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EBM hijacked

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

At the 23rd Cochrane Colloquium Vienna, Dr. John Ioannidis said this:

It was the first point on this really great slide:

And here’s the text of that slide, more legibly rendered:

  • The main utility of systematic reviews has been to reveal how miserably unreliable biomedical evidence is
  • This pervasive message should’ve sensitized to more people to do something about improving the evidence rather than just do more topic focused reviews
  • Instead, systematic reviews have been entrenched as some sort of gold standard
  • Given the prestigious systematic reviews have acquired an hierarchy of evidence, More and more people do more of them, creating bubbles of reviews on largely unreliable evidence with more than deserved credibility assigned to them
  • The systematic review factory includes people with goodwill, serious businessmen, and others use them as marketing tools

More recently, Dr. Ioannidis has commented thoroughly the hijacking of evidence-based medicine:

As EBM became more influential, it was also hijacked to serve agendas different from what it originally aimed for. Influential randomized trials are largely done by and for the benefit of the industry. Meta-analyses and guidelines have become a factory, mostly also serving vested interests. National and federal research funds are funneled almost exclusively to research with little relevance to health outcomes. We have supported the growth of principal investigators who excel primarily as managers absorbing more money. Diagnosis and prognosis research and efforts to individualize treatment have fueled recurrent spurious promises. Risk factor epidemiology has excelled in salami-sliced data-dredged articles with gift authorship and has become adept to dictating policy from spurious evidence. Under market pressure, clinical medicine has been transformed to finance-based medicine. In many places, medicine and health care are wasting societal resources and becoming a threat to human well-being. Science denialism and quacks are also flourishing and leading more people astray in their life choices, including health. EBM still remains an unmet goal, worthy to be attained.

Grim stuff. See for some more good perspective from Dr. David Gorski:

This is why we at SBM frequently refer to the “blind spot” of EBM. From our perspective, EBM has indeed been “hijacked.” I, for example, agree with Ioannidis that industry has to some extent hijacked EBM, but we also add that advocates of quackery have also done so …