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putting the “evidence” back in evidence-based medicine?  not likely!


“The irony is that in order to get through the massive mess and clutter of terrible research, some good researchers feel the need to play the clickbait title card, which in turn raises doubt about their biases and integrity. It’s a vicious circle, the best research being conducted that has the most value for improving society and people as a whole is lost somewhere in this mess.” From an elite but unnamed Ph.D researcher on an online mastermind group I am part of.

Just yesterday, cardiologist and renowned medical blogger, Dr. Milton Packer, took to the airwaves with his MedPage Today article titled Medical Journals: A Sluggish Form of Twitter? (Milton Packer Describes the Agonizing Decline of Medicine’s Publication Values).   In it he described this “clickbait” issue above, comparing journal publications to Twitter and linking much of the current mess back to a man named Eugene Garfield. 

Garfield — deceased for a couple of years (he was 91 when he passed) — was an Ivy League-educated chemist and linguist, who happened to have a penchant for computers, mathematics, and algorithms.  He created numerous companies, including the Institute for Scientific Information, of which the pillar of truth, Wikipedia, states……

“ISI maintained citation databases covering thousands of academic journals, including a continuation of its longtime print-based indexing service the Science Citation Index (SCI), as well as the Social Sciences Citation Index (SSCI) and the Arts and Humanities Citation Index (AHCI). All of these were available via ISI’s Web of Knowledge database service. This database allows a researcher to identify which articles have been cited most frequently, and who has cited them.

The database provides some measure of the academic impact of the papers indexed in it, and may increase their impact by making them more visible and providing them with a quality label. Some anecdotal evidence suggests that appearing in this database can double the number of citations received by a given paper.”

In other words, a journal had better be indexed by ISI or it’s not going anywhere.  Furthermore, the individual papers that are published in these journals had better have some ‘juice’ as well — they had better have something Garfield coined “IMPACT VALUE“.  According to Packer, Garfield’s chief contribution to our current system is that “He invented the ‘impact factor.’” 

In the academic research world, the measure of success used to be having a paper that was worthy of  publication in a medical journal.  Simply being published is no longer good enough.  Papers need impact value.  The impact factor is a citation metric.  In other words, the more times a paper is cited by other authors, the better it is according to Garfield’s algorithms, and the higher it ranks.  But it doesn’t end there.  These rankings turn back around and affect the journal’s overall rankings. 

Packer went on to state that as these rankings have become increasingly important to financial success, editors were flat out “driven nuts“. The result?  “An editor who understood how the formula was calculated could take steps to greatly exaggerate (manipulate) it. And if editors were determined to play the game, it was easy to implement a host of strategies that would enable them to leapfrog the competition.” 

What kind of strategies are we talking about here?  Without going into the sordid details — you can get the straight dope in my EVIDENCE-BASED MEDICINE COLUMN — Packer provided an overview of what the process has turned into — a Frankenstein-like metamorphosis if you will, that has severely devalued academic medicine.

“Suddenly — and particularly over the last year or so — the competition over impact factors has broken into open conflict. Editorial board meetings still spend time talking about the scientific merit of a paper, but they often spend much more time discussing or worrying about whether a candidate paper will be cited. 

In the past, the dominant question was: Does the paper utilize valid methods to collect important original data that are interpreted in an unbiased way that makes a meaningful contribution to the field?  Now the question is: Is the type, format, or topic of this paper conducive to it being repeatedly cited by other authors? Will it get attention?  It’s actually much worse than you think.”

Chief among the many things listed by Packer was ignoring really crappy research if that research has a high “impact value“.  We’ve all seen these sorts of studies being discussed in the media.  They carry titles that over-promise CANCER CURES (who could forget the brouhaha dredged up with the ‘Israeli Cancer Cure’ headlines this past January?).

Or WEIGHT LOSS (the myriad of studies on the benefits of DIET SODA as an aid for losing weight), or athletic performance (last June’s study published in the European Journal of Clinical NutritionChocolate Milk for Recovery from Exercise: A Systematic Review and Meta-Analysis of Controlled Clinical Trials).  Believe me when I tell you that I could have kept going.  The downstream consequences of this phenomenon were discussed by Packer.

“The editors now send a loud and clear message to all authors: Certain types of high-quality articles are not welcome because they are rarely cited. At the same time, many editors have warmly embraced certain types of low-quality publications that are notorious for using highly questionable methods.  Because these types of papers receive so much attention, many editors are inclined to ignore their enormous faults. (Their readers will never learn about these faults, since the papers are published in high-ranking journals.)

But it is better to publish a weak paper that will gain attention than a strong paper that might be neglected.  The end result: many journals have now become a form of Twitter. Their editors now focus on the number of “followers,” “retweets,” and “likes.” The only difference is: journals do not have a 240-character limit.”

In other words, Packer is saying that academic medical science is rapidly being reduced to titillating soundbites or SCRUMPTIOUS MEMES, exactly like we see occurring in the world of social media.  Now the medical community has their own little world of “Fake News” and propaganda (HERE is a great recent example) that even they can no longer ignore. 

