Practical Ethics

In a blistering letter in the current issue of the British Medical Journal, Miran Epstein identifies some of the factors we should consider in assessing the claims of so-called ‘evidence-based medicine’.[1] Nobody rationally disagrees with the suggestion that medicine should have an evidence base, and everybody should agree that in order for medicine to be based on reliable evidence, it should be free of the following ‘polluters’:

•  financial conflicts of interest

•  inadequately rigorous selection criteria, outcome measures and criteria of statistical significance

• the practice of testing products against placebo or no treatment (rather than current treatment), and then shouting ‘Eureka!’

• recruiting subjects using financial incentives that introduce outcome bias

• marketing campaigns masquerading as research

• research agendas driven by corporate interests rather than patient needs Continue reading →