Evidence-based medicine: can the evidence be trusted?

Abstract

Empirical research indicates that much of the evidence required for the practice of evidence-based medicine cannot be trusted. The research agenda has been hijacked by those with vested interests within industry and academia, determining what research is funded and how it is done and reported. Unnecessary, inappropriate, or poorly designed and reported research results in suboptimal health outcomes. Many well-reported randomized controlled trials are designed to deceive by their choice of comparators and outcomes, and manipulation of statistics to produce desired outcomes that are selectively reported. Undisclosed conflict of interest, ghost-writing, the manufacturing of disease to increase drug marketing, and the marketing of research disguised as education are common. Understanding the many ways in which research is used to deceive, rather than reliably inform health decisions, and reclaiming the research agenda, is the collective responsibility of the scientific community and civil society.