How Evidence-Based Medicine is Failing Due to Biased Trials and Selective Publication

Kermit Cole
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When evidence-based medicine (EBM) was announced in the early 90s, according to a paper in the Journal of Evaluation in Clinical Practice, it was hailed as a ‘new paradigm’ for improving care.  Now “health care costs have increased while there remains a lack of high-quality evidence suggesting EBM has resulted in substantial population-level health gains,” the paper states, asserting that “EBM’s potential for improving patients’ health care has been thwarted by bias in the choice of hypotheses tested, manipulation of study design and selective publication.”  Every-Palmer, S., Howick, J.; How evidence-based medicine is failing due to biased trials and selective publication. Journal of Evaluation of Clinical Practice. Online May 12, 2014.  doi: 10.1111/jep.12147.

See also:
A false economy . . . (1 Boring Old Man)

From the article:
“I don’t respond positively to the term Evidence Based Medicine [EBM]. I’ve most often heard it used to elevate the Randomized Clinical Trial [RCT] or somebody’s Guideline to the level of binding truth.”

 

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Kermit Cole
Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected]

4 COMMENTS

  1. I wasn’t able to pull up the entirety of the recommended journal article, but the 1 Boring Old Man assessment was quite insightful regarding what actually seems to be going on in the industry. EBM within the psychiatric industry is now a complete fallacy, due to the greed and lack of respect for patients of the APA and it’s followers.

  2. Comment by Dr. Bernard Carroll at 1boringoldman:

    May 15, 2014 | 10:02 PM

    Here is a delightfully trenchant commentary on EBM by the irrepressible Bruce Charlton. Bruce used to be editor of the journal Medical Hypotheses until he left that position in a disagreement with the publisher over a matter of principle. There are lessons here for all who would promote top-down science – Dr. Insel at NIMH, are you listening?

    http://charltonteaching.blogspot.co.uk/2009/08/zombie-science-of-evidence-based.html

    • Caveat Emptor:

      Since the name, Bruce Charlton, seemed familiar I checked it out and found that Bruce Charlton had posted at MIA before. Though he initially seemed to represent the survivors’ movement by exposing toxic psychiatric drugs, he quickly began to advocate for the supposed great benefits of ECT in his last MIA blog that did not go over at all well with most MIA members/followers. That’s because MIA members are much too well informed to fall for such a sham. See Linda Andre’s Doctors of Deception highly recommended by Bob Whitaker.

      Unfortunately, though I greatly admire the 1boringoldman web site in some ways, many of the strongest advocates/colleagues of Dr. Nardo who hosts this site advocate for ECT along with Dr. Nardo, which I find very unfortunate and inconsistent since they are quick to attack other very harmful practices of biopsychiatry including bogus studies and harmful/useless drugs as well as lack of patient centered care. I only hope that some day Dr. Nardo and his colleagues will do as much “evidence based” research on the deadly effects of ECT and the huge corruption behind it thanks to Max Fink and Harold Sackeim and protest against this evil as ferociously as they do toxic drugs and other fraudulent treatments and so called “science.”

      I am adding this caveat because when I posted the above comment citing an article by Bruce Charlton, I did not recall him being an ECT advocate at MIA. This is what Dr. Peter Breggin referred to as stealth advocacy whereby one gives the appearance of being a reformer and against “toxic psychiatry and drugs” when the so called advocate is pushing ECT and other types of brain damage/lobotomy that are even worse than the drugs and other treatments they attack.

  3. Evidence-based medicine and RCT may be the best we have. However, that requires them to be done in a scientifically sound way which in many cases is not happening. The first thing one should do is to take the clinical trials out of the hands of pharma and make sure that doctors have no financial or other incentive to produce positive results. That alone would solve a lot of problems.
    there are countless ways how one can manipulate the results: choice of patient groups, in case of psych disorders definition of the disorder itself, time of the trial etc. Then you can also use creative statistics and not publish the negative trials. I wonder why scientific literature is such a horrible mess of contradictory reports.

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