CORRUPTION IN HEALTHCARE
SHOULD WE BE SURPRISED ABOUT ANYTHING
HAVING TO DO WITH EVIDENCE-BASED MEDICINE?
The authors are both solid citizens, both MD's, both epidemiologists, and both used to raising a ruckus about what's going on with the research side of their profession. Dr. Paul Glasziou not only sees patients, but is a professor of EVIDENCE BASED MEDICINE at Australia's Bond University. His co-author, Dr. Ian Chalmers, among other things, helped create the COCHRANE COLLABORATION --- a loose-knit group of 40,000 doctors and researchers from around the world, dedicated to truth in research. Listen to their scathing words....
"If 50% of mail we posted never arrived, the outcry would be considerable. Although current estimates are that about half of research goes unpublished, there is little outcry. Unfortunately, the best predictor of publication seems to be whether the study is “positive” or “negative,” which means that the half of the research results we can access is biased."
I want you to note what they are telling you here, because once you grasp the implications, everything you see or read about medical research is on the table and open for discussion. The reason that half of all medical studies are never completed or never published is simple. Because drug companies are actually doing their own research (often times on the public dime), if they don't like what they see or if the study shows their product(s) in a bad light, they just pull the plug, fold up camp, make sure everyone is well paid, and bury the results so deep in the basement file cabinets there is no prayer of it ever seeing the light of day. These are so common in the research community (50%) that they actually have a name --- INVISIBLE & ABANDONED TRIALS.
What I want to talk about today, however, are some of the studies showing how the fifty percent of the research that actually makes it to publication is being finagled (HERE are some I've talked about in the past). In other words, it's not like the fifty percent of the research iceberg that's visible above the water is above reproach. Corruption always has to do with two things, money and power. Big Pharma has both.
After asking the question of whether or not the 50% statistic is accurate, and then showing a number of studies that show this phenomenon is not only occurring but occurring all over the world, they admit that it's a terrible waste of the 180 billion dollars used to fund said research. They go on to plead their case that none of this funding should be cut (another topic for another day), but that we just need better oversight. The interesting thing about this assertion is that THE GOVERNMENT has been ratcheting up the oversight for years, while everyone involved gets richer, and the basement file cabinets get fuller.
As is usually the case, the comment section provided more fun, frolic, and insight than the paper itself. First off, Dr. G threw the fifty percent waste statistic out the door when he answered a commentor by eliciting his article from last January's issue of the same journal --- BMJ Opinion (Is 85% of Health Research Really Wasted?). What's astounding is that these same two authors actually calculated the waste in medical research at 2.5% higher than this (87.5%), but decided to round down to 85%. If they are correct, it means that only 12.5 cents of every research dollar is going where it is supposed to go. You or I could never do this with our businesses, but when you are playing with house money (tax dollars), who really cares?
Another commentor provided the links to several studies showing that, "published journal articles tended to overestimate the effects of intervention, on average, by over 30%." Which studies are published? I already showed you --- the ones with positive results for whatever drug or procedure is being studied. Make sure to grasp the importance of this. Positive studies are exaggerated by a whoppig 1/3. Still another commentor brought up the issue of what's widely known in the industry as "data mining".
Nature dot com defines Data Mining thusly. "The process of extracting potentially useful information from data sets." The key word here is "potentially". Researchers have an uncanny ability to use computers and accounting tricks to make research say whatever they want it to say --- you know; the whole figures-never-lie-but-liars-figure thing. The research this last commentor used to back his assertion was fascinating. In a study published in this month's issue of PLoS One (Evidence of Selective Reporting Bias in Hematology Journals), researchers looked at the results of 109 studies published in journals having to do with blood. What did they find?
"Our analysis revealed 118 major discrepancies and 629 total discrepancies. Among the 118 discrepancies, 30 (25.4%) primary outcomes were demoted, 47 (39.8%) primary outcomes were omitted, and 30 (25.4%) primary outcomes were added. Three (2.5%) secondary outcomes were upgraded to a primary outcome. The timing of assessment for a primary outcome changed eight (6.8%) times. Thirty-one major discrepancies were published with a P-value and twenty-five (80.6%) favored statistical significance. A majority of authors whom we contacted cited a pre-planned subgroup analysis as a reason for outcome changes. Because RCTs ultimately underpin clinical judgment and guide policy implementation, selective reporting could pose a threat to medical decision making."
Although it might be a bit tough for people not versed in medical research to completely grasp what's going on here, it's clear to see that firstly, it's cheating the system at the expense of patient safety, and secondly, it was pre-planned. The authors knew what they were going to do ahead of time. However the data might come out, experts have actuarial contingency plans to tip the scales back so that results can be padded to look however they want them to look.
Still another commentor showed incidences of researchers filing their studies two times and in two different ways so that whatever happened in the lab, they could show a positive result (just bury the negative result). This is kind of like companies that hedge their bets by donating equally to both republicans and democrats (and maybe even Ralph Nader just to be safe) not really caring who wins just as long as they can peddle their influence. Once you factor in the reality that only about 1% of the adverse effects of drugs or procedures are ever reported to the authorities that actually maintain statistics (HERE), you start to see how scary (not to mention UNSUSTAINABLE) this whole house of cards really is.
If you are really interested in taking your health back and getting off the medical merry-go-round, take a look at this SHORT POST.
Hopefully you are starting to see why your healthcare is up to you. No one can do it for you and you can't always rely on the "best evidence". If you enjoy our site of find it helpful, make sure and spread the wealth. Best way to reach those you love and care about most? FACEBOOK of course.