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Friday, April 19th 2013

The Studies Are All Bad

One of my fellow residents might be a Ben Goldacre disciple except amongst all his citations in conversation I’ve never heard him reference the English Physician. I’ll call Dr. Goldacre the ‘Bill Nye’ or the ‘Neil Degrasse Tyson’ of the antagonistic medical epidemiology circle. But it’s a growing group. Amongst them as well the Greek epidemiologist, John Ioannidis.

There is a horrific set of facts about what we know in medicine.

1) Most medical research is so poorly designed that conclusions you can draw from it are…limited

2) The medical research we are conducting is low yield

3) Most medical research performed never comes to light because it fails to meet the hypothesis of those who conducted it

4) There is strong incentive to falsify results

Ioannidis has a famous paper entitled “Why Most Published Research Findings Are False,”

[T]he majority of modern biomedical research is operating in areas with very low pre- and post-study probability for true findings. Let us suppose that in a research field there are no true findings at all to be discovered.

A Huffington Post article by Dr. Ida Sim,

About 80 percent of clinical trials are funded by the commercial sector, but the commercial sector disproportionately studies drugs, and understudies behavioral treatments or older treatments that can’t be patented or profited from. When 75 percent of our medical costs are for chronic diseases that are largely due to poor lifestyle habits, where are the studies on prevention? On behavior? On effective patient-doctor or public health strategies? Where are the studies that examine the balance of benefits and harms, that guide patients and doctors on side effects and cost-effectiveness?

In England a researcher working for Aptuit is set to serve a prison sentence for falsifying lab results for a cancer drug.

Steven Eaton, from Cambridgeshire, has become the first person in the UK to be jailed under scientific safety laws.

[...]

Sheriff Michael O’Grady said: “I feel that my sentencing powers in this are wholly inadequate. You failed to test the drugs properly – you could have caused cancer patients unquestionable harm.

“Why someone who is as highly educated and as experienced as you would embark on such a course of conduct is inexplicable.”

Speaking after the case, Gerald Heddell, the Medicines and Healthcare Products Regulatory Agency’s director of inspection, enforcement and standards, said he welcomed the conviction.

He added: “This conviction sends a message that we will not hesitate to prosecute those whose actions have the potential to harm public health.”

Biomedical research is difficult to call science. What you can assume your doctor or surgeon knows about your condition is surprisingly less than you think. They will certainly act like they know and truly believe that they do but such knowledge is based on a limited amount of reliable data. In Dr. Ionnaidis’ essay there are some suggestions on making medical research better. And of course as Dr. Goldacre calls for all results of all medical research should be public. Even if that disincentivizes some research we may not be missing out on much.

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