How evidence-based medicine is failing due to biased trials and sel...

Widespread acceptance of pharma-sponsored medical studies has undermined the validity of contemporary medicine. The facade of evidence based medicine [EBM] is crumbling.

... 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. [emphasis mine]

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A way to finding the medicine which is right for you is to use the black market which permeates the Internet.

You use the 'suck it and see' test.

Or see which spammers promise the best results at the lowest prices with the greatest number of misspellings. :-)

Seriously, thanks for sharing this, with both a link to the actual journal article and a cartoon which visually sums it up.

The problem isn't just the pharmaceutical industry "counting their own votes"; they're deciding which polling places to open or close, and what (misleading) questions and wording to put on the ballots!

On the choice of treatments to test (or not):

 ... there have been very few clinical trials of exercise for treating depression, an intervention suggested ... to be of equivalent efficacy to conventional drug treatment. Whether exercise is useful for treating depression is highly clinically relevant yet has little commercial value because exercise cannot be patented.

Conversely, many ... important questions are neglected. For example, ... [no trials] investigate the effective treatment of antipsychotic-induced constipation, a distressing adverse effect occurring in up to 60% of antipsychotic-treated patients, which can progress to fatal bowel obstruction.

The article mentioned the widespread problem of companies simply not publishing studies unfavorable to their product, or sometimes publishing them with misleading results. In an analysis of the 74 antidepressant trials the FDA had approved, 38 showed positive results (the tested drug was more effective than another treatment or placebo), while 36 showed negative results. 22 of the negative trials were simply not published, while "11 were published in a way that falsely conveyed a positive outcome". The result: doctors reading medical journals would see 48 "positive" trials (only one of the real ones wasn't published) and only 3 negative ones.

The authors also suggest that studies whose investigators or funders have a conflict of interest be explicitly downgraded when ranking evidence.

Ben Goldacre, a British skeptic, wrote a book Bad Pharma.  It's good to see a skeptic who is also skeptical about pharmaceutical co's and their science. 

On a related note, higher patient satisfaction scores for medical treatment, may lead to higher cost and higher mortality.   But government and insurance companies are forcing medical providers to bow to the satisfaction surveys anyway.

A more dry article stating the same thing.  Quoting, "In a nationally representative sample, higher patient satisfaction was associated with increased inpatient utilization and with increased health care expenditures overall and for prescription drugs. Patients with the highest degree of satisfaction also had significantly greater mortality risk."  The study involved more than 50,000 people.

Also "In April, a New York area cardiologist admitted to defrauding government and private insurers of $19 million. This was described as the largest healthcare scam by a single physician ever recorded in New York or New Jersey.  Thousands of patients underwent unnecessary and possibly dangerous tests and treatments. He also employed unlicensed and unqualified personnel who treated patients.  As noted by Dan Diamond, managing editor of the Daily Briefing, the Healthgrades patient satisfaction scores for Dr. Katz ranged from very good to excellent.  In fact, Dr. Katz has received not one … not two … but three Healthgrades Quality Awards still in evidence on their website, which also reports no sanctions against him....

Forbes review of the satisfaction rating system "Nearly two-thirds of all physicians now have annual incentive plans, according to the Hay Group, a Philadelphia-based management consultancy that surveyed 182 health care groups. Of those, 66% rely on patient satisfaction to measure physician performance"

also "One emergency room with poor survey scores started offering Vicodin “goody bags” to discharged patients in order to improve their ratings. And doctors face the reality that uncomfortable discussions on behavioral topics–say, smoking or obesity–come with the risk of a pay cut."

I was waiting for things like that..




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