Why Evidence-Based Medicine is in Trouble
If you have ever been involved in science projects and research, you know that you start with a hypothesis (idea), and then you design a study to see if your idea is correct. Since the majority of our studies are funded by pharmaceutical companies, the studies are mostly to determine if this drug or that vaccine will benefit patients. What do you do if you are the company and your study is not looking like it will produce good results that support your hypothesis? Well you certainly don’t publish that study! To do so would be the end of that drug and potentially the loss of millions in research and development. This is one of the reasons most studies never make it to publications. That valuable data is lost and not available for review by those trying to make informed decisions. In addition to this major challenge to getting to the truth, studies are designed and the data is worked over to support the hypothesis that is desired. If you don’t pay close attention to the details (and often many details are summarized such that they are not even included in final publications), then you have a distorted representation where the results, or the design is misleading.
I am grateful to P Doshi (Link below) for taking this head on and requiring the pharmaceutical companies and researchers to publish or at least make available all data including that of unpublished studies. The only way we will have true evidenced based medicine is if we include all the evidence. While this would seem to be common sense, alas, our medical institutions, academies, insurance plans, and government medical agencies are all claiming
“evidence-based” when the fact is that in many cases the evidence is sadly distorted or just not accurate.
The truth is singular. I always cringe when I hear that the Cochran group or the AAP or the Institute of Medicine has determined that “vaccines are safe”, or that a particular treatment (drug) is the treatment of choice based on their comprehensive review of the literature, or that taking a certain vitamin is more dangerous than helpful. When I examine the references, not only are they often challenged by the issues above, but too often it is clear that the reviewing group themselves have intentionally excluded numerous studies that would have contradicted their final opinion. Thus the “evidence based” opinion is just a summary of some limited or distorted evidence.
Patients cannot possibly review all the information and thus they must trust doctors to interpret the studies. We doctors have trusted the literature in the past but sadly we have too often been blinded to the real facts as much remains unpublished or distorted. Doshi is throwing out the challenge that we get access to all the facts published and unpublished. This is a huge step in the right direction. With the ease of internet searches, information can be at our fingertips in seconds. It’s time for full disclosure and clear thinking.