A response to “systematic bias, wastage, error, and fraud in research underpinning patient care” has been published in a manifesto from researchers in the Center of Evidence Based Medicine at the University of Oxford.
Any healthcare service provides treatments based on scientific and medical research. But what happens when this research is not reliable? The consequences range from inefficiency to, in rare cases, death.
Professor Carl Heneghan and colleagues at the Center for Evidence Based Medicine recently published a manifesto that outlines the causes and consequences of poor quality evidence based medicine, and nine actions they believe will improve the quality of medical research.
So what makes medical research unreliable and how big of a problem is it? “Metascience”, the scientific study of science itself, has generated some alarming figures.
As much as 85% of biomedical research may be wasted because the results cannot be reproduced by other scientists, making them unusable.
The results from half of all clinical trials are never published - something Heneghan calls a “disgrace”. Of those that do get published, only 14% actually report any data on the main side effect or “harm outcome”.
In addition, “at least 80% of research is wasted on questions that don’t really matter, or reports outcomes that don’t influence decision making”, warns Heneghan. Less than 10% of British research funding is spent on treatment evaluation.
If you feel these figures paint a bleak picture, you are not alone. Since 2010, the Center for Evidence Based Medicine has run a regular conference called “Evidence live with the BMJ”.
“One of the emerging, or one of the major, themes that has run throughout that conference is the problems that exist within evidence based medicine through the development, uptake and use of poor quality evidence”, says Heneghan.
He believes that “it’s such a huge problem that we felt that we had to go and make a statement to say we’ve got to improve... the evidence in evidence based medicine”.
Heneghan said that one of their core principles is to “expand the role of patients, health professional, policymakers in research”. Their work suggests if patients were involved in the research process from the beginning, scientists would ask “better quality questions and answer the questions that matter to patients”.
However, the major limitation with the manifesto is that it’s voluntary. For instance, the British Medical Journal has recently introduced a patient reviewer scheme. Here, patients are asked to review academic papers before they are published, commenting on a study’s relevance to their lived experience of a disease. But, at the point of writing, the BMJ is the only journal to involve patients in such a way.
Heneghan recognises the limitations with such a voluntary manifesto but says “to solve or to find solutions...you’ve got to band together with like-minded individuals”.
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