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At BMJ: Evidence based medicine running into many of the same problems as felled earlier reform movements

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According to an op-ed in the British Medical Journal the culprits are “corporate interests, failed regulation, and commercialisation of academia”:

The advent of evidence based medicine was a paradigm shift intended to provide a solid scientific foundation for medicine. The validity of this new paradigm, however, depends on reliable data from clinical trials, most of which are conducted by the pharmaceutical industry and reported in the names of senior academics. The release into the public domain of previously confidential pharmaceutical industry documents has given the medical community valuable insight into the degree to which industry sponsored clinical trials are misrepresented.1234 Until this problem is corrected, evidence based medicine will remain an illusion…

Ironically, industry sponsored KOLs [key opinion leaders] appear to enjoy many of the advantages of academic freedom, supported as they are by their universities, the industry, and journal editors for expressing their views, even when those views are incongruent with the real evidence. While universities fail to correct misrepresentations of the science from such collaborations, critics of industry face rejections from journals, legal threats, and the potential destruction of their careers.8 This uneven playing field is exactly what concerned Popper when he wrote about suppression and control of the means of science communication.9 The preservation of institutions designed to further scientific objectivity and impartiality (i.e., public laboratories, independent scientific periodicals and congresses) is entirely at the mercy of political and commercial power; vested interest will always override the rationality of evidence.10

Jon Jureidini, Leemon B. McHenry, “The illusion of evidence based medicine” at the BMJ (March 16, 2022)

The COVID-19 “science-driven” public policy disaster is, of course, exhibit A in this area though the authors don’t bring it up. But sometimes things have to get really bad before they can even start to get better. In this case, a number of thoughtful people have gotten a massive dose of “Trust the Science!” (not!) and should be ready to insist on truthful answers to thoughtful questions.

You may also wish to read: At last someone is asking: Why Are Science Reporters So Credulous? Another way of putting it is that too many people are — at best — naive about government-led and government-funded science. And science writers can make a living out of avoiding realities and catering to their illusions while retaining a sense of impeccable righteousness.

2 Replies to “At BMJ: Evidence based medicine running into many of the same problems as felled earlier reform movements

  1. 1
    polistra says:

    The brand of ‘Evidence Based Medicine’ is obviously a tool of Big Pharma. This was clear a few years ago:

    http://polistrasmill.blogspot......itors.html

  2. 2
    Seversky says:

    This is not exactly a previously unknown problem. Take, for example, this post from Steven Novella’s Neurologica back in 2017:

    Practicing Evidence-Based Medicine

    Published by Steven Novella under Science and Medicine

    An excellent article in ProPublica by David Epstein discusses the problem of doctors not adhering to the best evidence-based standards. The full article is worth a read, and I won’t just repeat it here, but I do want to highlight a few points which align well with what I have been writing here and at SBM for years.

    The essential problem is that there is a disconnect between the best evidence-based standards and what is actually practiced out in the world. There are actually two problems here. The first is the scientific evidence itself. The second is the alignment of practice to this evidence.

    Scientific evidence in medicine has a few challenges. There is publication bias, researcher bias, p-hacking, the decline effect, and problems with replication. What all of this adds up to is that there is a lot of published preliminary evidence, most of which is wrong in the false positive direction. There is a tendency, in my opinion, of adopting treatments prematurely.

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