BMJ editorial: Against “evidence based medicine”

There’s a lot to digest here.

The illusion of evidence based medicine | The BMJ

This ideal is, however, threatened by corporations, in which financial interests trump the common good. Medicine is largely dominated by a small number of very large pharmaceutical companies that compete for market share, but are effectively united in their efforts to expanding that market. The short term stimulus to biomedical research because of privatisation has been celebrated by free market champions, but the unintended, long term consequences for medicine have been severe.

Underlying monopolization can’t be switched back or reversed based on an editorial in BMJ. Or this blog post. If the sole idea is to challenge evidence-based medicine based on flawed trials and even worse statistical assumptions, it is equivalent of charging at the windmills (in a more quixotic fashion). The illusion is handled by administrators and those who swear by “guidelines” because everyone knows that these are empirical assumptions in the management.

Here’s more:

Although universities have always been elite institutions prone to influence through endowments, they have long laid claim to being guardians of truth and the moral conscience of society. But in the face of inadequate government funding, they have adopted a neo-liberal market approach, actively seeking pharmaceutical funding on commercial terms. As a result, university departments become instruments of industry: through company control of the research agenda and ghostwriting of medical journal articles and continuing medical education, academics become agents for the promotion of commercial products

Public funding of science is NOT the way forward, but finding some mechanisms to generate IP, create “startups” and then dealing with companies. The notion of a tinkerer and eureka moments are romantic and belong to an erstwhile era. Clinicians are equally responsible for participating in the scientific process. Universities have become a method to burnish credentials, attract students from outside the country and those with tenure, a cushy life. There are ills associated with any system. I don’t think blaming the pharma companies alone is the way forward. The structure incentivizes this behavior and the editorial could have offered solutions instead.

Market led research is the way forward. Bedside medicine still has a lot of promise. Finding cheaper alternatives to whole genome sequencing, for example, is one way. Standardizing scientific processes so that it is reproducible in clinics is another. There is a lot of duplication of efforts (and almost similar approaches), which makes it redundant to focus on the same thing. I find inordinate efforts to track pathways to identify potential “molecules” without understanding the context of biomedical research and broader implications. Since no one has the answer to the potential outcomes anyway, it is allowed to happen the way it happens.

This isn’t the first editorial which has got prominence. This won’t be the last.

Here are some practical suggestions, though. Again. Not the first time about calls for “transparency”.

Our proposals for reforms include: liberation of regulators from drug company funding; taxation imposed on pharmaceutical companies to allow public funding of independent trials; and, perhaps most importantly, anonymised individual patient level trial data posted, along with study protocols, on suitably accessible websites so that third parties, self-nominated or commissioned by health technology agencies, could rigorously evaluate the methodology and trial results. With the necessary changes to trial consent forms, participants could require trialists to make the data freely available. 

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