Tainted Evidence

Medical guidelines should insists on proof that time-honored medical practices and procedures that cost money and may harm or kill patients are actually effective. This Forum is about how to force organized veterinary medicine to issue Evidence Based Guidelines.

Tainted Evidence

Postby malernee » Tue Jul 19, 2005 3:04 pm

Tainted Evidence
Bill Benda, MD, Editorial Board Member
Integrative Medicine: A Clinician's Journal

Evidence-based. Once part of an exclusive lexicon of
conventional medicine, this lofty directive has found its
way into every institution's mission statement within our
field, from the Consortium of Academic Health Centers to
the Institute of Medicine's 2005 report on Complementary
and Alternative Medicine in the United States. Even CAM
professions that once rejected reductionist research
methodology as inappropriate to their "holistic" philosophy
have come to recognize, as well as desire, the credibility
that this particular verbal duet conveys.

And they should. Every individual suffering from ill health
deserves the assurance that the therapies recommended by
his or her practitioner have been tested in an unbiased
manner and found to be reasonably efficacious and
relatively safe. While advertisements in medical journals
are recognized and accepted as mass-marketing strategies,
randomized controlled trials in a peer-reviewed publication
are vetted by the editorial board and transcend the
influence of money and politics. Right?

Not necessarily. "Journals have devolved into
information-laundering operations for the pharmaceutical
industry," wrote Richard Horton, editor of the The Lancet,
in March of 2004.[1] The facts are that the pharmaceutical
industry represents a $550 billion retail drug market, and
is slated to reach $700 billion in annual sales by 2008.
Companies such as Novartis spend 33% of sales on
advertising alone (compared to 19% on research and
development),[2] and their promotional efforts may not be
limited to glossy full-page ads. Two-thirds to
three-quarters of the trials published in prestigious
journals such as Annals of Internal Medicine, JAMA, and New
England Journal of Medicine are funded by the drug
industry,[3] and are coincidentally four times more likely
to claim favorable results than studies funded by other
sources.[4] And the sad truth is that peer review offers no
guarantee of academic validity because copious data from
multi-center trials can confuse even the most experienced

But the tide is turning for Big Pharma. The public's trust
in the industry has fallen precipitously in the past few
years; not only because of the recent Vioxx-type debacles,
but because the patient has begun to question all aspects
of the healthcare system, including us, the practitioners.
Our credibility is on the line, and if we make a promise,
we had better be able to back it up with more than just a
hyphenated adjective. So before we elevate the term
"evidence-based" to biblical stature, let us remember that
evidence is only as valid as the integrity of those who
create it.

1. Horton R. The dawn of McScience. New York Rev Books.
2. El Feke S. A survey of pharmaceuticals. The Economist.
2005, June 18th-24th.
3. Egger M, Bartlett C, Juni P. Are randomized controlled
trials in the BMJ different? BMJ. 2001;323:1253.
4. Lexchin J, Bero LA, Djulbegovic B, Clark O.
Pharmaceutical industry sponsorship and research outcome
and quality. BMJ. 2003;326:1167-1170.
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