“[C]onflicts of interest and biases exist in virtually every field of medicine, particularly those that rely heavily on drugs or devices. It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines.”
Every day, millions of Americans search for medical information on the Internet. Finding accurate information requires a discerning eye, for many websites appear to be a credible source of information but are inaccurate or misleading. (1)
Accurate information on many subjects can be found on the websites of medical societies, government agencies and university medical centers. Examples include the American Academy of Pediatrics (aap.com), the National Cancer Institute (cancer.gov), the National Library of Medicine (medlineplus.com) and the Mayo Clinic (mayoclinic.com).
Websites like those can provide you with valuable background information. However, if you are seeking the best research evidence on a question concerning diagnostic or therapeutic options for a specific case, you may need the help of a medical advocate like Dr. Alan Laufman.
Dr. Laufman has access to the research tools that are employed today in the practice of what is called evidence-based medicine. One objective of evidence-based medicine is to recognize when evidence to support a particular treatment is lacking or inadequate. For example, in 2007, one analysis classified 51% of the treatments studied as having insufficient evidence to validate the treatment and 7% as “tradeoffs between benefits and harms.”(2)
Nowhere is the need for best evidence research tools greater than when you review research findings and claims concerning the effectiveness and safety of drugs. It is so common for the authors of journal articles to have financial ties to drug companies that the editors of three of the world’s leading medical journals have gone on record to sound the alarm.
In 2004, Richard Horton, the current editor of The Lancet, declared, “Journals have devolved into information laundering operations for the pharmaceutical industry.” (3)
In 2005, Richard Smith, a former editor of the British Medical Journal, wrote an essay titled, “Medical Journals are an Extension of the Marketing Arm of Pharmaceutical Companies.” He observed that in 2003,
[S]tudies funded by a company were four times more likely to have results favorable to the company than studies funded by other sources…there are many ways to hugely increase the chance of producing favorable results, and there are many hired guns who will think up new ways and stay one jump ahead of peer reviewers.” (4)
In 2009, Marcia Angell, a former editor of The New England Journal of Medicine, went even further,
[C]onflicts of interest and biases exist in virtually every field of medicine, particularly those that rely heavily on drugs or devices. It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.(5)
The lesson here is that no study sponsored by a pharmaceutical company or conducted by physicians with financial conflicts of interest can be taken at face value.
Patients who do their own research on the treatment of a medical problem can easily fall prey to the misleading influence of “Big Pharma.”
(1) Deshpande A, Jadad AR. Trying to Measure the Quality of Health Information on the Internet: Is It Time To Move On? J Rheum. 2009; 36:1; Kunst H et al. Accuracy of information on apparently credible website: survey of five common health topics. BMJ. 2002; 324:581.
(2) Tovey D. BMJ Clinical Evidence Handbook. 2007.
(3) Horton R. The Dawn of McScience. New York Rev Books. March 11, 2004.
(4) Smith R. Medical Journals Are an Extension of the Marketing Arm of Pharmaceutical Companies. PloS Med. 2005; 2: e138. In that regard, Brody and Light recently proposed “the inverse benefit law”:
"[T]he ratio of benefits to harms among patients taking new drugs tends to vary inversely with how extensively the drugs are marketed. The law is manifested through 6 marketing strategies: reducing thresholds for diagnosing disease, relying on surrogate endpoints, exaggerating safety claims, creating new diseases, and encouraging unapproved uses." Brody H, Light DW. The Inverse Benefit Law: How Drug Marketing Undermines Patient Safety and Public Health. Am J Public Health. 2011; 101:399.
(5) Angell M. Drug Companies & Doctors: A Story of Corruption. New York Rev Books. January 15, 2009.