Evidence-based Medicine has been Hijacked - Report to David Sackett


This is a confession building on a conversation with David Sackett in
2004 when I shared with him some personal adventures in evidence-based
medicine (EBM), the movement that he had spearheaded. The narrative is
expanded with what ensued in the subsequent 12 years. EBM has become
far more recognized and adopted in many places, but not everywhere,
for example, it never acquired much influence in the USA. As EBM
became more influential, it was also hijacked to serve agendas
different from what it originally aimed for. Influential randomized
trials are largely done by and for the benefit of the industry.
Meta-analyses and guidelines have become a factory, mostly also
serving vested interests. National and federal research funds are
funneled almost exclusively to research with little relevance to
health outcomes. We have supported the growth of principal
investigators who excel primarily as managers absorbing more money.
Diagnosis and prognosis research and efforts to individualize
treatment have fueled recurrent spurious promises. Risk factor
epidemiology has excelled in salami-sliced data-dredged articles with
gift authorship and has become adept to dictating policy from spurious
evidence. Under market pressure, clinical medicine has been
transformed to finance-based medicine. In many places, medicine and
health care are wasting societal resources and becoming a threat to
human well-being. Science denialism and quacks are also flourishing
and leading more people astray in their life choices, including
health. EBM still remains an unmet goal, worthy to be attained.

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