more fun and frolic with evidence-based medicine

EVIDENCE-BASED MEDICINE
MORE FUN THAN YOUR OWN PERSONAL COURT JESTER

Evidence-Based Medicine

Braxton University

Although he has been said to be, “one of the most highly cited researchers in the world,” medical doctor and Stanford University professor, JOHN IONNIDIS, has become one of Evidence-Based Medicine’s most vocal critics.  The late David Sackett, a professor of epidemiology and widely considered to be the father of the “EBM” movement, is arguably most famous for authoring the textbook, Evidence Based Medicine.  Earlier this month, the Journal of Clinical Epidemiology carried a paper by Ionnidis called Evidence-Based Medicine Has Been Hijacked:  A Report to David Sackett.  In this paper, Dr. Ionnidis wrote of a conversation he had with Dr. Sackett back in 2004.  The paper’s abstract summarized his thoughts nicely.

“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.”

Not only is this EXACTLY WHAT I HAVE BEEN TELLING ANYONE WHO WOULD LISTEN since I first heard the term “EBM” a decade or so ago, the problem is not getting better.  It’s getting worse.  Just two days ago, the website Retraction Watch (a website devoted to exposing medical studies that have been retracted due to fraud) carried an interview with Ionnidis called Evidence-Based Medicine has Been Hijacked:  A Confession from John Ioannidis.  In this article, he talks about some of EBM’s massive shortcomings — one being about a grant he applied for almost two decades ago to study the effects of antibiotics on Sinus Infections (he never heard back concerning his application); something we’ve known for quite some time works no better than placebo (HERE).

“Hundreds of millions of people were treated with antibiotics without good evidence back then, and hundreds of millions of people continue to be treated with antibiotics nowadays even though most of them would not need antibiotics.”

I have shown you over and over and over again that despite the medical community’s warnings about ANTIBIOTIC OVERUSE AND ABUSE, prescription habits have barely budged over the course of these same two decades.  In fact, click the previous link and I show you 30 or 40 posts to this effect — including my most recent on how one of the doctors on the TV show The Doctors, actually blamed this fact on patients.  

Ionnidis goes as far as revealing that even the venerable COCHRANE COLLABORATION has fallen prey to “industry” influences.  He goes on to say that, “The sales and marketing departments in most companies are more powerful than their Research & Development departments. Hence, the design, conduct, reporting, and dissemination of this clinical evidence becomes an advertisement tool.”  Although that is certainly a scathing indictment, listen to what a recent article (last week) from Health News Review dot org by Dr. Susan Molchan (MD) had to say concerning the same topic.

“Journals make money from big trials.  The fact is, big successful industry-sponsored trials bring in hundreds of thousands if not millions of dollars in revenue for journals. In the case of Vioxx, the Wall Street Journal noted, the journal sold 900,000 reprints producing revenue of $697,000, most of them bought by the company selling the drug (Merck). In all likelihood the company selling Xarelto [a blood thinner that’s been in the news because of its poor side-effect profile] also bought plenty of reprints, although the amount is not made public by the journal. Scientists concerned with this obvious conflict of interest, and the publication bias that it can produce (i.e. the tendency of journals to publish studies with positive results while rejecting negative studies) [these are known both inside and outside the industry as “INVISIBLE & ABANDONED” STUDIES], have suggested that the number of reprints sold or revenue garnered from those sales be published with the articles, just as authors must disclose their conflicts of interest.”

Conflicts of interest?  YOU DON’T SAY.  The truth is, little of the so-called “Evidence” can be trusted.  Much of this is because smart people (scientists employed by the industry) have figured out how to make research results say whatever they want it to say (HERE).  Never forget that very little medical research in this nation comes from neutral parties, but is instead done by the very companies trying to get their products approved by the FDA (HERE).   All examples below are cherry-picked due to constraints on both time and space.  Trust me; you’ll get the point.

  • The October 3, 2013 issue of NPR carried a story by Richard Knox called Some Online Journals Will Publish Fake Science, For A Fee.  He wrote that, “Many online journals are ready to publish bad research in exchange for a credit card number.   That’s the conclusion of an elaborate sting carried out by Science, a leading mainline journal.  Contributor John Bohannon sent a deliberately faked research article 305 times to online journals.   A journalist with an Oxford University PhD in molecular biology, Bohannan fabricated a paper purporting to discover a chemical extracted from lichen that kills cancer cells. Its authors were fake too — nonexistent researchers with African-sounding names based at the fictitious Wassee Institute of Medicine in Asmara, a city in Eritrea.  In the end, the paper’s fictitious authors got 157 acceptance letters and 98 rejections – a score of 61 percent.  More than half the journals that supposedly reviewed the fake paper accepted it.

 

  • Who remembers the recent hubub over the DIABETES DRUG, Avandia (it causes heart attacks among other problems)?   Writing for the November 24, 2012 issue of the Washington Post, Peter Whoriskey wrote in As Drug Industry’s Influence Over Research Grows, So Does the Potential for Bias, that, “For drugmaker GlaxoSmithKline, the 17-page article in the New England Journal of Medicine represented a coup.  The 2006 report described a trial that compared three diabetes drugs and concluded that Avandia, the company’s new drug, performed best.  “We now have clear evidence from a large international study that the initial use of Avandia is more effective than standard therapies,” a senior vice president of GlaxoSmithKline, Lawson Macartney, said in a news release.  What only careful readers of the article would have gleaned is the extent of the financial connections between the drugmaker and the research. The trial had been funded by GlaxoSmithKline, and each of the 11 authors had received money from the company. Four were employees and held company stock. The other seven were academic experts who had received grants or consultant fees from the firm.”  Rarely can you trust Big Pharma or the government watchdogs looking after Big Pharma (including Congress) to police themselves (HERE).

