From Retraction Watch, interviewing John Ioannidis,
John Ioannidis is perhaps best known for a 2005 paper “Why Most Published Research Findings Are False.” One of the most highly cited researchers in the world, Ioannidis, a professor at Stanford, has built a career in the field of meta-research. Earlier this month, he published a heartfelt and provocative essay in the the Journal of Clinical Epidemiology titled “Evidence-Based Medicine Has Been Hijacked: A Report to David Sackett.” In it, he carries on a conversation begun in 2004 with Sackett, who died last May and was widely considered the father of evidence-based medicine. We asked Ioannidis to expand on his comments in the essay, including why he believes he is a “failure.”
Retraction Watch: You write that as evidence-based medicine “became more influential, it was also hijacked to serve agendas different from what it originally aimed for.” Can you elaborate?
John Ioannidis: As I describe in the paper, “evidence-based medicine” has become a very common term that is misused and abused by eminence-based experts and conflicted stakeholders who want to support their views and their products, without caring much about the integrity, transparency, and unbiasedness of science.
RW: You write that clinical evidence is “becoming an industry advertisement tool” and that “much ‘basic’ science [is] becoming an annex to Las Vegas casinos.” Provocative — what do you mean?
JI: Since clinical research that can generate useful clinical evidence has fallen off the radar screen of many/most public funders, it is largely left up to the industry to support it. The sales and marketing departments in most companies are more powerful than their R&D departments. Hence, the design, conduct, reporting, and dissemination of this clinical evidence becomes an advertisement tool. As for “basic” research, as I explain in the paper, the current system favors PIs who make a primary focus of their career how to absorb more money. Success in obtaining (more) funding in a fiercely competitive world is what counts the most. Given that much “basic” research is justifiably unpredictable in terms of its yield, we are encouraging aggressive gamblers. Unfortunately, it is not gambling for getting major, high-risk discoveries (which would have been nice), it is gambling for simply getting more money.More.
Of course, the term “evidence-based medicine” may have escaped and morphed into a wild type as well. Not too long ago, yer humble news hack was asking about the health issues experienced by very old seniors, and it came out: There aren’t that many people around who are nearly one hundred years of age, and few of them are enrolled in clinical studies, let alone long term studies. Treatments do not always work the same way in very old seniors as they do in younger ones, so physicians need to exercise a high level of skill and caution, and sometimes creativity in helping the patient understand. One such physician calls that “evidence-based medicine” = Does what I am doing appear to be working?
See also: Memo to Science in therapy: Get angry more
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2 Replies to “Evidence-based medicine “hijacked,” says top researcher”
What other common terms are misused and abused by eminence-based experts and conflicted stakeholders who want to support their views and their products, without caring much about the integrity, transparency, and unbiasedness of science?
Should exorcists be excused from providing scientific evidence or should these practitioners be publicly labeled as “quacks”? How about “design theorists” who cannot scientifically explain the known basics of how the “intelligence” of even an insect works?
Once upon a time I did some work in the evidence-based medicine field, working on a tool for researchers to evaluate procedures and be alerted for new findings related to old research (note – the project, which generated some amount of excitement at the time, got canned after development due to contract problems).
Anyway, EBM is quite an interesting field. I have mixed thoughts on it. On the one hand, there have been an exceptionally large number of treatments that have been handed out in modern medicine that actually hurt more than they helped. I don’t remember all of the specifics, but they were quite disturbing.
However, the human body is quite complicated, and focusing too hard on large-scale randomized trials may miss what personalized medicine can give.
Additionally, the real reason I posted, is to link to what I think is one of the funnier moments in science – a group of doctors got fed-up with the EBM crowd and fought back. It’s a great read, doubly so if you know the inside baseball. A lot of people think that science is very stodgy, and sometimes it is. But you can also have a bit of fun with it.