Monday, February 12, 2007

The Threat of Pseudoevidence-Based Medicine

Clinical Governance, a respected but not widely-circulated journal from the UK, just published an article (subscription required) entitled "pseudoevidence-based medicine: what it is, and what to do about it," written by Health Care Renewal occasional blogger Dr Wally R Smith. [Smith WR. Pseudoevidence-based meidicne: what it is, and what to do about it. Clinical Governance 2007; 12: 42-52.] The article was featured on the publisher's latest monthly highlights page.

I read (and commented on) an earlier draft of this article, and was struck by its use of the term pseudoevidence-based medicine to describe some of the less healthy trends we have discussed on Health Care Renewal. Some key quotes:

Another, perhaps not new threat to the practice of EBM [evidence-based medicine] has been discovered -- pseudoevidence-based medicine (PBM). PBM can be defined as the practice of medicine based on falsehoods that are disseminated as truth. Falsehoods may result from corrupted evidence--evidence that has been suppressed, contrived from purposely biased science, or that has been manipulated and/or falsified, then published. Or falsehoods may result from corrupted dissemination of otherwise valid evidence. These falsehoods, when consumed as truth by unwitting and well-intentioned practitioners of EBM, then disseminated and adopted as routine practice, may well result not only in inappropriate quality standards and processes of care, but also in harms to patients.

EBM rests on the premises of professionalism in science and medicine. EBM presumes that evidence is produced by scientists who strive to be objective. EBM presumes that those producing evidence have no pre-conceived hopes or goals for what the evidence will show. EBM presumes that producers of evidence have no stakes in what the evidence will show. EBM presumes, or at least strives to assure, that the scientific evidence-production process is free manipulation by people with vested interests with goals other than improvement in patients’ mortality, morbidity, or quality of life.

There are reasons to believe EBM’s presumptions are in question, and that PBM is a “new” threat to EBM. Only two conditions are necessary for PBM to flourish. First, one link in the chain of evidence production, assembly, or dissemination must be purposely corrupted, resulting from a compromise of professionalism in science and medicine. Second, the belief must be promulgated that a given piece of evidence is true and of the highest quality possible, when in fact it is tainted.

Smith attributed the rise of pseudoevidence-based medicine to the conflict between the profit motive and physicians' traditional values.

By definition, pharmaceutical companies, device manufacturers, some health care providers, many insurance providers, and various middlemen and brokers in health care are in business for a profit. And while the profit motive is not itself wrong or dangerous, the profit motive is dangerous when placed in direct competition with protecting and prolonging human life, the precise business in which health care stakeholders should be engaged.

As they say, "read the whole thing."

And I think that we will find the term pseudoevidence-based medicine very useful on Health Care Renewal.


Anonymous said...

"Facts are the enemy of truth!" cries Don Quixote de la Mancha.

Steve Lucas

LK said...

The issues raised here are paramount to the evolution of the pharmaceutical industry. Only when we demand the highest standards of the pharmaceutical industry will the production of drugs become safe for consumers. Additionally, the demands of the industry will foster new technologies and a higher quality of professionals, both in research and education, elevating the industry to the safety and ethical standards we should except in the 21st century. Also, we should not forget, as pointed out in the blog, that we cannot achieve a complete level of safety and validity, but any expectations that fall short of those goals will allow for the existence of medicine which fails to meet the safety standards to which all consumers are entitled.

james gaulte said...

For some time I have worried about the extent to which physicians who sincerely wish to practice EBM are at risk for being decieved by various tactics and ploys such as stacking the RCT deck and spinning the data and worse not reporting all the negative data regarding a drug.Then the bogus or at least misleading results are amplified and disseminated by thought leader dinners, ghost written articles and journal supplements financed by drug companies.The term pseudoevidence based medicine may be just what the doctor ordered to call attention to all of this in a memorable sound bit that just might catch on.

Unknown said...

If evidence-based medicine is the answer, who wrote the evidence is the question.

Bug said...

2 Timothy 4:3 For the time will come when they will not listen to the sound doctrine, but, having itching ears, will heap up for themselves teachers after their own lusts ...

This is nothing new. "We" have always preferred to believe lies. Just look at your e-mail inbox for proof.