We all want evidence-based medicine – but not all evidence is created equal. In fact, much of the medical research we rely on to make clinical decisions is of poor quality, according to a new piece (pdf) in the European Journal of Clinical Investigation by Stanford professor Dr. John Ioannidis, Lown Institute Vice President Shannon Brownlee, and co-founders of the quality improvement group Delfini, Dr. Michael Stuart and Sheri Strite. The ubiquity of low-quality research “contributes considerably to overuse, underuse, avoidable adverse events, missed opportunities for right care and wasted healthcare resources,” the authors write.
“Low-quality research contributes considerably to overuse, underuse, and avoidable adverse events.”
In the article, they identify four key problems with clinical evidence that make medical research a “mess”:
Too much medical research is of uncertain reliability, offers no benefit to patients, or is not useful to decision-makers. Not only are many clinical trials in danger of bias because of industry funding, but few studies provide results that address an important clinical problem and reflect patient priorities. The amount of research we do does not correspond to the number of people affected by various diseases, and the move toward measuring surrogate markers rather than mortality lessens the utility of this research for patients.
Health care professionals are unaware of these problems. Too many clinicians rely on reading abstracts alone, which can be misleading, or place their trust in journal editors (who are often unaware of methodological problems as well).
Many health care professionals also lack the skills to discern the reliability and usefulness of evidence. Unfortunately, most clinicians fail tests of basic clinical appraisal skills, including identifying the lack of a control group and recognizing the difference between absolute and relative risk. Even creators of clinical guidelines fall prey to these mistakes, leading to inaccurate guidelines that drive wrong care.
Patients and families don’t have access to accurate information and guidance when they need to make medical decisions. People are “bombarded with misleading information” from medical news stories,spurious websites, direct-to-consumer ads,” and more, the authors say. Discussions between clinicians and patients don’t do enough to combat misinformation, as clinicians rarely discuss the risks and benefits of treatment or ensure that patients understand their decision.
We can take up the resposibility to master skills and become the teachers.
What do we do about the mess of medical misinformation? The authors recommend more research to find out best practices for teaching evidence-based medicine and raising awareness of bad science among clinicians, journal editors, and the public. Reforms can be implemented on an individual as well as institutional level, the authors assert. “Health care professionals can take up the responsibility to master skills and become teachers and trainers for themselves and for others during encounters with patients and decision-making,” they write.