Sunday, February 14, 2010
Evidence-Based Medicine? (Part 2)
By Christopher Johnson, ND
In the first segment of this series I presented evidence that randomized controlled trials (RCT’s) are often manipulated by the drug industry. In this segment, I will demonstrate how these studies are then used to influence both the medical community and general public.
Distorted trials funded by the pharmaceutical industry would do them no good if everyone knew the studies were biased. To avoid this undesirable outcome, the drug companies need validation from a trusted source. Enter medical journals.
Everyone knows the article they read in the New York Times or the local newspaper, or the story they hear on the nightly news – “A recent study published in the journal X found that X drug reduces symptoms of X disease by X amount”. The media relies on the supposed integrity of the prominent medical journals.
There may have been a time when this trust was justified, although considering that the rise of JAMA – and for that matter, the AMA - was significantly aided by tobacco industry advertising from the early 1900’s right up through the 1950’s, maybe not. In any case it is clear that in this day and age the most prestigious medical journals are far different than their objective, pillar-of-science reputations suggest.
But don’t take my word for it. Consider the following:
- “Medical journals are an extension of the marketing arm of pharmaceutical companies”
- - Richard Smith - for 25 years editor of BMJ. 2005.
- “Journals have devolved into information laundering operations for the pharmaceutical industry”.
- - Richard Horton - Editor, The Lancet. 2004
- The pharmaceutical industry is “primarily a marketing machine” which is willing to co-opt “every institution that might stand in its way.”
- - Marcia Angell, for 20 years an editor of New England Journal of Medicine. Currently a professor at Harvard Medical School. 2004
- “Medical journals have allowed their interests to become aligned with those of the pharmaceutical industry by printing advertisements for drugs, publishing trials designed by drug companies’ marketing departments, and making profits on reprints used as marketing tools.” Editors, PLoS (Public Library of Science), 2004.
Here is some data from the medical literature itself:
- The 2009 BMJ flu vaccine study mentioned in my previous segment found that studies funded by the drug industry were significantly more likely to appear in “high impact factor” journals - meaning, journals which have a strong influence on both the medical community and the media (JAMA, NEJM, The Lancet, BMJ, etc). This study also found that industry-funded studies were more likely to be cited as references by other studies – further amplifying their impact.
- “Whole or part industrial funding was associated with publication in journals with higher impact factors”
- “Higher citation index factor was associated with partial or complete industry funding”
- Studies “sponsored by industry had greater visibility as they were more likely to be published by high impact factor journals and were more likely to be given higher prominence by the international scientific and lay media.”
- In a 2005 editorial, former BMJ editor Richard Smith offered the following data:
- “Between two thirds and three quarters of the trials published in the major journals – Annals of Internal Medicine, JAMA, The Lancet, and New England Journal of Medicine – are funded by the industry. For the BMJ it’s only one-third – partly, perhaps, because the journal has less influence than the others in North America, which is responsible for half of all the revenue of drug companies”
So here we have a situation where drug companies manipulate studies to get the results they want and then entice prestigious medical journals with vast sums of money. The medical journals are only too willing to un-critically accept and publish these studies, thereby lending them credibility. The media, who are also highly indebted to the pharmaceutical and other medical industries (as they are significant sources of advertising revenue) then, again un-critically put forth this information for the public to digest.
Doctors then use this information to guide their treatment protocols. Being that they simply don’t have the time to pour through dozens of studies to figure out which ones are accurate they must rely on the good name of various medical journals and take the studies as presented. Additionally, a good number of doctors, especially at larger medical centers with research facilities, receive significant amounts of money from the medical industry and are therefore biased in their assessment of the medical literature.
The end result is that everywhere patients/consumers turn they are reassured that various drugs and procedures are “evidence-based”. All sources of the mainstream media tell them so. Prestigious medical journals tell them so. Their doctors tell them so. Surely it must be the case.
In the next segment I will demonstrate how the “evidence” base of conventional medicine is much thinner than asserted.
Christopher Johnson, ND is a naturopathic doctor specializing in the use of homeopathy and nutrition to address a broad range of conditions in both the adult and pediatric populations. He is owner of Thrive Naturopathic, a holistic health care facility located in Alexandria, Virginia. He speaks widely on how homeopathy is the answer to many of today's health challenges, and is available for phone consultations for those not in the area. Visit his website at: www.ThriveNaturopathic.com