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from Medium Website
Spanish version Evidence Based Medicine (EBM) is great. The reality, though, not so much. Human perception is often flawed, so the premise of EBM is to formally study medical treatments and there have certainly been some successes...
The reality, though, not
so much. Human perception is often flawed, so the premise of EBM is
to formally study medical treatments and there have certainly been
some successes.
In acute heart attacks studies confirm that this is an effective procedure. In chronic heart disease the COURAGE study and more recently the ORBITA study showed that angioplasty is largely useless.
EBM helped distinguish
the best use of an invasive procedure.
The 2 most prestigious journals of medicine in the world are The Lancet and The New England Journal of Medicine (NEJM).
Richard Horton, editor in chief of The Lancet said this in 2015:
Dr. Marcia Angell, former editor in chief of NEJM wrote in 2009 that,
This has huge implications.
Evidence based medicine is completely worthless if the evidence base is false or corrupted. It's like building a wooden house knowing the wood is termite infested.
What caused this sorry state of affairs?
Well, Dr. Relman another former editor in chief of the NEJM said this in 2002:
The people in charge of the system , the editors of the most important medical journals in the world, gradually learn over a few decades that their life's work is being slowly and steadily corrupted.
Physicians and
universities have allowed themselves to be bribed.
Trials run by industry are 70% more likely than government funded trials to show a positive result.
Think about that for a second.
Selective Publication
Negative trials (those that show no benefit for the drugs) are likely to be suppressed.
For example, in the case of antidepressants, 36/37 studies that were favorable to drugs were published. But of the studies not favorable to drugs, a paltry 3/36 were published.
Selective publication of positive (for the drug company) results means that a review of the literature would suggest that 94% of studies favor drugs where in truth, only 51% were actually positive. Suppose you know that your stockbroker publishes all his winning trades, but suppresses all his losing trades.
Would you trust him with your money? But yet, we trust EBM with our lives, even though the same thing is happening.
Keep in mind that this is the only rational course of action for Sanofi, or any other company to pursue.
It's idiotic to publish data that harms yourself. It's financial suicide. So this sort of rational behavior will happen now, and it will not stop in the future. But knowing this, why do we still believe the evidence based medicine, when the evidence base is completely biased?
An outside observer, only looking at all published data, will conclude that the drugs are far, far more effective than they are in reality.
Yet, if you point this out in academic circles, people label you a quack, who does not 'believe the evidence'.
Or consider the example of registration of primary outcomes.
Prior to year 2000, companies doing trials did not need to declare what end points they measured. So they measure many different endpoints and simply figured out which one looked best and then declared the trial a success.
Kind of like tossing a
coin, looking at which one come up more, and saying that they were
backing the winning side. If you measured enough outcomes, something
was bound to come up positive.
They required companies to register what they were measuring ahead of time. Prior to 2000, 57% of trials showed a positive result. After 2000, a paltry 8% showed good results.
More evidence of the evidence base being completely corrupted by commercial interest, and the academic physicians who were getting rich on it tacitly allowing corruption because they know that you don't bite the hand that feeds you
Or this example of a review paper in the NEJM that fracture rates caused by the lucrative bisphosphonate drugs were "very rare".
Not only did the drug companies pay lots of consulting fees to the doctors, three of the authors of this review were full time employees! To allow an advertorial to be published as the best scientific fact is scandalous.
Doctors, trusting the NEJM to publish quality, unbiased advice have no idea that this review article is pure advertising.
Yet, we still consider the NEJM to be the very pinnacle of evidence based medicine. Instead, as all the editors of the journals sadly recognize, it has become lucre-based publishing.
Mo money = better
results.
The reasons for this problem is obvious to all :
Journals want to be read.
So they all try to get a high Impact Factor (IF). To do this, you need to get cited by other authors. And nothing boosts ratings like a blockbuster produced by Big Pharma.
They have the contacts and the sales force to make any study a landmark.
