Our work here is done Tonto.
It’s official. Testosterone supplementation and clinical treatment has no effect whatsoever. It’s all in our heads. Millions and millions of men who feel like they are benefitting from testosterone products actually aren’t, it’s ALL the placebo effect.
Well, so claims a recent study’s heavily biased author Adriane Fugh-Berman, director of anti-Pharamceutical organisation PharmedOut.
The meta study (a study of other studies), published in the PLOS One journal and widely reported in the mainstream media, was orchestrated by Fugh-Berman and her colleagues at PharmedOut.
They whittled down a whopping 11417 studies conducted between January 1st 1950 and April 9th 2016 to a final total of 156 studies, and published a damning indictment of the testosterone therapy arm of the pharmaceutical industry.
Testosterone therapy, they claimed, had been proven to be an utter falsehood. There was no evidence whatsoever that testosterone was beneficial to men. It was all a massive marketing sham.
Say what you like about her, Fugh-Berman certainly knows how to deliver a momentous sound bite. Here are a handful of prime examples;
So, we should all pack up and go home then? Everything is solved and settled, no need for further research at all. Thank Goodness for Fugh-Bergman, what would we do without her?
OK, time at this point in the article for a reality check and for us to take proper stock of this study.
If you are indeed one of the millions of men who does work at keeping their testosterone levels up, you may well feel insulted by this. I certainly do.
It is literally the equivalent of a (very self-important) man standing up and telling women that “Pre-menstrual tension is all in your head, a figment of your imagination. It doesn’t exist ladies, so get into the kitchen and make me some dinner.” OK, I added that bit at the end on, but you know what I mean.
To make these sweeping statements about such a big subject based on such a small piece of work is just laughable.
Fugh-Berman makes for good copy, which is why the report generated as much publicity as it did (here’s a good example, in mainstream left of centre UK newspaper The Guardian). But it really didn’t deserve it. It is a badly constructed meta study conducted by a heavily biased party looking to generate ‘evidence’ to use against their opponents.
The problem is that when a study is organised by a group of people who are biased at the outset, they tend to get the result they were looking for. We covered this in our article ‘What Makes a Good Clinical Study?‘ if you want more background.
The bottom line is that, whether consciously or sub-consciously, the investigator’s pre-conceived bias bleeds into the work.
And you don’t get much more biased than Adriane Fugh-Berman and her team from PharmedOut. Who are PharmedOut? They are a Georgetown University sponsored project that essentially attempts to discredit pharmaceutical marketing.
Fugh-Berman has acted as an expert witness in litigation against the pharmaceutical industry (in relation particularly to TRT). She likes to cause a stir.
Don’t get me wrong here, I actually admire what she stands for (in particular she made a lot of noise outing ghost writing in pharmaceutical reviews), but she is wholly unsuitable to be conducting supposedly impartial studies on testosterone treatments. Especially when the way the meta study is carried out is so massively subjective.
Let’s look at how they established whether studies were ‘relevant’ or not. From an original 11417, only 156 were ultimately chosen. That equates to only 1.4% of the total.
How long did this team spend filtering these down? You may well ask. Not very long as it happens, this was all the result of some automated filtering.
According to the PLOS One report on the study, they basically automated the filtering by extracting only the ones containing the following key terms;
So there’s only two overlapping terms between the three database searches – the terms ‘therapy’ and ‘deficiency’.
One thing which definitely stands out is the search seems deliberately biased towards returning results where there was an adverse reaction.
And what is going on with the PsycNET searches? They are all weighted towards addiction and drug dependency. Which makes no sense at all when you reflect that they were trying to establish clinical efficacy in otherwise normal (apart from the obvious hypogonadism) older males.
Of the results this filtering set returned, the remainder were manually reviewed based on the abstract and discarded or retained.
The potential for investigator bias to influence this last stage of the process is just enormous.
Completely subjective and determined by members of a team aiming to establish a specific result.
This piece of work was leapt upon by mainstream journalists who just love a story like this. The Erin Brockovich esque plot : one woman’s mission to bring down a whole industry etc etc.
It sells newspapers, they lap it up.
In the mighty lexicon of testosterone based research this idiotic meta sideshow does not merit a place in the footnotes.
So, with Adriane Fugh-Berman’s uncanny ability to incontrovertibly solve some of the largest and most complicated issues using only some quick database searches, what might the future hold for her?