BMJ: Evidence based medicine: a movement in crisis?

[Esther12]

Currently open access, but these things tend to disappear behind a pay-wall after a while, so if interested, get in there quick:

http://www.bmj.com/content/348/bmj.g3725

I didn't think it was that great a piece, but this bit was interesting both because it had so much in common with BPS CFS work, and because it was written with such an assumption that these problems are driven by industry and the free-market, rather than simply the desire of researchers to hype their own results and exaggerate their own expertise:

Distortion of the evidence based brand
The first problem is that the evidence based “quality mark” has been misappropriated and distorted by vested interests. In particular, the drug and medical devices industries increasingly set the research agenda. They define what counts as disease (for example, female sexual arousal disorder, treatable with sildenafil16 and male baldness, treatable with finasteride17) and predisease “risk states” (such as low bone density, treatable with alendronate).18 They also decide which tests and treatments will be compared in empirical studies and choose (often surrogate) outcome measures for establishing “efficacy.”19

Furthermore, by overpowering trials to ensure that small differences will be statistically significant, setting inclusion criteria to select those most likely to respond to treatment, manipulating the dose of both intervention and control drugs, using surrogate endpoints, and selectively publishing positive studies, industry may manage to publish its outputs as “unbiased” studies in leading peer reviewed journals.20 Use of these kinds of tactic in studies of psychiatric drugs sponsored by their respective manufacturers enabled them to show that drug A outperformed drug B, which outperformed drug C, which in turn outperformed drug A.21 One review of industry sponsored trials of antidepressants showed that 37 of 38 with positive findings, but only 14 of 36 with negative findings, were published.22

Evidence based medicine’s quality checklists and risk of bias tools may be unable to detect the increasingly subtle biases in industry sponsored studies.23 Some so called evidence based policies (such as dementia case finding for the over 75s and universal health checks for the over 40s in the UK) seem to be based largely on political conviction.24 25 Critics have condemned the role of the drug industry in influencing the policy makers who introduced them.26

They don't really go into enough specifics to be sure, but I got the impression that they were rather too keen on the instinctive judgements of experts (at least, those funded by the state rather than industry). To me, it seemed rather British Establishment in it's attitude and values, and they seem to downplay how bad things are. Anyway, posting up in case others are interested.

 

[Denise]

Currently open access, but these things tend to disappear behind a pay-wall after a while, so if interested, get in their quick:

http://www.bmj.com/content/348/bmj.g3725

I didn't think it was that great a piece, but this bit was interesting both because it had so much in common with BPS CFS work, and because it was written with such an assumption that these problems are driven by industry and the free-market, rather than simply the desire of researchers to hype their own results and exaggerate their own expertise:



They don't really go into enough specifics to be sure, but I got the impression that they were rather too keen on the instinctive judgements of experts (at least, those funded by the state rather than industry). To me, it seemed rather British Establishment in it's attitude and values, and they seem to downplay how bad things are. Anyway, posting up in case others are interested.

Thanks very much for posting it!