Web EpiMonitor

Today’s Flaws In Evidence-Based Medicine Called "A Public Health Problem"

The  Journal of Clinical Epidemiology currently includes a series of seven papers about promoting transparency and accountability in clinical and behavioral research. According to editorialists Daniel Kotz, Peter Tugwell, and Andre Knottnerus writing in the same issue, the seven papers have a “common storyline”, namely an urgent need to revise the way research is currently carried out, and with no quick or easy solution in sight.

So what’s the problem?

Basically, it’s an erosion of trust in research. The contributors to the series assert that the current incentive system facilitates bias, inefficiency, and scientific misconduct. These are serious charges and echo some of the concerns reported in The Lancet in 2014. “All actors decide how best to proceed in their circumstances, which too often increase waste and reduce value in biomedical research. The scientific process needs to be reinvigorated and its guiding principles promulgated…By ensuring that efforts are infused with rigour from start to finish, the research community might protect itself from the sophistry of politicians, disentangle the conflicted motivations of capital and science, and secure real value for money for charitable givers and taxpayers through increased value and reduced waste.”

Other Views

Ben Goldacre, an epidemiologist at the London School of Hygiene and Tropical Medicine, and his colleague Tracey Brown from Sense About Science express their views in the Journal in an article entitled “Fixing Flaws in Science Must Be Professionalized”.

According to these observers, “Science currently faces multiple challenges to its credibility. There is an ongoing lack of public trust in science and medicine…there is clear evidence that we have failed to competently implement the scientific principles we espouse.”

The examples Goldacre and Brown describe reflect many shortcomings in the conduct and reporting of clinical trial data, including incomplete reporting and manipulation of data.

Questions for Epidemiology

They state, “For epidemiology, all this raises important questions. It is clear that there are discretionary decisions made by researchers that can affect the outcomes of research, whether observational studies or randomized trials.”

  “…the flaws we see today, in the structures of evidence based medicine, are a significant public health problem. It is remarkable that we should have identified such widespread problems, with a demonstrable impact on patient care, documented them meticulously, and then left matters to fix themselves. It is as if we had researched the causes of cholera, and then sat proudly on our publications, doing nothing about cleaning the water or saving lives. Yet all too often efforts to improve scientific integrity, and fix the flaws in our implementation of the principles of evidence based medicine, are viewed as a hobby, a side project, subordinate to the more important business of publishing academic papers."

Goldacre and Brown argue that to fix these problems we must professionalize the work associated with fixing the flaws in a way that earns investigators grants, salaries, and priority attention.

Must Do Activities

Included in their list of professional activities to help assure the integrity of research are 1) extensive lobbying of policy makers and professional bodies, 2) close analysis of evidence on flaws and opportunities, 3) engaging the public to exert pressure back on professionals, 4) creating digital infrastructure to support transparency, and 5) open, public audit of best and worst practice.

Some of the titles for other papers in the series are included below. All of these articles are In Press at the Journal.

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