A less obvious benefit is the fees that are generated by Big Pharma purchasing articles for reprint. If a company publishes an article in the NEJM, they may order several hundred thousand copies of the article to be distributed to unsuspecting doctors everywhere.
These fees are not trivial:
No wonder these journals are ready to sell their readers (ordinary physicians) down the river. It pays...
Who needs journalistic
ethics when there's a Mercedes in the driveway? Mo money, baby. Mo
money...
Bribery of Journal Editors
A recent study by Liu et al in the BMJ shed more light on the problem of crooked journals. Crooked journal editors.
Editors play a crucial role in determining the scientific dialogue by deciding which manuscripts are published. They determine who the peer reviewers are.
Using the Open Payments database, they looked at how much money the editors of the most influential journals in the world were taking from industry sources. This includes 'research' payments, which are largely unregulated.
As mention previously,
much 'research' consists of going to meetings in exotic locale. It
is funny how many conferences are held in beautiful European cities
like Barcelona, and how few are done in brutally cold Quebec City.
Other particularly corrupt journals include:
No wonder the JACC loves drugs and devices. It pays the private school bills.
Mo money = we'll publish your crooked studies for you.
Mo money, baby, mo money.
The evidence base that EBM depends upon is completely biased.
Some people think I'm really anti-Pharma, but this is not really true. Big Pharma companies have a duty to their shareholders to make money. They have no duty to patients.
On the other hand, doctors have a duty to patients. Universities have a duty to remain unbiased. It is the failure of doctors and universities to keep their greedy paws out of the corrupting influence of Big Pharma money that is the problem.
If Big Pharma is allowed to spend lots of $$$ paying off doctors and universities and professors, then it should do so to maximize profits. That is their mission statement...
Doctors love to blame Big Pharma companies because it takes peoples gaze off the real problem - lots of doctors taking $$$ from anybody who will pay.
The pharma industry is
not the problem. Bribery of university doctors is the problem -
one that is easily fixed if the political will exists.
Approximately 28% of studies never made it to the finish line. That's a problem. If all the studies that don't look promising for drug candidates are not published, then it appears that the drugs are way way more effective than they really are.
But the published
'evidence base' would falsely support the drug. Indeed, Pharma
sponsored trials were 5 times more likely to be
unpublished.
Every time it comes up heads, it counts... This happens 28% of the time.
Now, instead of a 50/50
split of heads and tails, it's more like a 66/34 split of
heads/tails. So the 'evidence based medicine' lover claims that
heads is far more likely to come up than tails, and castigates
people who don't believe the results as 'anti-science'.
Indeed, the very editors whose entire careers have been EBM have now discovered it to be worthless.
We can't believe evidence
based medicine until the evidence has been cleaned up from the
corrupting influence of commercial interests.
Also known as "gifts" to doctors, is a well accepted practice. A national survey in the New England Journal of Medicine in 2007 shows that 94% of physicians had ties to the pharmaceutical industry.
This gravy train only rides in one direction:
Sure Big Pharma can simply pay doctors directly, and it does plenty of that.
It's no surprise that medical students with more exposure to pharmaceutical reps develop a more positive attitude towards them. Many medical schools have limited exposure of medical students in response, but declined to get off the gravy train themselves.
There is a simple relationship between how prominent a physician is (more articles published - almost always academic doctors and professors) and how much money they take from Big Pharma.
Mo prominent = mo money...
Further, there is a 'clear and strong link' between taking industry money and minimizing the risk of side effects of medications.
What, you thought people teach at prestigious institutions like universities for the good of mankind? Maybe that's why they went there, but that's not why they stay.
They came for the science. They stayed for the money...
When the evidence base of medicine is bought and paid for, people die.
That is how doctors have created this opioid crisis that kills thousands of people. Pharmaceutical companies want to pay off doctors, just as drug lord want to pay off judges and police officers.
Doctors, being human, should put safeguards against this temptation. Unfortunately, doctors and universities have been willing participants in this game of killing for profit...
We need to end it now. End the corruption of the universities.
Stop the bribery of doctors...
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