3. There may be built-in biases in the way the experiments are designed, too often based on a profit motive or a conflict of interest, but sometimes for other reasons, too.
Not surprisingly, this aspect of evidence-based outcomes creates more controversy than the others.
The outcomes of clinical trials and experiments are often published in medical journals.
While medical journal articles can be very useful and informative, sometimes they can be misleading. Until the past few years, the results of studies might be published regardless of who sponsored them. This meant that a pharmaceutical company could publish the results of its own study showing its drug was the best drug to treat any particular ailment. A competing drug company could do the same. In both cases, of course, those companies had a stake in showing which one was best. Further, they were under no obligation to reveal study results that might have been more negative to their businesses. They only showcased their most positive outcomes.
A study reported in 2004 showed that when researchers looked into the qualifications of the authors of studies published in the New England Journal of Medicine (NEJM) and the Journal of the American Medical Association (JAMA), considered to be two of the most prestigious medical journals, up to 32% of them had undisclosed conflicts of interest.
Shortly afterward, many medical journals began a real crackdown on the authors of studies, informing them that full disclosures must be made of who was underwriting studies, including any conflicts of interest, and creating more rules that would make the initial study goals and the real outcomes more transparent to those with interest in the outcomes. Their goal was to make sure that the studies produced more objective, evidence-based results that would be more appropriately applied to patients.
Some professionals believe this only encouraged those companies with profit motives to look for more creative ways to support research. One example was the publication in 2006 of study results which showed that CT scans could detect lung cancer in its early stages, published in the New England Journal of Medicine. The authors claimed no conflicts of interest, and a small notation at the end of the article cited a non-profit organization called the Foundation for Lung Cancer: Early Detection, Prevention and Treatment. In March 2008, The New York Times uncovered tax documents which showed that non-profit foundation to be underwritten by cigarette maker The Liggett Group.
A second example of how profit motives and conflicts of interest can get in the way of objectivity can be seen with the lack of clinical trials to develop evidence for CAM therapies -- complementary and alternative medicine -- like herbs and supplements or even yoga, massage or acupuncture.
It becomes a circular argument: Because there are so few doctors who understand and recommend CAM therapies to their patients, and because those therapies tend to cost much less than pharmaceutical drugs and are therefore not nearly so profitable, there are few studies that prove or disprove the usefulness of these therapies. Since there are so few studies, there is little scientific evidence, clinical trial evidence that shows how well they do (or don't) work. Since those studies are not undertaken, and therefore there is little literature to support their use, doctors don't spend much time learning about them, and consequently don't recommend them to their patients.
What is the Solution? How Should Evidence Based Medicine Be Used?
Many medical professionals will tell you that medicine in general is as much art as it is science. While much of scientific evidence-based medicine is considered a gold-standard in treatment approaches, keeping the "art" aspect in mind is as good an approach as any to determining whether evidence-based medical study results are useful to you as you and your doctor consider possible treatment for whatever your medical problem is.
Clinical trials are usually conducted to show the efficacy of drugs or other therapies that will eventually be approved by the FDA. Therefore, the FDA is charged with monitoring the objectivity and safety of these trial results, and making sure there was no conflict of interest built in to the trial design. Unfortunately, in recent years, the FDA has been found to be lacking in its ability to provide good oversight is many cases of drug approval applications.
To take up the slack, some medical journals, other disease or condition-focused organizations, and the media have begun to provide some of the scrutiny necessary to make sure that these potentially life-altering drugs and therapies have been tested in the most objective manner possible.
The bottom line for patients is this: Understand the possible pluses and minuses of any medical study and the evidence it has produced. Look into journal articles, make sure the information you have found is the most current, and discuss the possibilities with your doctor. Be sure to stay true to your values and beliefs, too.
Evidence-Based Medicine and the Future
On the horizon of medical treatment, and already in use for some medical problems, is personalized medicine, an approach that is in some ways the opposite of evidence-based medicine, and in some ways makes use of the evidence.
You as a patient will find, as time goes on, more and more ways in which your own genetic code can help solve some of the mysteries of disease and illness. Until then, the evidence found by studying groups of people may be the closest you can come to what will work for you.