 

  • Have you ever heard of Merck?  Not only is the Merck Manual the oldest and most famous of any number of online reference texts for the medical community (it’s been around since the very early 1900’s), it’s now published free online.  It is owned by the pharmaceutical giant of the same name.  Listen to what Bob Grant had to say in the April 30, 2009 edition of The Scientist (Merck Published Fake Journal).  “Merck paid an undisclosed sum to Elsevier to produce several volumes of a publication that had the look of a peer-reviewed medical journal, but contained only reprinted or summarized articles–most of which presented data favorable to Merck products–that appeared to act solely as marketing tools with no disclosure of company sponsorship.  “I’ve seen no shortage of creativity emanating from the marketing departments of drug companies,” Peter Lurie, deputy director of the public health research group at the consumer advocacy nonprofit Public Citizen, said, after reviewing two issues of the publication obtained by The Scientist.  “But even for someone as jaded as me, this is a new wrinkle.””  This is almost identical to what GSK was fined three billion smackeroos for something quite similar just five short years ago (HERE).

 

  • A few weeks later, the same author carried a similar article (Elsevier Published Six Fake Journals) in the same journal showing that the previous bullet point was merely a hint of things to come.  “Scientific publishing giant Elsevier put out a total of six publications between 2000 and 2005 that were sponsored by unnamed pharmaceutical companies and looked like peer reviewed medical journals, but did not disclose sponsorship.  Elsevier declined to provide the names of the sponsors of these titles.    When confronted with the questionable publishing practices, Elsevier indicated that it had no plans of looking into the matter further…   [Listen to their initial response]  I understand this issue has troubled our communities of authors, editors, customers and employees, but I can assure all that the integrity of Elsevier’s publications and business practices remains intact.”  What they are really saying here is that lying, cheating, and stealing is the new norm.

 

  • Writing for the November 9, 2009 issue of the Ethical Nag (NEJM Editor: ‘No Longer Possible to Believe Much of Clinical Research Published’), author Carolyn Thomas quotes from DR. MARCIA ANGELL’S then brand new book. “It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.  No one knows the total amount provided by drug companies to physicians, but I estimate from the annual reports of the top nine U.S.-based drug companies that it comes to tens of billions of dollars a year in North America alone.  By such means, the pharmaceutical industry has gained enormous control over how doctors evaluate and use its own products. Its extensive ties to physicians, particularly senior faculty at prestigious medical schools, affect the results of research, the way medicine is practiced, and even the definition of what constitutes a disease.”  This means that even though you like and trust your doctor, you can’t trust what they are telling you or prescribing you, as they themselves have been lied to — and some might say “brainwashed” (HERE).

 

  • Not to be outdone, Dr.. Richard Smith, the 25-year past editor of one of the oldest and most prestigious medical journals on the planet (the British Medical Journal), wrote in the May 2005 issue of the medical journal PLoS One (Medical Journals Are an Extension of the Marketing Arm of Pharmaceutical Companies) that, “Journals have devolved into information laundering operations for the pharmaceutical industry.  The most conspicuous example of medical journals’ dependence on the pharmaceutical industry is the substantial income from advertising, but this is, I suggest, the least corrupting form of dependence. The advertisements may often be misleading and the profits worth millions, but the advertisements are there for all to see and criticize. Doctors may not be as uninfluenced by the advertisements as they would like to believe….   The much bigger problem lies with the original studies, particularly the clinical trials, published by journals. Far from discounting these, readers see randomized controlled trials as one of the highest forms of evidence. A large trial published in a major journal has the journal’s stamp of approval (unlike the advertising), will be distributed around the world, and may well receive global media coverage, particularly if promoted simultaneously by press releases from both the journal and the expensive public-relations firm hired by the pharmaceutical company that sponsored the trial. For a drug company, a favorable trial is worth thousands of pages of advertising, which is why a company will sometimes spend upwards of a million dollars on reprints of the trial for worldwide distribution. The doctors receiving the reprints may not read them, but they will be impressed by the name of the journal from which they come. The quality of the journal will bless the quality of the drug.”  Trust me when I tell you that this is the nicest part of Smith’s blistering expose.

 

  • The Centre for Research on Globalization is an independent research and media organization based in Montreal, Canada.  In a March 2015 article (The Evils of Big Pharma Exposed) that questions VACCINES in general (muchly because of MERCURY and other neuro-toxic ingredients) and the FLU VACCINE specifically.  After invoking the massive health-related conspiracy of the ROCKEFELLERS, author Joachim Hagopian stated, “This is the story of how Big Pharma seeks enormous profits over the health and well-being of the humans it serves, and how drug companies invasively corrupted the way that the healthcare industry delivers its vital services. This is neither a new nor unique story. In fact, the story of Big Pharma is the exact same story of how Big Government, Big Oil, and Big Agri-Chem Giants like Monsanto have come to power.”  And they’re all in bed with our politicians.  In fact, sometimes they are our politicians.

When I tell you that this is just the very tip of the iceberg, I mean it’s the very tip of the tip.  If given a bit of time, a person could write a veritable multi-volume encyclopedia of similar articles and studies.  The takeaway?  Take care of your health as though your life depends on it — because it does.  Sure; your doctor and the drugs he / she prescribes you, might be able to keep you alive longer than you would otherwise live while living the way you chose to live now (say that three times fast!).  But real health?  Sorry folks; that’s something your doctor cannot do for you no matter how much money you are willing to spend.  You’ll have to do it yourself.  Fortunately for you, those who are desperately overweight, struggling with Chronic Pain, or suffering with any number of Chronic Inflammatory or Autoimmune Diseases, can get a taste of what real health entails and how to start the process of restoring yours by taking a look at THIS SHORT POST.

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