Don't trust me (I'm Big Pharma)
July 21st 2017, 12:15
When you start something, are you prepared to see it through to the bitter end? Whatever the outcome or consequences? Without fear or favour?
These are questions that a group of brave souls will need to answer if they're going to achieve their ambition to clean up medicine. The group, mostly made up of doctors and researchers, wants to put evidence—rather than money or other inducements—at centre stage when determining best practices or choosing the most effective drugs for treatment.
Experts from Oxford University's Centre for Evidence-Based Medicine have teamed up with the editorial panel from The British Medical Journal to produce a manifesto that lays out nine steps to make medicine ethical, patient-focused and, yes, scientific.
This bold proposal wants to bring patients into the decision-making process (patients deciding their own treatment?—whatever next) as well as put health professionals and policy makers in the driving seat of medicine. Presumably, that means the drug companies are pushed into the back seat, like a troublesome in-law on a long car journey.
It's a bold and brave move that, if successful, should turn medicine on its head. Not that the drug companies can complain: they've been fleecing taxpayers and health insurers for years with their products that are often supported by only the dodgiest research.
And that seems to be the spur driving the ambition of the group's manifesto. Research studies are poorly designed and executed, says Prof Carl Heneghan, editor of the journal Evidence-Based Medicine, and then the results are withheld (if unfavourable) or released only piecemeal. It's a problem that's getting worse, he claims, and this has compromised medicine's ability to provide affordable, effective, high-value care to patients.
Together, these failings "contribute to escalating costs of treatment, medical excess . . . and avoidable harm".1
They've certainly caught the mood among doctors. More than 80 per cent of them don't trust medical research, a recent survey has discovered—which is pretty worrying, as that's what they're supposed to base their clinical decisions on.2
In a poll of more than a thousand doctors across the UK, 82 per cent said they doubted the results of any clinical trials into drugs funded by the manufacturer. And as the drug company is almost always the sole funder of research into its own products, most doctors are doubting the outcomes and conclusions of their own science.
The public is nearly as sceptical: around two-thirds of the 2,000 people questioned also doubted the reliability of clinical research. Instead, they took their health advice from family and friends.
Let's take pause and recap here for a moment: the multibillion-dollar drugs industry is being driven by doctors who don't believe the science that tells them the drug is safe or effective, or both, but who are nonetheless prescribing them to people who also don't believe in the science behind whatever it is they're taking.
Meantime, the UK taxpayer is throwing around £112 billion a year at the National Health Service while, in the US, many billions of dollars more are being coughed up by health insurers for a medical system that nobody believes in and which everyone knows is crooked. As such, it's a scandal and a confidence trick being perpetrated on the public—or it would be if patients didn't seem to have their eyes open.
So what is sustaining the system? Essentially, no one can imagine an alternative, so everyone puts up with a mediocre or inadequate service that can, on occasion, work. This is especially true of surgery—and of emergency treatment in particular—but even this is questionable. Professor Andy Carr, an orthopaedic surgeon working for Oxford University Hospitals, has suggested that many surgical procedures are unnecessary and that any improvement the patient experiences is actually down to the placebo effect.3
Because of ethical concerns, very few surgical procedures have ever been tested against a placebo, where the surgeon does nothing. But when a procedure has been tested against non-treatment or a placebo—as has happened with knee surgery for arthritis, spinal cement injections for vertebral fracwtures and gastric balloon procedures—there's scarcely been any difference in outcome.
So, hats off to the evidence-based crowd. But will they see it through to the bitter end and its inevitable—and medicine-transforming—conclusions?
BMJ, 2017; 357: j2973