"Evidence-based medicine has been hijacked:” A confession from John Ioannidis

[Dolphin]

http://retractionwatch.com/2016/03/...en-hijacked-a-confession-from-john-ioannidis/

Not as detailed as I would like.

John Ioannidis: As I describe in the paper, “evidence-based medicine” has become a very common term that is misused and abused by eminence-based experts and conflicted stakeholders who want to support their views and their products, without caring much about the integrity, transparency, and unbiasedness of science.

You write that clinical evidence is “becoming an industry advertisement tool”

You’re worried that Cochrane Collaboration reviews — the apex of evidence-based medicine — “may cause harm by giving credibility to biased studies of vested interests through otherwise respected systematic reviews.”

Systematic reviews may sometimes be most helpful if, instead of focusing on the summary of the evidence, highlight the biases that are involved and what needs to be done to remedy the state-of-the-evidence in the given field.

one needs to act pre-emptively and make sure that the evidence to be produced will be clinically meaningful and unbiased, to the extent possible.

 

[Cheshire]

Nice comment from Lynn Shepler MD JD (psychiatrist):

With respect to medical practice, SYMPTOMS are evidence. There is no black and white line that separates signs and symptoms, and as a physician, you would be ill-advised to ignore what someone reports as a serious “symptom” — alleging it to be merely “subjective,” data to be tossed. What I see as a danger is where “thought leaders” with ties to industry attempt to re-characterize serious symptoms as “subjective” and investigation is thwarted, the patient told they have a “contested illness,” or the dubious “MUS” (medically unexplained symptoms). As a psychiatrist, this practice is extremely dangerous and abusive in the medical context — a critical task being to discern where psychiatric “symptoms” reported by the patient represents an undiagnosed medical illness not comprehended by the internist, pediatrician, rheumatologist, etc. But we have physicians with virtually NO TRAINING in psychiatry (except a 6-week rotation as medical student) who are either dumb as rocks, or with commercial incentives proclaiming syndromes are subjective and psychiatric in nature!

 

[barbc56]

I particularly like this quote.

.... the work of my team is aiming to protect science, defend the scientific method, question dogma, and enhance the capability and efficiency of research methodology and research practices. In this regard, it is at the very opposite pole than those who want to attack science, question the scientific method and promote dogmas

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Here's the original article.
http://www.sciencedirect.com/science/article/pii/S0895435616001475

His comment when warned about being too outspoken is hysterical.

 

[alex3619]

I have been saying very much the same thing. EBM can be easily biased, its rarely done well, and though the principle is good the execution is currently a fail.

 

[Sean]

Second, instead of dealing with these major public health risks, the production of spurious, false-positive, or confounded putative risk factors is more dangerous than ever. Jumping from correlation to causation [29], data dredging is called causal evidence and fuels guidelines. Most data and protocols are not shared.

Reminds me of something.

 

[Art Vandelay]

I would pay money to watch Ioannidis dissect and destroy PACE.

 

[Simon]

Fascinating article, Ioannidis sounds really, really 'frustrated' with the current situation.

My own favourite:

The issue is that basic medical scientists have hijacked the granting bodies and have erected research policies that place greater value in serving their own personal curiosities than in serving sick people [25][25].”

Given that most research funders, private and public, fund research precisely to help sick people, that's all the more galling. And probably like all patients I find it maddening too.

Ioannidis's frustration in a nutshell:

We are cheering people to learn how to absorb money [26][26], how to get the best PR to inflate their work [27][27], how to become more bombastic and least self-critical. These are our science heroes of the 21st century.