Isn’t it doubly interesting that studies are showing that overexposure to and infatuation with this sort of media leads to chronic __________ (insert your term of choice here — stress, depression, anxiety, bullying, eating disorders, suicide, etc, etc, etc); all of which come up readily on Google searches?  And lest you think that Packer was talking about the myriad of new pay-to-publish journals springing up for this very purpose, his response in the comment section suggested otherwise.

“My blog post this week focused on the decline in publication values of our important journals — the ones that we care about, the ones that we love and nurture, and the ones that represent our carefully tended gateways to progress. If the publication values of these top-tier journals fall into the abyss, then medical journals will die.”

They already are.  How bad is it?  The brand new issue of the Journal of Scientific Practice and Integrity published a study titled Academic Publishing and Scientific Integrity: Case Studies of Editorial Interference by Taylor & Francis, which took on the British publishing company, Taylor and Francis — a company that’s been around for nearly 170 years, publishes numerous journals (over 1,500 different titles), and earns over half a billion dollars a year in the process — to task for money-fueled bias.

“Editorial independence, the license of editors to approve a contribution for publication free from the influence of
owners, advertisers, or media company directors, is a bedrock of journalism and academic publishing.  The growing domination of academic publishing by large, for-profit corporations threatens this independence. There is alarming evidence that large companies too often serve their own business interests and those of powerful clients rather than serving the scientific community and the general public.”

What did these authors expose that T&F was first going to publish in one of their journals but then decided against?  Is anyone here familiar with the MONSANTO FIASCO that’s recently come to light concerning their weed killer GLYPHOSATE? To recap: last August, San Fransisco groundskeeper, Dewayne Johnson, was awarded nearly 300 million dollars in a jury trial that found Monsanto at fault for his cancer; and just last month, Edwin Hardeman, another California resident, was awarded 80 million for the same thing. 

The problem isn’t just that these people used Roundup and got cancer, it’s that Monsanto knew for decades that their product(s) carried significant risks, and did not want it to come out that they had been actively and aggressively working to cover it up from the very beginning.

“The company would ghostwrite a number of articles in the names of academic toxicologists. This, he says, is how Monsanto handled another safety review of the glyphosate-formulation, Roundup, published under the names of Williams, Kroes and Munro in 2000.  Their paper, Safety Evaluation and Risk Assessment of the Herbicide Roundup and its Active Ingredient, Glyphosate, for Humans, the purported evaluation of three ‘independent’ scientists, was widely cited by Monsanto and used in submissions to regulatory agencies [LIKE THIS ONE] to support the widespread use of Roundup.

The origin of that manuscript, by Heydens’ own admission, was an in-house Monsanto ghostwriting project.  Monsanto was trying to beat back a report by British toxicologist, James Parry, who, under contract with Monsanto, observed evidence of carcinogenic effects associated with glyphosate formulations. The Parry report was subsequently suppressed by Monsanto and replaced with Williams et al.”

As I’ve shown you previously, GHOST-WRITING is an all too common practice in the scientific research community, whereby a corporation will make up some data from off the top of their heads, have someone put it together into a nice and neat package, pay big bucks to researchers willing to sign their John Henry’s to the study, and then hire a PR firm to vigorously promote it as gospel truth. 

While it’s maybe not as common a way of distorting the truth / steering the “evidence” as is INVISIBLE & ABANDONED studies — half of all research done is never published because it does not conform to the financial goals of whoever is underwriting the funding — it is common nonetheless.  And this was only one of the case reports the authors dealt with. 

The other had to do with a rich chemistry professor at the University of Washington (Larry R. Dalton) who had certain research findings and financial conflicts of interest (COI) overlooked or suppressed (author’s words) because he had already donated something like $20 million to the university, with his 40 million dollar estate promised, TOD.

“An impartial observer might suspect that these donations served to shield deviant research practices, past, present, and future, from scrutiny. The Dean at the time, Ana Mari Cauce, told author BK that Dalton was acting ‘within professional norms.'”

Within professional norms?  It’s another way of saying ‘business as usual’.  It’s why, as I’m continually reminded by the group mentioned in the post’s first quote from the top of the page that when it comes to biomedical research and “evidence-based medicine,” little is as it seems.  Which leads me to comment on a study (Treatment Patterns Among De-novo Metastatic Cancer Patients Who Died Within One Month of Diagnosis) that was published a few days ago in the journal JNCI Cancer Spectrum. 

The study was downright disheartening but not surprising, and something that I have been watching happen for decades (HERE).  It seems that in many cases, people are being treated with surgery and chemotherapy drugs right up until their death — long after any real chance of saving them had passed.

After looking at over 100,000 patients who died within a month of their diagnosis, a team of seven oncologists and cancer experts found that almost 30% of the colon cancer group had surgery, and nearly 1 in 5 of the lung cancer patients received radiation — not much different than what I showed you four years ago next month (HERE). 

Although I could go on, I’m out of time.  Just remember that your health is ultimately up to you.  What’s super empowering is that you can actually make a difference, not only with nasty disease like cancer (HERE), but with just about anything that’s ailing you (HERE).   If you feel this sort of information needs to make the rounds, be sure to reach those you love and value most by liking, sharing or following on FACEBOOK.


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