Article : The Corruption of Evidence Based Medicine — Killing for Profit

[Arnie Pye]

Title :The Corruption of Evidence Based Medicine — Killing for Profit

Author : Dr Jason Fung

Article Date : 10th April 2018 - 10 minute read

Link :

https://medium.com/@drjasonfung/the-corruption-of-evidence-based-medicine-killing-for-profit-41f2812b8704

The idea of Evidence Based Medicine (EBM) is great. The reality, though, not so much. Human perception is often flawed, so the premise of EBM is to formally study medical treatments and there have certainly been some successes.

Consider the procedure of angioplasty. Doctors insert a catheter into the blood vessels of the heart and use a balloon like device to open up the artery and restore blood flow. In acute heart attacks studies confirm that this is an effective procedure. In chronic heart disease the COURAGE study and more recently the ORBITA study showed that angioplasty is largely useless. EBM helped distinguish the best use of an invasive procedure.

So, why do prominent physicians call EBM mostly useless?

Article continues at above link.

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It is worth reading the responses. One in particular caught my eye, on the subject of MCS - Multiple Chemical Sensitivity. It sounded to me like the respondent (Steve Chalmers) was almost writing a possible short history of ME.

 

[Snowdrop]

If only this were more widely known. The article places blame on Big Pharma (no problem there) but you could replace BPh with Insurance and the same thing applies.


“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”

This has huge implications. Evidence based medicine is completely worthless if the evidence base is false or corrupted. It’s like building a wooden house knowing the wood is termite infested. What caused this sorry state of affairs? Well, Dr. Relman another "); background-size: 1px 1px; background-position: 0px calc(1em + 1px);">former editor in chief of the NEJM said this in 2002

“The medical profession is being bought by the pharmaceutical industry, not only in terms of the practice of medicine, but also in terms of teaching and research. The academic institutions of this country are allowing themselves to be the paid agents of the pharmaceutical industry. I think it’s disgraceful”

We must be more skeptical of evidence.

A list of problems with EBM is included:

So here’s a damning list of all the problems of EBM

1. Selective Publication
2. Rigged outcomes
3. Advertorials
4. Reprint Revenues
5. Bribery of Journal Editors
6. Publication Bias
7. Financial Conflicts of Interests

It doesn't however have anything to say about how to turn this around.

 

[Barry]

It doesn't however have anything to say about how to turn this around.

That is the really big question.

 

[chrisb]

Might not some of the problems in this area lie in the way in which "experts" come to be viewed, both by themselves and by those who seek their opinions? They may genuinely see themselves as the fount of all relevant knowledge in an area and believe themselves to be acting in good faith in demanding such alterations and citations. Sometimes, of course, they may not be.

It is safest always to view the opinions of experts as contingent and provisional.

 

[erin]

@Snowdrop and @Barry, I understand both of your points. However, I feel one can only point out what is wrong and Dr Fung managed to do this while he is -I think- still working in the system that he criticizes. This is very brave of him and also must be very energy consuming, hard work. Pointing out the corruption is hard enough, I feel it is unrealistic to expect him to know and explain how to turn this around. He's aware of something is very wrong and shared this knowledge with many is very good of him. One person or few persons can not turn and have a plan how to -this systematic corruption of decades. They can only point out and the rest is up to us; all of us starting from all workers of health establishments, patients and patients families and friends, basically every human. To start with we need to sit and think about this. We can not sit and wait someone to tell us how to to sort out such a deep corrupt system. Everyone has to think very seriously about what really is going on in this world including the big pharma, I can not and don't want to get political and we're not really allowed to be political, which is quite telling. I'm only wondering what can an individual do to reject the system interfering with our lives.

 

[Barry]

@Snowdrop and @Barry, I understand both of your points. However, I feel one can only point out what is wrong and Dr Fung managed to do this while he is -I think- still working in the system that he criticizes. This is very brave of him and also must be very energy consuming, hard work. Pointing out the corruption is hard enough, I feel it is unrealistic to expect him to know and explain how to turn this around. He's aware of something is very wrong and shared this knowledge with many is very good of him. One person or few persons can not turn and have a plan how to -this systematic corruption of decades. They can only point out and the rest is up to us; all of us starting from all workers of health establishments, patients and patients families and friends, basically every human. To start with we need to sit and think about this. We can not sit and wait someone to tell us how to to sort out such a deep corrupt system. Everyone has to think very seriously about what really is going on in this world including the big pharma, I can not and don't want to get political and we're not really allowed to be political, which is quite telling. I'm only wondering what can an individual do to reject the system interfering with our lives.

Sorry, I think my comment was unclear. Was not a criticism at all. When I say 'that is the really big question' I really was throwing that out to the wider world, because as you say, it is beyond any one person to solve. The efforts of Dr Fung are a major step in the right direction.

 

[erin]

Sorry, I think my comment was unclear. Was not a criticism at all. When I say 'that is the really big question' I really was throwing that out to the wider world, because as you say, it is beyond any one person to solve. The efforts of Dr Fung are is a major step in the right direction.

