Roy Poses, a regular contributor to the email discussion group Evidence Based Health wrote a provocative email pointing out the manipulation of research, ghost-writing, and suppression of research that is being done to support the marketing of unsafe and/or ineffective drugs. Some of the web links that Dr. Poses included are quite interesting.
He then goes on to wonder if this dishonesty invalidates the evidence based medicine process.
Physicians may no longer trust the EBM process to find an approximation of the truth in the face of purposeful manipulation of the evidence by vested interests
There's no easy answer to this. One positive thing is that one of the most powerful tools in the arsenal of EBM, the systematic review, is the tool that has been used to uncover much of the dishonesty in research. So you could argue that we would be a lot worse off if we didn't have EBM, because we wouldn't even know we were being deceived.
Another thing to remember is that a lot of research being done has no vested commercial interests. The big drug trials get all the attention, but there is a lot more to the practice of medicine than just prescribing drugs. I'm not a doctor, but I suspect that most of the things that you do to help your patients get better don't involve a pill. Do we disregard all of the non-pharmaceutical research just because the research on drugs is possibly tainted?
And you also might want to read a counterpoint to all the criticisms about pharmaceutical statistics that was written by Stephen Senn.
- Fear and loathing of pharmaceutical statistics [PDF]. www.wtcrf.ed.ac.uk/education/Talks/Stephen%20Senn%202June%202005.pdf
We have to be careful not to throw out the baby with the bathwater. A lot of good work is done by people with a commercial interest in the outcome. You just have to make sure that the appropriate safeguards are in place. Research done by people with a commercial interest in the outcome is like observational research. Some of it is done badly and some of it is done quite well. The trick is to recognize which is which.
In spite of all this, I do share some of the pessimism of Dr. Poses. There's a lot of funny stuff going on behind the scenes and it is almost impossible for us outsiders to uncover the truth.
This work is licensed under a Creative Commons Attribution 3.0 United States License. It was written by Steve Simon.
You can find an earlier version of this page on my original website.