Evidence-Based Medicine, Hijacked?

A bonus article summary – not a required reading.

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

– John Ioannidis

One of the most cited researchers (worldwide) and a Stanford professor, John Ioannidis, has recently published a highly thought-provoking article – in the form of a letter to a previous acquaintance.  In his one-sided conversation, Ioannidis, challenges the medical research community and all of its stakeholders, specifically in terms of how research policies are created and research itself carried out.

Ioannidis writes about his personal experiences over many years of medical research, and how evidence-based medicine was once a low priority for studies, only “tolerated…when it [could] produce largely boring evidence reports that [were] shaped and endorsed by experts.”  Evidence meant less to those requesting and funding the study than the names tied to the research.  During this time era (the 1990s and 2000s), although I have no doubt that this trend has only continued (probably grown), doctors were more or less paid by pharmaceutical companies to produce research which rendered results that would allow them to grow their sales.  Unfortunately, money – not illness or our people –  was and remains, the most important factor in research, particularly within the United States.  Eventually the use of evidence-based medicine (EBM) started to become increasingly more important, although Ioannidis points out that it was not in actuality tied to research which represented it. The term was thrown in to add prestige, creating a false sense of trust in the studies being completed.  He goes one to explain that although the work being done was in many sense efficient and considered “high quality”, the studies “…often ask[ed] the wrong questions with the wrong short-term surrogate outcomes, the wrong analyses, the wrong criteria for success, and the wrong inferences…”.

To this day the healthcare industry remains convoluted by large corporations who provide funding for supposed EBM, although many of the trials are rigged so that the results can be used as forms of advertisements for their drug of the day.  Researchers are being bought by these big companies to prove pieces of information which will support sales of their products, even if they are not in the best interest of those who need treatment.  Ioannidis points out that this has been cause for concern in terms of hiring practices, since it is becoming increasingly difficult to determine whether an individual’s resume “…reflects hard work and brilliant leadership or the composite product of dexterous power game networking, gift authorship and excellence in the slave trade of young researchers.”  He goes into detail about a personal experience he had with this type of biased research, when he was asked to co-author a randomized trial.  Ultimately, he was informed that his name on the study and resulting paper was merely going to be based on the number of patients he recruited for the trial – the more he did, the higher up he would be listed in authorship.  The protocol itself and its paper would be written by staff at the sponsoring company.

As Ioannidis continues his letter, he speaks of epidemiology and the lack of action by our health organizations to prevent further deaths.  The data has been found, it has just not been shared or encouraged in many ways by those in control, to educate the masses.  Today, most studies done in this area lack specific protocols  or analyses and are often not shared.  Another item he brings up is the concept of “gift authorship”, which means that many professional co-authors are those which are automatically added to articles.  He states, that sometimes “the submitting author may forget that they are long dead..” – “they” referring to the gift authors.  Finally, Ioannidis concludes that due to all of the cracks in the foundation of EBM, since it was introduced twenty-five years ago, it has yet to be obtained in actuality – although it should remain a priority and is a worthwhile goal.

I found Ioannidis’ paper to be very easy to read and follow, I really enjoyed the letter/conversational formatting of it.  He definitely confirmed many of the fears that I have had related to the state of medical research.  It is always an unsettling time to find yourself ill or in need of medical treatment, however I think know that there are corporations out there working to deliberately sway you from the truth of what you may need, adds much more fear to the situation.  All of that being said, Ioannidis, made a point to state how much pressure those completing the research are under in order to publish Our country places its highest priority on money, which is to our detriment and causes our people suffering every single day.  Ioannidis shed light on one crucial area where profits often outweigh truth.

I now wonder, as Librarians, how important is it that we consider who the research is being funded by and published by prior to disseminating articles to patrons or health professionals?

 

Reference

Ioannidis, J. A. (2016). Evidence-Based Medicine Has Been Hijacked: A Report to David Sackett. Journal Of Clinical Epidemiology, doi:10.1016/j.jclinepi.2016.02.012

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