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Staffan
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The illusion of evidence based medicine

"Evidence based medicine has been corrupted by corporate interests, failed regulation, and commercialisation of academia, argue these authors."

"The pharmaceutical industry’s responsibility to its shareholders means that priority must be given to their hierarchical power structures, product loyalty, and public relations propaganda over scientific integrity."

Artikel på British Medical Journal:
https://www.bmj.com/content/376/bmj.o702

// Staffan

Evidence based medicine has been corrupted by corporate interests, failed regulation, and commercialisation of academia, argue these authors The advent of evidence based medicine was a paradigm shift intended to provide a solid scientific foundation for medicine. The validity of this new paradigm, however, depends on reliable data from clinical trials, most of which are conducted by the pharmaceutical industry and reported in the names of senior academics. The release into the public domain of previously confidential pharmaceutical industry documents has given the medical community valuable insight into the degree to which industry sponsored clinical trials are misrepresented.1234 Until this problem is corrected, evidence based medicine will remain an illusion. The philosophy of critical rationalism, advanced by the philosopher Karl Popper, famously advocated for the integrity of science and its role in an open, democratic society. A science of real integrity would be one in which practitioners are careful not to cling to cherished hypotheses and take seriously the outcome of the most stringent experiments.5 This ideal is, however, threatened by corporations, in which financial interests trump the common good. Medicine is largely dominated by a small number of very large pharmaceutical companies that compete for market share, but are effectively united in their efforts to …
Condor
7
#1

#0:

Den här artikeln är egentligen bara en sammanfattning av en bok med samma namn. Den här boken baserar på att läkemedelföretaget Forest Laboratories hade manipulerat 2 studier som gjordes med antidepressiva.

Bedrägeri händer överallt, men man kan inte skylla det på den evidensbaserade medicinen. Tvärtom finns det granskningar av oberoende experter (peer rewiev) innan någonting betrakts som evidensbaserat.

De här studierna betraktades inte som evidensbaserade. Samma Journal som artikeln som du länkade till (BMJ) publicerade en rättelse av studien. Den kom fram till ett helt annat resultat än vad Forest Laboratories kom fram till. Det visade sig att medicinerna inte hade en effekt och orsakade skador:

https://www.bmj.com/content/351/bmj.h4320

"Conclusions Neither paroxetine nor high dose imipramine showed efficacy for major depression in adolescents, and there was an increase in harms with both drugs. Access to primary data from trials has important implications for both clinical practice and research, including that published conclusions about efficacy and safety should not be read as authoritative. The reanalysis of Study 329 illustrates the necessity of making primary trial data and protocols available to increase the rigour of the evidence base."

Företaget fick böta 3 miljarder dollars. Källa: https://www.aerzteblatt.de/nachrichten/64184/Studie-329-Re-Analyse-bezweifelt-Effektivitaet-und-Sicherheit-von-SSRI-fuer-Jugendliche

Man kan alltså inte säga att den evidensbaserade medicinen "är bajs" och dra allt över en och samma kam. Det finns alltid fuskare i alla brancher, men om de blir vslöjade blir det dyrt. Som alternativ till evidensbaserad medicin finns det bara att vem som helst kan publicera vad som helst, utan granskning. Då litar jag mer på evidensbaserad medicin med granskning av oberoende experter, även om det inte är en 100 % garanti att någon inte lyckas att fuska.

Objectives To reanalyse SmithKline Beecham’s Study 329 (published by Keller and colleagues in 2001), the primary objective of which was to compare the efficacy and safety of paroxetine and imipramine with placebo in the treatment of adolescents with unipolar major depression. The reanalysis under the restoring invisible and abandoned trials (RIAT) initiative was done to see whether access to and reanalysis of a full dataset from a randomised controlled trial would have clinically relevant implications for evidence based medicine. Design Double blind randomised placebo controlled trial. Setting 12 North American academic psychiatry centres, from 20 April 1994 to 15 February 1998. Participants 275 adolescents with major depression of at least eight weeks in duration. Exclusion criteria included a range of comorbid psychiatric and medical disorders and suicidality. Interventions Participants were randomised to eight weeks double blind treatment with paroxetine (20-40 mg), imipramine (200-300 mg), or placebo. Main outcome measures The prespecified primary efficacy variables were change from baseline to the end of the eight week acute treatment phase in total Hamilton depression scale (HAM-D) score and the proportion of responders (HAM-D score ≤8 or ≥50% reduction in baseline HAM-D) at acute endpoint. Prespecified secondary outcomes were changes from baseline to endpoint in depression items in K-SADS-L, clinical global impression, autonomous functioning checklist, self-perception profile, and sickness impact scale; predictors of response; and number of patients who relapse during the maintenance phase. Adverse experiences were to be compared primarily by using descriptive statistics. No coding dictionary was prespecified. Results The efficacy of paroxetine and imipramine was not statistically or clinically significantly different from placebo for any prespecified primary or secondary efficacy outcome. HAM-D scores decreased by 10.7 (least squares mean) (95% confidence interval 9.1 to 12.3), 9.0 (7.4 to 10.5), and 9.1 (7.5 to 10.7) points, respectively, for the paroxetine, imipramine and placebo groups (P=0.20). There were clinically significant increases in harms, including suicidal ideation and behaviour and other serious adverse events in the paroxetine group and cardiovascular problems in the imipramine group. Conclusions Neither paroxetine nor high dose imipramine showed efficacy for major depression in adolescents, and there was an increase in harms with both drugs. Access to primary data from trials has important implications for both clinical practice and research, including that published conclusions about efficacy and safety should not be read as authoritative. The reanalysis of Study 329 illustrates the necessity of making primary trial data and protocols available to increase the rigour of the evidence base.