The Illusion of Evidence Based Medicine
Medicine is ever more under pressure from corporate interests and commercialisation of academia.
In March 2022, British Medical Journal (BMJ), one of world’s leading medical journals, published an article wherein its authors expressed concern over the growing corporate influence in today’s medicine. Drawing from a number of examples and experiences, they claimed that much of today’s research is no longer independent, but directly or indirectly vested with corporate interests. “Medicine is largely dominated by a small number of very large pharmaceutical companies that compete for market share, but are effectively united in their efforts to expanding that market,” said Jon Jureidini and Leemon B. McHenry, authors of the piece, themselves a research leader at Adelaide University and professor emeritus at California State University (CSUN) respectively. They entitled their article “The Illusion of Evidence Based Medicine”.
Authors first dwell on the notion of ‘evidence-based medicine’ itself, discussing its origin and advancement. They refer to Karl Popper’s philosophy of critical rationalism which advocated for the integrity of science, with researchers steering clear of any ‘pet theories’ they could have. And yet in today’s world, Jureidini and McHenry claim, the notion has lost any actual meaning. The first and foremost prerequisite for evidence based medicine has always been the availability of reliable, independent clinical trial data. However, in a situation where states lack sufficient means – or at times the necessary political will – to finance various kinds of medical research, those are usually paid for by the pharmaceutical industry itself. To leave an impression of impartiality, the results of corporately funded research is then oftentimes reported under the names of acclaimed academics who in reality have had nothing to do with the studies themselves.
Moreover it is the pharmaceutical industry which is often enough the one to decide which research is carried out to begin with and which results are eventually shared with the public. The authors bring examples of concealed negative results and raw data reclaimed only by a court order. One of these is the case of GlaxoSmithKline’s flu vaccine Pandremix, the risks of which came to be manifold from what was initially reported. The advocates of free market economy have praised the push the privatisation of biomedical research first produced. Yet the inadvertent long-term results of this policy have been devastating and Jureidini and McHenry feel adamant that “the adverse impact of commercial interests on the research agenda, universities, and regulators” have resulted in the death of patients.
Though universities have had tight ties with interested parties in the form of funds and endowments already in the past, they have previously still attempted to keep the role of truthkeepers and moral conscience of the society. Yet in the persistent conditions of governmental underfunding many of them have adopted a neoliberal ideology and have agreed to take commercial interests of the supporters into account. They have allowed for the corporate interests to seep into the academic sphere, turning from the society’s intellectual elite into tools of corporate industry, promoting factually only their selected products and approaches. Authors of the article express additional concern over the ways the leadership of academic institutions is being handed down unto professional fundraisers and managers instead of top specialists in the fields. Such transformation of relations between the industry and academia have rendered the entire idea of an open society questionable.
“As well paid members of pharmaceutical advisory boards and speakers’ bureaus, KOLs [key opinion leaders] present results of industry trials at medical conferences and in continuing medical education. Instead of acting as independent, disinterested scientists and critically evaluating a drug’s performance, they become what marketing executives refer to as “product champions”,” the authors find.
It is not rare to find heads of institutions amongst the shareholders of pharmaceutical companies, which inevitably leads to a conflict of interest in approving any particular drug. The same goes for the scientific advisory boards of governmental offices. In worst cases, authorisations for drugs have been passed without even examining the raw data of safety trials.
In 2018, a similar concern was raised by Charles Piller and Jia You in their article in Science, another highly acclaimed academic journal. Therein an investigation into FDA’s (Food and Drug Administration of the US) compensation records bore witness to personal payments or research support from pharmaceutical industry in favor of several former members of the administration’s councils. In some cases, the number exceeded one million US dollars over four years. Understandably, this makes the objectivity of authorisations handed out by such advisors unreliable.
The situation has paved road to a world-view by which the focus of medicine falls on the suppression of ailments and intake of drugs, and far less on prevention and causality. Once institutions teaching and researching medicine need to consider commercial interests, it is only natural for them to try and solve each problem by a profitable drug. Medicine as a science thus gets subdued by the logic of market economy wherein material profit reigns highest. The situation endangers not only the general health of people, but compromises the trustworthiness of science at large and dilutes social cohesion.
Jureidini and McHenry conclude their article with a list of proposals for improvement. They say the institutions governing the authorisation of drugs need to be entirely relieved from corporate funding, drug production needs to be taxed and the tax money then used for open and independent trials. But first and foremost, anonymous trial data needs to be made available to expert third parties immediately.
And...nobody has picked this up.
I would like to chime in Doctor Paul Ioannidis, whose papers delineating the relation amongst Big Pharma, renown "scientists" and bias found in published works are squarely prolific.