Lies, Damned Lies and Medical Science

Medical-Research It’s hard to beat that title of this interesting David H. Freedman/The Atlantic article (H/T John Goodman) about medical researcher, John Ioannidis, who has made a name for himself establishing that most medical information that physicians commonly rely upon is largely flawed:

.  .  . can any medical-research studies be trusted?

That question has been central to Ioannidis’s career. He’s what’s known as a meta-researcher, and he’s become one of the world’s foremost experts on the credibility of medical research. He and his team have shown, again and again, and in many different ways, that much of what biomedical researchers conclude in published studies-conclusions that doctors keep in mind when they prescribe antibiotics or blood-pressure medication, or when they advise us to consume more fiber or less meat, or when they recommend surgery for heart disease or back pain-is misleading, exaggerated, and often flat-out wrong. He charges that as much as 90 percent of the published medical information that doctors rely on is flawed.

His work has been widely accepted by the medical community; it has been published in the field’s top journals, where it is heavily cited; and he is a big draw at conferences. Given this exposure, and the fact that his work broadly targets everyone else’s work in medicine, as well as everything that physicians do and all the health advice we get, Ioannidis may be one of the most influential scientists alive. Yet for all his influence, he worries that the field of medical research is so pervasively flawed, and so riddled with conflicts of interest, that it might be chronically resistant to change-or even to publicly admitting that there’s a problem. [.  .  .]

We could solve much of the wrongness problem, Ioannidis says, if the world simply stopped expecting scientists to be right. That’s because being wrong in science is fine, and even necessary-as long as scientists recognize that they blew it, report their mistake openly instead of disguising it as a success, and then move on to the next thing, until they come up with the very occasional genuine breakthrough. But as long as careers remain contingent on producing a stream of research that’s dressed up to seem more right than it is, scientists will keep delivering exactly that.

“Science is a noble endeavor, but it’s also a low-yield endeavor,” he says. “I’m not sure that more than a very small percentage of medical research is ever likely to lead to major improvements in clinical outcomes and quality of life. We should be very comfortable with that fact.”

2 thoughts on “Lies, Damned Lies and Medical Science

  1. The real problem in science is that the conflict of interest turns out to be government money, and lots of it. Remember all those people claiming that anyone who might dissent from the current Climate Change Theology was funded by the oil industry, with its megabucks?
    Folks, in the world of science, private industry is NOT where the money is (to quote Willie Sutton, who understood these things). No, it is with government, and the last time I checked, government still was political. Here is the link to a letter of resignation from prominent scientist Harold Lewis to the president of the American Physical Society:
    http://blogs.telegraph.co.uk/news/jamesdelingpole/100058265/us-physics-professor-global-warming-is-the-greatest-and-most-successful-pseudoscientific-fraud-i-have-seen-in-my-long-life/
    And this follow-up article:
    http://www.csmonitor.com/Commentary/Opinion/2010/1019/Climate-change-fraud-letter-a-Martin-Luther-moment-in-science-history
    The problem is not that scientists can be wrong, but rather that because government pretty well determines the direction of science, it is GOVERNMENT that cannot declare itself to be wrong. So, I would agree wholeheartedly with your post, but want to add that Ground Zero is and always will be government funding.

  2. ah tom, the great meta-researcher failed to grapple with the most obvious data in his busyness of being smarter than everyone: lard-ass americans are living longer and better than ever before because the system of basic research to bedside works WELL, even in the face of worsening habits.
    i will agree with him if he can make his criticism more modest–instead, he is headline seeking and grabbing, without enough substance to his points, just as he accuses others of doing.
    great points would be: 1) researchers should not talk to popular media as it injects journalists with inadequate training and deadline pressures into conversations in which they are incompetent and in turn they toss their vapid “analysis” to a public too ignorant of critical thinking AND lacking the science background to have an intelligent opinion. daily i watch otherwise bright, talented attorneys, engineers, Phds in this or that act like they might know something because some guy with a b.a. in journalism had to meet a deadline—–give it up–reminds me of doctors thinking they are good lawyers or teachers or accountants…..
    a second good criticism would be that physicians need better training to understand HOW our process works, well AND poorly–it goes something like this: most of us read several hundred journals a year. when we read published-in-good-journals, peer-reviewed, prospective, double-blind, randomized, placebo-controlled studies, with editorial comment from bright guys and such studies are replicated and eventually “consensus opinion” by more bright guys is published with critical “letters to the editor” published along the way, THEN, we sorta have something we can sorta rely on though it may change—–everything less than this is even less reliable and our job is to know the difference, account for biases– financial and other conflicts of interest and THEN deliver the bacon–i think it is valid to observe we as physicians may not be as disciplined in thinking this way as we are in other aspects of our professional lives. in school, we were taught near perfectly in anatomy, physiology, pathology etc. with less than adequate training in statistics and analysis of study design, hence the “problem”.
    truth be known, good medical science will likely make it where the now 60 and younger crowd will live so long (and better) that we will become giant burdens of poor vision, hearing, memory and bad joints that we will drive our kids to an early, overtaxed grave–aint science great?

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