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Tainted Medical Evidence Corrupts Evidence-Based Medicine

Corruption In Our Medical Labs

I’ve written before on the corrupted state of our medical research (see “Healthcare USA: Biased Research, Bogus Medicine” and, of course, Our Healthcare Sucks).

The fact that the big money in medicine is in pharmaceuticals has not been lost on academic medical centers, as seen in the gross commercialization of medical research.

This inter-mingling of commerce and science has infiltrated the conduct of clinical trials of new drugs under development. It’s also seriously compromised the integrity and validity of the medical “science” on which so much of medical practice is based.

This is no big revelation. Former editors of major medical journals that review thousands of clinical studies for publication in their journals have flat-out labeled the whole process “corrupt”. Here are a few of their comments (emphases added):

  • “The  influence  that  the  pharmaceutical  companies, the for-profits, are having on every aspect of medicine…is so blatant now you’d have to be deaf, blind and dumb not to see it…We have allowed them to take over, and it’s our fault, the whole medical community.”[1]

             Dr. Catherine deAngelis, former editor

              Journal of the American Medical Assoc.

  • Physicians can no longer rely on the medical literature for valid and reliable information.”[2]

                Dr. Marcia Angell, former editor-in-chief

               The New England Journal of Medicine

  • “A medical profession that is being educated by an industry that sells the drugs physicians prescribe…is abdicating its ethical commitment to serve as the independent fiduciary of its patients.”[3]

         Dr. Arnold S. Relman, former editor-in-chief

        The New England Journal of Medicine

“Garbage In, Garbage Out”

Clearly there are fundamental problems with the state of the science of modern medicine. This alone should discourage patients from relying solely on medical judgments that are reliant on such dubious “science”.

There’s a term that’s popular – “junk science” – that increasingly applies to much of what appears in the medical literature these days.

There’s another term from the computer sciences that also applies…“garbage in, garbage out”.

In this case, if the information on which doctors are basing medical decisions is based on tainted studies riddled with conflicts of interest, then their output – our treatment regimens – are likely to be unsound and possibly even harmful.

This, of course, undercuts the efficacy of evidence-based medicine that’s at the core of our healthcare reform efforts in America.

Research Fraud On The Rise

A couple of studies in the Journal of Medical Ethics lend credence to this concern. The first of these examined the trend in retracted – as in withdrawn – medical research papers from 2000-2010.

It found 742 studies were retracted during this period for errors and fraud. Almost a third – or almost 250 studies – were never even noted by the publishers of these studies as having been retracted.

Even worse news is it’s a trend that’s worsening. As the study’s authors noted:

“Total papers retracted per year have increased sharply over the decade, as have retractions specifically for fraud…Journals often fail to alert the naïve reader (meaning our doctors).”[4]

Fraudulent medical research is skyrocketingThis graph from the study shows this skyrocketing trend in fraudulent and erroneous research. The sky-rocketing blue line represents retracted studies in relation to the published research represented by the green bars.

This, of course, very much mirrors the increase in our medical spending.

You’re not paranoid if you suspect a connection.

A second study in the same journal examined the probable effects of these retracted papers on patient care. It noted not only the number of patients involved in the over 700 withdrawn studies, but those involved in subsequent research that relied on these withdrawn studies.

This study documents the ripple effect of such fraudulent and erroneous research…

“Retracted papers were cited (in subsequent research) over 5,000 times, with 93% of citations being research related, suggesting that ideas promulgated in retracted papers can influence subsequent research

“Over 28,000 subjects were enrolled and 9,189 patients were treated in 180 primary retracted studies. Over 400,000 subjects were enrolled and 70,501 patients were treated in 851 secondary studies which cited a retracted paper…

“Papers retracted for fraud treated more patients per study than papers retracted for error…

“Many patients are put at risk by retracted studies. These are conservative estimates, as only patients enrolled in published clinical studies were tallied (emphasis added).”[5]

Tip of the Iceberg?

What this last sentence means is the almost half a million patients in these studies are just the tip of the iceberg. Many more are put at risk every day in medical practice that’s based in part on these fraudulent and erroneous studies – and the subsequent studies that relied on them.

Consider this ripple effect and how it’s likely to impact millions of patients now and in the future:

    # patients                             # patients                       # patients

   affected by                       affected by studies              affected in

 retracted studies             citing retracted studies       medical practice

28,000 studied                    400,000+ studied                  millions?

  9,189 treated                      70,501 treated                     millions?

If the first ripple effect went from tens of thousands to hundreds of thousands, it’s highly likely the second ripple effect on medical practice “in the trenches” is in the millions.

So even if your doctor is one of the honest and conscientious ones, he or she may be relying on bogus research to base his or her treatment plan for you or a loved one.

Who knows, after all, when the truth is unknown? 

Weigh in below with your comments

[1] Medical schools, journals start to fight drug industry influence. USA Today. 9/10/08.

[2] Industry Sponsored Clinical Research – a Broken System. JAMA. 2008; 300(9):1069-1071.

[3] Medical professionalism in a commercialized health care market. Cleveland Clinic J of Med. 11/08. Vol. 75, Suppl. 6, S33-6.

[4] Retractions in the scientific literature: is the incidence of research fraud increasing? J Med Ethics 2011;37:249-253 doi:10.1136/jme.2010.040923

[5] Retractions in the medical literature: how many patients are put at risk by flawed research? J. Med. Ethics 2011;0:jme.2011.043133v1-jme.2011.043133

 

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