A Scottish GP has written in the BMJ [£] about the dodgy practices of the pharmaceutical industry and how they use "evidence" to push their products.
Evidence based medicine is broken
Evidence based medicine (EBM) wrong footed the drug industry for a while in the 1990s. We could fend off the army of pharmaceutical representatives because often their promotional material was devoid of evidence. But the drug industry came to realise that EBM was an opportunity rather than a threat. Research, especially when published in a prestigious journal, was worth more than thousands of sales representatives. Today EBM is a loaded gun at clinicians’ heads. “You better do as the evidence says,” it hisses, leaving no room for discretion or judgment. EBM is now the problem, fueling overdiagnosis and overtreatment.Long time readers will be with me on this already, and the timescale stacks up too. Replace "clinicians'" with politicians and it would explain a lot.
You see, without so called “evidence” there is no seat at the guideline table. This is the fundamental “commissioning bias,” the elephant in the room, because the drug industry controls and funds most research.Remember that this is posted in the BMJ which has no intention whatsoever of limiting pharma-funded research, however shonky or biased, despite claiming impartiality by banning funded items from others. It is also quite happy to publish demonstrable poppycock from study designers with astonishing conflicts of interest.
So the drug industry and EBM have set about legitimising illegitimate diagnoses and then widening drug indications, and now doctors can prescribe a pill for every ill. The billion prescriptions a year in England in 2012, up 66% in one decade, do not reflect a true increased burden of illness nor an ageing population, just polypharmacy supposedly based on evidence. The drug industry’s corporate mission is to make us all sick however well we feel.Funny that, because there are NHS PCTs up and down the country desperately pushing ineffective solutions - because they are paid to do so - to 'cure' a habit that most users were comfortable with up until the turn of the century. Yet having created the market for change, alternatives such as e-cigs - which earn no cash for the NHS - are actively opposed by the same PCTs who say how urgent it is for everyone to quit smoking immediately.
The oft-repeated reason being, of course, that there is no "evidence" for the efficacy of e-cig whereas there is tons published - in 'impartial' organs like, oh I dunno, the BMJ for example - for pharmaceutical NRT.
You may be very happy with your choices, but if it ain't pharma you ain't healthy. Capiche?
Corruption in clinical research is sponsored by billion dollar marketing razzmatazz and promotion passed off as postgraduate education. By contrast, the disorganised protesters have but placards and a couple of felt tip pens to promote their message, and no one wants to listen to tiresome naysayers anyway.Highly paid men in suits against grass roots campaigns condemned as irrelevant if amateurish, or as "astroturf" if organised, do you mean?
How many people care that the research pond is polluted, with fraud, sham diagnosis, short term data, poor regulation, surrogate ends, questionnaires that can’t be validated, and statistically significant but clinically irrelevant outcomes?He forgot binning of studies which don't agree with pharma-led consensus and demonisation of anyone who comes up with a challenge, but you get the idea.
Medical experts who should be providing oversight are on the take.He can say that, I couldn't possibly comment.
Even the National Institute for Health and Care Excellence (NICE) and the Cochrane Collaboration do not exclude authors with conflicts of interest, who therefore have predetermined agendas.NICE who refuse to endorse e-cigs for long-term harm reduction but who are over the moon about long-term useless pharma NRT, you mean?
The current incarnation of EBM is corrupted, let down by academics and regulators alike.Rings a bell, that.
What do we do? We must first recognise that we have a problem.Indeed we must. All the while the MHRA, for example, is "funded entirely by the Pharmaceutical industry and a recent chairman had worked for years for Glaxo Smith Kline" we're on a hiding to nothing.
If we don’t tackle the flaws of EBM there will be a disaster, but I fear it will take a disaster before anyone will listen.Err, who wants to listen when there is so much money in it; when any differing voices have been eradicated from the debate; and when there are so many disgraceful lobbyists posing as health professionals willing to ignore abuses in order to further their own agenda/mortgage?
Some vested interest industries - and their self-serving abuse of science and evidence - are far more equal than others within the health lobbying community, it seems.