How evidence-based medicine is failing due to biased trials and selective publication

[A.B.]

Evidence-based medicine (EBM) was announced in the early 1990s as a ‘new paradigm’
for improving patient care. Yet there is currently little evidence that EBM has achieved its
aim. Since its introduction, health care costs have increased while there remains a lack of
high-quality evidence suggesting EBM has resulted in substantial population-level health
gains. In this paper we suggest that EBM’s potential for improving patients’ health care has
been thwarted by bias in the choice of hypotheses tested, manipulation of study design and
selective publication. Evidence for these flaws is clearest in industry-funded studies. We
argue EBM’s indiscriminate acceptance of industry-generated ‘evidence’ is akin to letting
politicians count their own votes. Given that most intervention studies are industry funded,
this is a serious problem for the overall evidence base. Clinical decisions based on such
evidence are likely to be misinformed, with patients given less effective, harmful or more
expensive treatments. More investment in independent research is urgently required. Inde-
pendent bodies, informed democratically, need to set research priorities. We also propose
that evidence rating schemes are formally modified so research with conflict of interest bias
is explicitly downgraded in value.

http://onlinelibrary.wiley.com/doi/10.1111/jep.12147/pdf

This paper is well worth reading.

 

[Esther12]

More investment in independent research is urgently required. Inde-
pendent bodies, informed democratically, need to set research priorities. We also propose
that evidence rating schemes are formally modified so research with conflict of interest bias
is explicitly downgraded in value.

The MRC and DWP funded PACE trial indicated that other sources of funding have their own biases!

Will try to read the full paper later. Ta.

 

[A.B.]

The MRC and DWP funded PACE trial indicated that other sources of funding have their own biases!

Let's not forget several of the authors having ties to insurance companies.

 

[alex3619]

I have sections in my book outline corresponding to arguments in this paper. I now get to reference it.

 

[ahmo]

Evidence-Based is a total con as far as I can tell.

To me, the citizen science that we're doing on forums like this is Evidence-Based. Sharing and collecting evidence of what's working, furthering the understandings of the whole community.

 

[alex3619]

I wouldn't call EBM a total con. It has saved hundreds of thousands of lives by revealing bogus and dangerous treatments. However it is subject to GIGO, hype, vested interests, irrationalities, and being managerial driven translation from medicine, and not itself science or medicine. In other words in its current form its over-hyped and highly fallible.

In my view the most dangerous thing about it is not medical practice, but its use in managing medicine. Its being used to deny medical treatment that works, and to promote medical treatment that doesn't, and to promote cheap over expensive. Its being used by bean counters not scientists.

 

[end]

It is a corrupt world run by corrupt people.

Without running of into a philosophical tangent; I question our humanity more and more lately

 

[alex3619]

It is a corrupt world run by corrupt people.

Without running of into a philosophical tangent; I question our humanity more and more lately

In my current opinion, most organized evil in the world is not due to corruption, or criminality, or people being evil.

Its our humanity (though I think you meant humanity in the sense of humane) that leads to evil. We are fallible and limited. Overt evil is easy to spot, but most organized evil is from people doing what they think is right.

We have a limited understanding of the world. Our organizations reflect this. Its all compartmentalized. Government is supposed to have oversight, but they are influenced by the information they are given, and either individually or collectively are much less smart they they like to portray.

The single biggest problem is ignorance. Who is ignorant? Everyone. We have limited areas of competence, and even in those much of what we think is right isn't. When problems in the world cross areas of competence, or most of what we probably need to know is not even discovered yet, then the world's collective intelligence is not much better than the hind end of a donkey. The outcome is often very harmful

There are evil people in the world. There are psychopaths who only care about power. There are greedy people who only care about their own wealth. But mostly we have people doing the "right" thing with no awareness of the consequences.

We had a probable diagnostic and evaluative test for ME since 1949. I don't believe that 65 years of doctors were evil. I do believe they had no clue. They still don't, for the most part.

Sorry, but I do tend to run off into philosophy, being a pancritical rationalist.