I kind of knew that you were not criticizing Dr Fung, I felt I had to write what I wrote because whenever I point out similar issues to family and friends, they always ask me what is the alternative or what to do? They expect me know all the answers because I know/ aware of the wrongness. And of course I don't know what to do about it.

 

[Snowdrop]

@Snowdrop and @Barry, I understand both of your points. However, I feel one can only point out what is wrong and Dr Fung managed to do this while he is -I think- still working in the system that he criticizes. This is very brave of him and also must be very energy consuming, hard work. Pointing out the corruption is hard enough, I feel it is unrealistic to expect him to know and explain how to turn this around. He's aware of something is very wrong and shared this knowledge with many is very good of him. One person or few persons can not turn and have a plan how to -this systematic corruption of decades. They can only point out and the rest is up to us; all of us starting from all workers of health establishments, patients and patients families and friends, basically every human. To start with we need to sit and think about this. We can not sit and wait someone to tell us how to to sort out such a deep corrupt system. Everyone has to think very seriously about what really is going on in this world including the big pharma, I can not and don't want to get political and we're not really allowed to be political, which is quite telling. I'm only wondering what can an individual do to reject the system interfering with our lives.

No argument from me on that. I did notice that he is speaking in parliament but I tend to keep my posts rather brief as I can't manage long posts.

I think the points he made are well taken and I did suggest that this needs to be widely disseminated. People need to care.

I am one of the affected by this opioid crisis perpetrated by BigPH. My GP would not Rx my sleeping med at the last visit I was able to get to.

Politics affecting ME is allowed by the rules I believe. Other political commentary would soon become fractious I think.

 

[alex3619]

It is safest always to view the opinions of experts as contingent and provisional.

An expert is only more likely to be right. In science everything is provisional. Medicine is even more inexact, and long standing views get overturned from time to time. In fact many of the big successes in EBM have come from overturning views.

The main problem with EBM, as I see it, is how the medical community views it. Too many do not view it critically or scientifically, but as another source of dogma. If the EBM revolution really took off we would have a global community of doctors trained to identify unreliable or bad research. This appears to be rare, including in my local region.

Psychiatry sets good examples of bad medical research practice because almost everything in psychiatry is unreliable to an extent that means it cannot be considered gold standard. Yet the medical community has a very long history of just accepting psychiatric claims. For psychiatry to improve, psychiatric research must be held to a high scientific standard, and objective findings need to be a requirement for anything considered "gold" standard.

For the medical community to improve, doctors need to be trained in critical analysis. That means ongoing training for all of them as a compulsory requirement.

Even EBM organisations need to tighten their standards. Lax research standards should automatically downgrade any research involved. That means, sadly, that ME clinical research would be downgraded as we are using a consensus definition ... but so would all psychiatric research not looking at objective marker subgrouping. They need objective diagnostic tests.

Pyschopsychiatric research without valid and useful objective outcomes would be downgraded twice. That would make them "bronze" standard at best. A study riddled with flaws like the PACE trial should be downgraded to a new category, lower than anecdotal evidence ... especially with the deliberate manipulation of data to create the desired outcome, with the calculation of "normal". Heck, they should just call it scientific misconduct.

At least ME research is focusing on objective markers and outcomes, though subjective outcomes still seem to be used in early studies. That is a big step up over most of psychiatry. Once we have biomarkers that reliably define ME or subgroups, things will improve again. That cannot happen fast enough.

 

[erin]

No argument from me on that. I did notice that he is speaking in parliament but I tend to keep my posts rather brief as I can't manage long posts.

I think the points he made are well taken and I did suggest that this needs to be widely disseminated. People need to care.

I am one of the affected by this opioid crisis perpetrated by BigPH. My GP would not Rx my sleeping med at the last visit I was able to get to.

Politics affecting ME is allowed by the rules I believe. Other political commentary would soon become fractious I think.

Sorry to hear you were affected by the big pharma directly.

I used politics in general not only affecting ME. Opposed to the superficially very free times that we live, I believe we are not allowed to be political in this era, I felt there was more freedom in the past in my experience. We appear to be very free but we really are not, internet is very tightly controlled; you are not allowed to make anonymous comment and very silly points can be used against one self, not allowed to have spur of the moment demos without booking. Everything is tightly controlled.

 

[Snowdrop]

Sorry to hear you were affected by the big pharma directly.

I used politics in general not only affecting ME. Opposed to the superficially very free times that we live, I believe we are not allowed to be political in this era, I felt there was more freedom in the past in my experience. We appear to be very free but we really are not, internet is very tightly controlled; you are not allowed to make anonymous comment and very silly points can be used against one self, not allowed to have spur of the moment demos without booking. Everything is tightly controlled.

I didn't pick up on that point. I'm not completely certain but I don't think we need permits here in Canada (or at least in Toronto) to demonstrate.

The age of internet and it's consequences is a big subject and I have no ability to consider it's implications.

Valid concerns. Maybe there are forums out there that cater to this kind of discussion.