What's evidence based medicine? Drug companies are hiding research
Drug companies may not be publishing complete and comprehensive data that could affect a physician's ability to practice safe and effective medicine. "Evidence-based medicine" is the trend in the medical community. But, what if the research was biased and based on selectively published clinical trials? It seems that this may what is actually happening and it could be a deadly scenario for all of us.
Alltrials.net is a website created by Dr. Ben Goldacre, turned epidemiologist. Dr. Goldacre felt misled with information that drug companies were hiding critical clinical trial results. Dr. Goldacre explained in a Ted Talk that while positive clinical trial results are published; many negative clinical trial results are not published. As pharmaceutical companies publish positive data and suppress the negative, physicians base clinical decisions on what may be biased and selective data.
As an example, anti-depressants have led to a billion dollar pharmaceutical industry in North America. However, these medications are rarely prescribed in many countries overseas. A recent analysis of 74 studies of anti-depressants showed that 38 clinical trial results were positive and 36 trial results were negative
. Thirty-seven out of the 38 clinical of the positive results were published while only one out of the 36 negative results was published
. This is an example of a misleading bias, which may have caused many physicians, including Dr. Goldacre and I, to practice unsafe medicine because what is believed to be "evidence-based medicine", could actually be "selectively-biased medicine."
The publication bias may not only be limited to Anti-depressants. Tamiflu is a popular anti-viral drug used to treat influenza. Roche, the makers of Tamiflu, have refused to release 8 out of the 10 clinical trial results conducted on Tamiflu
. In 2009, the BMJ (British Medical Journal) contacted Roche requesting the manufacturer release the data as an effort to subject the medication to unbiased scrutiny. Roche has not released the data
.Concurrently, an investigation into conflicts of interest within WHO (World Health Organization) was published, presenting links between creating the guidelines for pandemic flu planning and Roche
. The two published studies resulting in a positive effect were funded by Roche, authored by Roche employees and external experts paid by Roche
100,000 unnecessary deaths?
Lorcanide is an anti-arrhythmic drug prescribed to reduce the rate of deaths in those following a myocardial infarction (heart attack). In a study performed in the 1980s, 95 people were assigned to either placebo or Lorcanide
. Nine of the 49 people in the Lorcanide group died, while just one person in the placebo group died
. This study was not published at the time and may be another example of publication bias
. Due to the fact that this study was not published at the time it was conducted, multiple pharmaceutical companies created anti-arrhythmic drugs which Dr. Goldacre believes may have led to 100,000 unnecessary deaths in North America
. Dr. Goldacre's claim may seem dubious, but two large clinical trials have demonstrated that the misuse of anti-arrhythmic drugs can greatly increase the rate of sudden cardiac death
Your Physician may not be at fault
This may not be a mistake made by a physician. Many physicians genuinely have the patient's best interests in mind and would likely be infuriated with if they were aware that drug companies and lobbyists could be hiding clinical trial results. Many medical graduates in North America have spent more than ten years in school and require continuing education credits to maintain their independent practice license. These physicians sacrificed years of their life to help others and would like nothing more but to practice quality evidence based medicine. Unfortunately, It may be very difficult to practice evidence-based medicine when you have to question every clinical guideline and claim may by the pharmaceutical industry.
I do not claim to have a solution to this issue, but I am doing what I can by writing this article and making it known that my desire is to make the best clinical decisions with the best evidence available.
The first thing I would like everyone to do is to sign the petition at alltrials.net. When you sign this petition, you're forcing drug companies to release all clinical trials so your physician has all research, not just the research the drug companies publish.
What else can you do? Use social media to your advantage and spread awareness of this growing issue. You can start by sharing this article or Dr. Goldacres' Ted talk which can be found here
My hope is that you do not believe that all medications are bad for your health or that physicians are prescribing medications without keeping the patient's best interest in mind. This is not the case -- there are many quality pharmaceuticals with valid research that can alleviate suffering and extend your life. I sincerely hope we can continue to discover more natural and pharmaceutical products with unbiased quality research so physicians and make the best clinical decisions.