Doctors and patients need to be ‘evidence-literate’

An interview with John Ioannidis, MD

February 9, 2016

By Margie Coloian, MSJ

Dr. Ioannidis, professor of medicine at Stanford University School of Medicine, is a keynote speaker at the 4th Annual Lown Institute Conference, April 15-17 at the JW Marriott Hotel Chicago.

You’ve written extensively, exposing the bad science that exists regarding patient care. How can patients be sure that they’re receiving the right care, given all the divergent research out there about tests and treatments?

Patients are in a difficult position, and doctors are too. They’re surrounded by conflicted evidence. Up to 90 percent of research may be flawed in some disciplines. That’s a major issue. Patients need to be trained in how to become evidence-literate, to ask the right questions. And doctors should become more evidence-literate on how much uncertainty there is on what we believe we know. Patients should be told of these uncertainties because it is very important to have a population cognizant about this, and the communities need to push for a new research agenda instead of being happy with what we have. We need research that is based on our values.

What are those values?

Transparency and accountability. We need to align incentives and rewards with better science and better outcomes. We don’t have that now. There are major flaws in research. We do lots of small, poorly designed, manipulated selected studies, which have great conflicts of interest and have no transparency.

How can medical research be improved?

There are multiple solutions being proposed about that. Not all solutions will work, of course, and some may actually cause harm. First, we need to be careful with what we endorse. We need less ‘expert’ opinions that often come with bias. We need fewer committees (like those that develop guidelines) that set the agenda, and we need more evidence. Guidelines from specialty societies may be reaching a tipping point now and may be doing more harm than good. Many guidelines that are produced are based on no evidence at all or the interpretation of evidence. We have too much trust in guidelines, but we need to place our trust in real data.  The conflicts of interest are prominent and many are industry-influenced. What we need is more randomized evidence to inform our policies.

You are asked to present at a multitude of conferences each year. Why did you say yes to the Lown Conference?

I believe the Lown Conference is spectacular. There are very few groups that look at the big picture of health care. The Lown Conference does. Most other groups look at the little aspects of health care or medicine, but looking at the big picture—how health care can change—is what Lown does best.

What do you hope you get out of the conference?

There are going to be a lot of very smart people attending who have brilliant ideas. And unlike other conference attendees, they won’t have any conflicts of interest. I want to learn from them and hear all the exciting ideas that will surely emerge.