Are we heading into an era of junk
science? From all indications, this seems to be the case. Patients
will suffer and doctors will be blamed. Yet, it is Big Pharma that
sets many of the studies that are not reliable and the leaders of the
many physician organization, associations, and academies that promote
the guidelines based on unreliable studies and data.
If you think otherwise, read this article in the New York Times and this blog by Dr. Malcolm Kendrick
about why studies are not done to refute or confirm the previous
studies. Another blog that is interesting is this one by Tom
Naughton.
All confirm how poor and poorly
constructed the research studies of today are and give some idea of
where medicine is headed.
Normally I do not reference articles
appearing in the New York Times because they are written for
sensationalism, but this article actually outlines many of the
problems of today's research studies. The biggest truth is some of
the steps you can find out about a study.
“This random assignment is
powerful. If done with enough people, it causes the two groups to be
statistically identical to each other except for the experience of
the treatment (or not). Whatever changes are observed can usually be
attributed to that treatment with a good degree of confidence.”
“Though a randomized trial makes
two groups statistically identical to each other — apart from
treatment received — it still doesn’t mean either group is
identical to you. If the individuals selected to participate in the
trial happen to be very similar to you — similar ages, income,
living environment and so forth — that increases the chances that
the results would apply to you. But if you’re, say, a 65-year-old,
middle-class New Yorker, a study whose subjects were poor
30-somethings in rural China may not translate to your experience.”
“This is one of the chief
limitations of randomized trials. They’re typically focused on
narrow populations that meet strict criteria — those most likely to
benefit from treatment. Many drug trials exclude older patients or
children because of ethical or safety concerns. Many, particularly
much earlier trials didn’t include women. We know a lot less about
how drugs affect groups who weren’t studied than we might like.
Harm could even come if it was assumed that findings from those who
were studied applied to people who weren’t.”
Dr. Kendrick says, “It has
become clear that much of medical research is flawed, and so
inherently biased that much of it/most of it simply cannot be relied
upon. One of the strongest critics of this current situation is a
brilliant statistician, Professor John P Ionnadis. His seminal paper
on the subject of medical research, which is nearly ten years old
now, was entitled ‘Why Most Published
Research Findings Are False ‘.”
I think if you can read all three of
the links in the second paragraph above, you will understand why many
studies are so poor.
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