the AllTrials campaign, what were the chances that Cochrane would then undercut its own position by issuing a review stating that it came to conclusions essentially identical to those reported by the Roche analysis?

The close connection between BMJ and Cochrane in pursuing the data release, and the steady stream of editorial content critical of Roche and Tamiflu over the last two years, creates serious questions about the peer review process as well.

Ideally, the data once acquired would have been reviewed by an independent group and published in a journal without ties to the controversy.

Historically, the role of medical journals has been to provide a neutral forum for the discussion of scientific and medical data. BMJ in recent years has become highly politicized, and its editors increasingly combative and dismissive of dissent from what they have defined as political correctness. Its a different approach, I guess time will tell whether it is successful and whether it leads to better medicine.

As I say above – inter alia – it’s the criteria for inclusion that I find most interesting and worthy of comment.

But I must also admit I have neither the skill nor the inclination to take up the kind invitation to analyse 150,000 pages of data. But I take great comfort this is a shortcoming shared by the authors, who state:

“The main limitation of our study is our relative inexperience in dealing with large quantities of information and our lack of familiarity with certain trial documents such as blank case report forms. A further limitation of our review is that the methods we have developed to assess and summarise information from clinical study reports may not apply to non-industry trials (which may not be reported in clinical study reports).”

Also, in the interests of openness I have no conflicts of interest: I have never received a penny from a pharmaceutical company, I do not work for a competitor of the BMJ or any other interested parties and – for the avoidance of doubt – I have never contributed to any Cochrane Collaboration review or been associated with Cochrane etc etc.

I have no dog in the fight here and I only make this point to follow @Trish’s laudable precedent – and I’m sure anyone else who takes time to comment will do likewise if it’s relevant.

Again, very sincere thanks for all the comments. That anyone would take time so to do I find humbling and bewildering in equal measure.

(http://dx.doi.org/10.5061/dryad.77471).

Carl Heneghan, Tom Jefferson, Peter Doshi
http://www.bmj.com/content/348/bmj.g2545?tab=responses

Since 1998 The BMJ has published nearly 100,000 Rapid Responses to articles in The BMJ, many of them substantive. Yet the recent articles on neuraminidase inhibitors have had only a handful of Rapid Responses.

Why the silence?

Trish Groves
Head of Research, The BMJ

tgroves@bmj.com
Twitter/trished

Competing interests: I chair The BMJ’s weekly research committee meetings, including the one where we accepted the Cochrane reviews on neuraminidase inhibitors

It all boils down to ££$$££
And whilst over time the amount of novel new treatment reduces, the only thing left to do is to re-invent it. This allows the renewal of the patent rights.

The tweak usually is the third carbon along the chain and then have another cockroach review to say; it now has a enhanced targeting mechanism