According to Dr. Aseem Malhotra, a prominent cardiologist and best-selling author in the U.K., evidence-based medicine has been compromised through the influence of pharmaceutical companies and other commercial interests, the spread of misinformation, and the failure of medical education to provide doctors and patients with the tools to recognize poorly conducted research.
As per the evidence-based medicine triad, health-care professionals using this model to make decisions about patient care generally consider: 1. patient values and preferences, 2. the best evidence available, and 3. their own clinical expertise.
Malhotra believes in prioritizing patient values when providing care, but he asks whether “the public [is] getting full information to make those choices, and how far are we away from truly informed consent?”
Informed consent about a treatment or procedure is impossible when “the best available clinical evidence unfortunately has been corrupted by commercial influence,” Malhotra explains. Studies published in prominent medical journals often distort data to cast certain pharmaceutical interventions and procedures in a positive light.
“A third of medical journal articles published between 2004 and 2006 in the JAMA, BMJ, and the Lancet actually use relative risk when they were showing the benefits of a drug and use absolute risk in the harms, which is just absolutely ridiculous,” Malhotra explains.
Rather than helping improve this situation, many doctors prove ill-equipped or unaware: “Most health-care professionals are not aware of this problem … and they also lack the necessary skills to evaluate the reliability and usefulness of medical science,” Malhotra says.
Moreover, many doctors receive financial incentives to prescribe certain drugs or perform specific procedures, which Malhotra claims leads to an excess of unhelpful treatments. Such treatments place a financial burden on patients and the health-care system while failing to improve patient conditions and in some cases causing harm.
Restoring the possibility of conducting evidence-based medicine is contingent upon two things, Malhotra claims: We need better education for medical professionals so they can evaluate research and need a public inquiry that brings to light all the corruption and misinformation that debases much of the scientific literature evidence-based medicine seeks to use as its foundation. He argues the public needs to become aware of how the system works, how to properly evaluate research, and how to make informed decisions.
“So when I walk into a coffee shop, if the barista serving me says to me, ‘Do you know that most published research is false?’ I know we’re winning, right? I know we’re winning then,” Malhotra says. “We can change the system,” he concludes.
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