Evidence, Missing Evidence, Alteplase and Stroke
14:00 Tuesday June 19th
Since the 1980s debate has continued to develop over the possible role of thrombolytic drugs to treat stroke patients. This worldwide debate has often exhibited more heat than light. The infrastructure to facilitate a balanced and engaged discussion in the UK has been eroded due to a complex range of reasons. We aim to present some key facets relating to the evidence behind the treatment, particularly examining the alteplase story. Our hope is to promote a measured discussion on the way forward in this, and perhaps other, contentious areas of medical science.
Roger Shinton will set the scene by explaining the issues of concern in the trials relating to alteplase and their publication. This short talk will be followed by shorter presentations from Sir Richard Thompson and Peter Wilmshurst expressing their concerns about the way that the Expert Working Group of the Commission on Human Medicines reviewed the data.
Roger Shinton, who hails from the West Midlands, is an independent clinical epidemiologist and former consultant physician. His clinical work focused on the care of stroke patients, setting up a stroke unit in the 1990s. He trained at Cambridge, Kings College Hospital and the LSHTM. He was elected Honorary Secretary and later President of the West Midlands Physicians Association. His academic work has mainly focused on the causes of stroke and their subsequent management. More recently he has explored the hidden details, conduct and presentation of clinical trials.
Sir Richard Thompson was for thirty years a general physician and academic gastroenterologist at St Thomas’ Hospital, London, and then Treasurer and later President of the Royal College of Physicians of London. He writes on various subjects, such as the benefits of gardening on mental and physical health, and the absence of balanced scrutiny of the evidence that is used to justify several current treatments.
Peter Wilmshurst has investigated and reported research misconduct for more than 30 years. As a result he has had to defend legal threats and libel claims from academic institutions, pharmaceutical and medical device corporations and individual researchers. He was awarded the annual Health Watch Award in 2003 “for courage in challenging misconduct in medical research”. He was the first recipient of the BMJ Editors Award in 2012 “for persistence and courage in speaking truth to power.” He is a consultant cardiologist at the Royal Stoke University Hospital.