Friday, May 02, 2014

Medical Research is a Scandal

Richard Smith: Medical research—still a scandal

31 Jan, 14 | by BMJ

Extract:
For the entire article please visit: 
http://blogs.bmj.com/bmj/2014/01/31/richard-smith-medical-research-still-a-scandal/
Richard SmithTwenty years ago this week the statistician Doug Altman published an editorial in the BMJ arguing that much medical research was of poor quality and misleading. In his editorial entitled, “The Scandal of Poor Medical Research,” Altman wrote that much research was “seriously flawed through the use of inappropriate designs, unrepresentative samples, small samples, incorrect methods of analysis, and faulty interpretation.” Twenty years later I fear that things are not better but worse.
Most editorials like most of everything, including people, disappear into obscurity very fast, but Altman’s editorial is one that has lasted. I was the editor of the BMJ when we published the editorial, and I have cited Altman’s editorial many times, including recently. The editorial was published in the dawn of evidence based medicine as an increasing number of people realised how much of medical practice lacked evidence of effectiveness and how much research was poor. Altman’s editorial with its concise argument and blunt, provocative title crystallised the scandal.
Why, asked Altman, is so much research poor? Because “researchers feel compelled for career reasons to carry out research that they are ill equipped to perform, and nobody stops them.” In other words, too much medical research was conducted by amateurs who were required to do some research in order to progress in their medical careers.
Ethics committees, who had to approve research, were ill equipped to detect scientific flaws, and the flaws were eventually detected by statisticians, like Altman, working as firefighters. Quality assurance should be built in at the beginning of research not the end, particularly as many journals lacked statistical skills and simply went ahead and published misleading research.
“The poor quality of much medical research is widely acknowledged,”  wrote Altman, “yet disturbingly the leaders of the medical profession seem only minimally concerned about the problem and make no apparent efforts to find a solution.”
Altman’s conclusion was: “We need less research, better research, and research done for the right reasons. Abandoning using the number of publications as a measure of ability would be a start.”

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