Friday, September 28th 2012

Is The Ideal of Evidence Based Medicine Foolhardy?

The Guardian has an excerpt from Dr. Ben Goldacre’s book Bad Pharma. The piece in The Guardian looks at how negative data for treatments, specifically commercialized ones, is suppressed and how that severely skews the ideal of evidence based medicine.

Negative data goes missing, for all treatments, in all areas of science. The regulators and professional bodies we would reasonably expect to stamp out such practices have failed us. These problems have been protected from public scrutiny because they’re too complex to capture in a soundbite.

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In 2003, two [systemic reviewes] were published. They took all the studies ever published that looked at whether industry funding is associated with pro-industry results, and both found that industry-funded trials were, overall, about four times more likely to report positive results. A further review in 2007 looked at the new studies in the intervening four years: it found 20 more pieces of work, and all but two showed that industry-sponsored trials were more likely to report flattering results.

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How do industry-sponsored trials almost always manage to get a positive result?

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You can compare your new drug with something you know to be rubbish – an existing drug at an inadequate dose, perhaps, or a placebo sugar pill that does almost nothing. You can choose your patients very carefully, so they are more likely to get better on your treatment. You can peek at the results halfway through, and stop your trial early if they look good. But after all these methodological quirks comes one very simple insult to the integrity of the data. Sometimes, drug companies conduct lots of trials, and when they see that the results are unflattering, they simply fail to publish them. Because researchers are free to bury any result they please, patients are exposed to harm on a staggering scale throughout the whole of medicine.

The book is yet out and won’t be, in the United States at least, until January. When it is I’m inclined to pick up a copy based on the above.

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