De "gouden standaard" van Evidence Based Medicine heeft te kampen met integriteitsproblemen van wetenschappelijk onderzoek door commerciële belangen (vaak van de farmacie).
Het korte antwoord op de vraag "wat is er mis met EBM?" is
The entire system of clinical investigation is driven by profit, we are seeing the corruption of a system of research...
In een gezamenlijk redactioneel commentaar dat in september 2001 is gepubliceerd in twaalf toonaangevende medische tijdschriften, waaronder The Lancet, The New England Journal of Medicine (NEJM) en het Journal of the American Medical Association (JAMA), staat een redactioneel commentaar, getiteld "Sponsorship, Authorship, and Accountability" (Sponsoring, Auteurschap en Verantwoording). Dit commentaar sprak de bezorgdheid uit over de toenemende invloed van commerciële sponsoren op klinische proeven, in de volgende bewoordingen:
"Investigators may have little or no input into trial design, no access to the raw data, and limited participation in data interpretation. These terms are draconian for self-respecting scientists, but many have accepted them because they know that if they do not, the sponsor will find someone else who will. And, unfortunately, even when an investigator has had substantial input into trial design and data interpretation, the results of the finished trial may be buried rather than published if they are unfavorable to the sponsor’s product..."
In The Lancet van aug 2009 melden ze het volgende probleem: in Australië was er publicatie van 9 fake journals, en registratie van nog eens 13. Met de veelzeggende uitspraak "Education is a euphemism for marketing".
In een artikel van de WHO (Bulletin of the World Health Organization, 2001, 79 (12) p1093:)
Titel: Maintaining the integrity of the clinical evidence base (Jonathan Quick)
"Clinical trials form the basis of effective research and development, but their reliability is currently imperilled by three major flaws: conflicts of interest on the part of the investigators; inappropriate involvement of research sponsors in their design and management; and publication bias in disseminating their results. On financial conflicts of interest, Bodenheimer has reviewed studies showing that authors who supported use of certain cardiovascular treatments were significantly more likely to have a financial relationship with the drug’s makers than those who did not; that studies funded by the manufacturer of a new therapy were more likely than others to find in favour of that therapy; and that independently funded pharmacoeconomic studies of cancer drugs were seven times more likely than industry-sponsored studies to reach unfavourable conclusions about a product (...)
’ The former editor of the New England Journal of Medicine argues in a separate piece that the editors did not go far enough. ‘‘The entire system of clinical investigation is driven by profit,’’ he writes: ‘‘we are seeing the corruption of a system of research that used to have high ideals and be clearly in the public interest’’ ( Relman A. Trust me, I’m a scientist. New Scientist, 22 September 2001: 46–47. ) "
Reacties
Een reactie posten