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Experts write manifesto for evidence-based medicine

They aim to tackle systematic bias, wastage, error, and fraud in research behind patient care

Louise Prime

Wednesday, 21 June 2017

Experts have produced their ‘manifesto for evidence-based medicine’ in response to what they say is the systematic bias, wastage, error, and fraud in the research that underpins patient care. They lament the questionable integrity of much of today’s evidence, the lack of research answering questions that matter to patients, and the lack of relevant evidence to inform patients’ and clinicians’ shared decision-making, and have called for a series of measures to help rectify the situation.

The authors of today’s editorial,* in The BMJ, from the Centre for Evidence Based Medicine at the University of Oxford and The BMJ itself, argue that too many research studies are poorly designed or executed, and too much of the resulting research evidence is withheld or disseminated piecemeal. And they argue that as the volume of clinical research activity has grown, the quality of evidence has often worsened – “which has compromised the ability of all health professionals to provide affordable, effective, high value care for patients”.

Their work has uncovered many problems with current evidence, including that: a third (34%) of scientists report questionable research practices, including data mining for statistically significant effects, selective reporting of outcomes, switching outcomes, publication bias, protocol deviations, and concealing conflicts of interest; a 2012 survey of 9,036 BMJ authors and reviewers found that of the 2,782 (31%) who replied, 13% had witnessed or had first-hand knowledge of UK-based scientists or doctors inappropriately adjusting, altering, or fabricating data during their research for the purpose of publication; and 8% of authors from 630 articles admitted they had lied in their authorship statements.

Part of their solution is their collaboration on Evidence Live, a yearly conference (opening today in Oxford) set up to “develop, disseminate and implement better evidence for better healthcare, and orchestrate change in global healthcare”. They explain that through this and other projects, they have discovered more about not only the substantial problems with evidence, but also found “progress and solutions spanning the breadth of the evidence ecosystem, from basic research to implementation in clinical practice”.

Their manifesto for evidence based medicine aims to tackle existing problems and sets out steps required to develop trustworthy evidence. These include:

  • expanding the role of patients, health professionals and policy makers in research
  • increasing the systematic use of existing evidence
  • making research evidence relevant, replicable, and accessible to end users
  • reducing questionable research practices, bias and conflicts of interests
  • ensuring drug and device regulation is robust, transparent and independent
  • producing better usable clinical guidelines
  • supporting innovation, quality improvement, and safety through the better use of real world data
  • educating professionals, policy makers, and the public in evidence based healthcare to make an informed choice

They concluded: “Tackling the problems will take time, resources, and effort. The evidence-based medicine community should take responsibility for this. However, it is a vast project that is being led, and will be led, by disparate groups around the world. We hope to focus attention on the tools and strategies most effective at delivering change, so that we can all work together to improve healthcare using better quality evidence.”

* Heneghan C, Mahtani KR, Goldacre B, et al. Editorial: Evidence based medicine manifesto for better healthcare. BMJ 2017; 357:j2973 doi: 10.1136/bmj.j2973

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