The journal Clinical Evidence, a project of the British Medical Journal, reports that at least 50% of common therapeutic interventions are completely unproven – meaning neither doctors nor researchers have any idea if they work or not. Worse yet, only 35% of treatments are known to be beneficial (11%) or likely beneficial (24%).
Recall, a few years ago the journal Obstetrics and Gynecology published a story reporting that only 30% of Ob/Gyn clinical practice guidelines were evidence based. When combined with the flurry of recent data on publication bias, fraud in scientific publishing and a more recent report that the Majority of Landmark Cancer Studies cannot be Replicated (to be clear, this study is paywalled and we can only access the abstract), the evidence base, in supposedly evidence-based practices, is crumbling quickly.
To address the lack of evidence the clinical practice, Congress authorized the Patient Centered Outcomes Research Institute (PCORI) along side the Affordable Care Act. Per their website, PCORIs mandate is:
to conduct research to provide information about the best available evidence to help patients and their health care providers make more informed decisions. PCORI’s research is intended to give patients a better understanding of the prevention, treatment and care options available, and the science that supports those options.
A laudable goal to be sure, bringing patients to the table in medical decision-making and research is long overdue. However, given the breadth and depth of the lack of evidence and the astronomical costs of adverse events and poor medical outcomes, educating patients about non-evidence based therapeutic options or comparing treatment A to treatment B as seems to be the focus, might not be enough to solve this problem. And given the billions of dollars at stake in pharmaceutical sales, it seems unlikely that bringing patients to the table will have any impact on product safety.
Indeed, if product pharmaceutical marketing is any indication about the direction the industry continues to pursue, it is clear that product safety and efficacy concerns are minimal at best.
John Oliver’s: Marketing to Doctors
Beyond the shenanigans on the front lines of pharmaceutical marketing noted by John Oliver, everything from the initial research (and definitions of the disease itself), peer review and publication, through FDA approval, CDC and other agency marketing, to the clinical guidelines to which physicians must practice, is influenced by pharmaceutical industry funding that sways evidence favorably. So much so, that recent reports have suggested there most medical research is utterly flawed.
Medicine has become all about the money, not people’s health. Even when evidence clearly shows that a treatment does more harm than good, it is ignored. Case in point – hysterectomy and oophorectomy. Both surgeries are destructive yet gynecologists continue to remove female organs for benign conditions at alarming rates. Most gynecologic conditions can be treated with organ-sparing procedures. So it is not surprising that the journal Obstetrics and Gynecology reported that only 30% of Ob/Gyn clinical practice guidelines were evidence based.
BTW – I got a good laugh from the video. Sad though how true it is.