BMJ Opinion: The Illusion of Evidence Based Medicine, 2022, Jureidini and McHenry (and some doctors' opinions)

Do you think evidence based medicine has been compromised?

  • Yes

    Votes: 39 97.5%

  • No

    Votes: 0 0.0%

  • Not sure

    Votes: 1 2.5%

  • Other (Please explain)

    Votes: 0 0.0%
  • Total voters
    40
D

DigitalDrifter

Senior Member (Voting Rights)
https://www.bmj.com/content/376/bmj.o702
Evidence based medicine has been corrupted by corporate interests, failed regulation, and commercialisation of academia, argue these authors

The advent of evidence based medicine was a paradigm shift intended to provide a solid scientific foundation for medicine. The validity of this new paradigm, however, depends upon reliable data from clinical trials, most of which are conducted by the pharmaceutical industry and reported in the names of senior academics. The release into the public domain of previously confidential pharmaceutical industry documents has given the medical community valuable insight into the degree to which industry sponsored clinical trials are misrepresented.
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Reddit thread:
 
Not directly messing with scientific evidence, but some political leaders in Canada have removed all public health measures except vaccinations. The presumed message is the pandemic is over.

Medical experts repeatedly state the COVID pandemic is not over. Canada is in its 6th wave, but pandemic deniers seem to have won, despite scientific evidence to the contrary.
 
In relation to ME my heart always sinks when I read the phrase ‘evidence based medicine’ as it generally means bad evidence relying on bad science, more specifically unblinded trials relying on subjective outcomes.

I also think here in the UK, as @DokaGirl suggests in Canada, policy on Covid-19 is now more about a political desire for the pandemic to be seen as over rather than the medical reality.
 
The article is entirely focused on the influence of pharmaceutical companies with the dual problems of hiding data and adverse outcomes, and effect on academic research through funding.

All important stuff and depressing that so little progress has been made on getting all protocols published in advance, all results published, and all patient level anonymised data published too, to allow open scrutiny.

No mention of the equally harmful malign influence of insurance and government departments and research funding bodies on psychosomatic research and treatments and denial of benefits etc. for conditions without curative drug treatments, and the skewing effect of this source of funding and influence on academic promotions and 'evidence based medicine'.

The pharmaceutical side is important, and easy to understand. Hence someone like Ben Goldacre can make his name exposing it. Those involved in making this the story public seem less inclined to take up the massive problem with psych evidence.
 
Yes, I found it a bit dated and lacking practical insight. The senior author Leemon McHenry I know from my philosophy world. A very nice guy, interested in Whitehead, Leibniz and such people but I was not aware of an interest in medicine.

There is a muddling up of science and evidence too. Popper was about science and theories. The medical problem is simply about having reliable facts about what treatments work, forget any theories or rational thought!
 
Getting a bit tired of these kind of critiques focusing on the pharmaceutical industry. Whatever their dodgy practices might be, at least their claimed treatments have the advantage of actually being amenable to proper blinding/placebo control. e.g. Rituximab.

Needs to be a lot more focus on the standards of non-pharmacological therapeutic claims, and their systematically inferior methodologies.

Assuming the critics are actually interested in standards, not just bashing the pharmaceutical industry in order to promote non-pharmacological treatments.
 
Caroline Struthers said:
My favorite comment - nail on the head "we have no real guardians - with the power to serve proper punishments"

https://www.bmj.com/content/376/bmj.o702/rr-13
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Yes it's a thing of beauty:
"Quis custodiet ipsos custodes? (Who shall guard the guardians?) .. The current answer is ... no-one."

Well I vaguely recall the guards calling Jonathan a pain in the flesh or some such ---- so I'd nominate you and Jonathan!
 
Sean said:
Getting a bit tired of these kind of critiques focusing on the pharmaceutical industry. Whatever their dodgy practices might be, at least their claimed treatments have the advantage of actually being amenable to proper blinding/placebo control. e.g. Rituximab.

Needs to be a lot more focus on the standards of non-pharmacological therapeutic claims, and their systematically inferior methodologies.

Assuming the critics are actually interested in standards, not just bashing the pharmaceutical industry in order to promote non-pharmacological treatments.
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I agree. I don't think they are really interested in standards, otherwise people like Ben Goldacre, Paul Glaziou, Paul Garner, everyone in Cochrane as far as I can tell, would not continue to ignore the shockingly poor standards in trials of behavioural and psychological treatments.
 
Caroline Struthers said:
"we have no real guardians - with the power to serve proper punishments"
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Agreed. The quack psychologists who had me sectioned for being bed bound (and their supporting GPs, Social workers, etc) never faced justice for the permanent harm they did. My GP claims the best evidence based treatment for ME is GET. I've been too scared to call my GP for anything since late 2014 because he condoned my sectioning.
 
A precision @DokaGirl: I am therefore lucky because, in my Province, the basic sanitary measures (mask in public places, physical distancing, hand washing, isolation, etc.) are still in place. And our government is following public health guidelines, no 6th wave deniers here.
 
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