
“Evidence-based medicine has been hijacked”: John Ioannidis (2016) - ajna91
http://retractionwatch.com/2016/03/16/evidence-based-medicine-has-been-hijacked-a-confession-from-john-ioannidis/
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ekianjo
> The sales and marketing departments in most companies are more powerful than
> their R&D departments.

Yes, this is correct.

> Hence, the design, conduct, reporting, and dissemination of this clinical
> evidence becomes an advertisement tool.

This does not follow well logically. The design of clinical trials still
belongs to R&D and not Marketing/Sales departments. Even if Marketing/Sales
want to target for a specific outcome, there is nothing saying that this
particular outcome will be met until you actually try it clinically. And
specific outcomes are usually desirable outcomes: for example, showing that
your drug is non just superior to placebo, but superior to the current best-
in-class treatment. Or measuring patient-related outcomes that are tied to
economic value (for example, making a patient recover faster has tangible
societal benefits - they can come back to work, be an active family member,
etc...) is also relevant these days.

So, there is not a strong link between "pushing for an outcome that you can
advertise" and "this outcome being clinically meaningless". If it were
meaningless, FDAs and other regulatory bodies would not even accept it during
the clinical trial design review phase.

> As for basic research

Basic research should be the responsibility of academics, not companies. And
they do. But not many academics focus on "checking whether what we have been
using for 20 years really works", there's too much priority on new clinical
targets.

~~~
RobertRoberts
> If it were meaningless, FDAs and other regulatory bodies would not even
> accept it during the clinical trial design review phase.

Go look up how many corporate stooges are in the place in the FDA over the
years.

A good starting point is the history of Aspartame, I'd link some articles, but
I suspect the sources would be shot down and evidence ignored. The people at
the FDA were complicit in its approval, despite scientific evidence showing it
was dangerous.

~~~
ekianjo
Assuming the FDA is corrupted is one thing, assuming regulatory bodies ACROSS
the world are all corrupted at the very same time is just very close to being
a ridiculous claim.

~~~
marcus_holmes
it's known as "regulatory capture" and it's extremely common.

Most planning authorities worldwide are captured by property developers.

The more money involved in an industry, the more likely it is that the
industry regulator is captured.

~~~
andrewla
Regulatory capture will mean that outsiders - small companies without big
pharma connections - will find it difficult to get effective drugs approved.

Similarly, innovative ways of proving drug effectiveness, even if they are
more efficient and accurate, will be difficult to bring into practice.

------
newcrobuzon
It is a sad reality that some of the regulatory agencies have been captured by
the industry groups. This is especially concerning in healthcare and pharma
industry. Take for example Vioxx and Opioid issues: Merck Manipulated the
Science about the Drug Vioxx - [https://www.ucsusa.org/manipulating-science-
about-drug-vioxx](https://www.ucsusa.org/manipulating-science-about-drug-
vioxx) Purdue infiltrated WHO, manipulated opioid policies to boost sales,
report finds - [https://arstechnica.com/science/2019/05/world-health-
organiz...](https://arstechnica.com/science/2019/05/world-health-organization-
parroted-purdues-deceptive-opioid-claims-report-says/)

Yet it is still surprising to see that on HN in general anyone questioning
safety of pharmaceutical products get downvoted into oblivion.

~~~
Madmallard
It's way worse than that. Fluoroquinolone antibiotics are well known in
research for being seriously dangerous yet they were prescribed like candy for
over a decade. So many people develop disabling symptoms overtime that end up
not being linked to the drug because dna adduction and mtdna depletion won't
necessarily show up quickly. The drugs have likely disabled hundreds of
thousands at this point by Dr Bennett's estimations at UNC. There's something
like 10,000 reports and those are assumed at being less than 10% and possibly
1% of total incidents.

------
lez
He is a spiritual brother of Dr. Peter Gøtzsche, who is also very clearly
describing the corruption going on in the medical sciences.

He made simple statistical analysis to prove certain drugs like
antidepressants causing side effects / death. His findings ignored, he was
removed from his leading position from Cochrane Collaboration.

Videos:
[https://youtube.com/watch?v=dozpAshvtsA](https://youtube.com/watch?v=dozpAshvtsA)

[https://youtube.com/watch?v=UVHSpQ9PbSs](https://youtube.com/watch?v=UVHSpQ9PbSs)

[https://youtube.com/watch?v=G2mFHHWyTrc](https://youtube.com/watch?v=G2mFHHWyTrc)

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nordsieck
It looks like he gave a 30 minute talk [0] on this paper.

___

0\.
[https://www.youtube.com/watch?v=N63skNtYaJw](https://www.youtube.com/watch?v=N63skNtYaJw)

~~~
acqq
Yes, the aricle we comment here was posted March 2016. The video is from April
same year.

Also June 2016 "John Ioannidis - Why most clinical research is not useful"
(University of Oxford, Centre for Evidence-Based Medicine)

[https://www.youtube.com/watch?v=Uok-7NPFn4k](https://www.youtube.com/watch?v=Uok-7NPFn4k)

The paper:

[https://journals.plos.org/plosmedicine/article?id=10.1371/jo...](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002049)

------
nkurz
Here's the underlying paper that the article is about:

Evidence-based medicine has been hijacked: a report to David Sackett (2016)

[http://sci-hub.tw/10.1016/j.jclinepi.2016.02.012](http://sci-
hub.tw/10.1016/j.jclinepi.2016.02.012)

------
outlace
There wasn’t a lot of substance in this article, would have to read Dr.
Ioannidis’ referenced papers to actually understand his point.

~~~
DoreenMichele
Off the top of my head:

He does meta studies -- aka studies of studies -- and finds that most studies
are flawed, so most of the evidence we think we have isn't really there.

It doesn't exactly make him popular because he calls into question a lot of
existing supposedly "proven" medical science.

He talks a lot about the biased assumptions that are the foundation of a lot
of the framing of studies. If your baseline framing is sufficiently flawed,
the entire study is junk. He thinks a lot of studies are, in fact, junk.

~~~
Nasrudith
Stupid question - what makes us think the meta studies are themselves valid?

Also wouldn't junk itself have many subclassifications as how it is junk? Say
poor study data quality, wrong assumptions of wider applicability, wrong
analysis or conclusions, etc.

~~~
icelancer
>> Stupid question - what makes us think the meta studies are themselves
valid?

This is not a stupid question. Many meta studies are done by people with their
own frameworks of deciding what is and isn't a legitimate approach to studying
something. Unsurprisingly, their findings are overwhelmingly negative due to
their own publication bias.

Meta studies are pretty worthless in my opinion. Primary studies in all fields
should be forced to be published with open data, and any study that received -
directly or indirectly - more than $1 from the public taxpayer should be
forced to publish Open Access.

Lay bare all the raw data and let the software developers and data analysts
get after it, not so-called expert meta reviewers.

~~~
Jedd
> Lay bare all the raw data and let the software developers ...

Really can't tell if you're being sarcastic here, even in the context of HN.

> Meta studies are pretty worthless in my opinion. Primary studies in all
> fields should be forced to be published with open data ...

And until that happens meta studies are both worthwhile and one of the most
effective ways to correlate and sensibly interpret the existing published data
sets.

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cneurotic
Dubious evidence in medical studies is a big problem.

But I'd argue that it's only the core of the issue. The second layer out — and
I think the more influential layer — is the JOURNALISM surrounding these
medical studies.

Even if the underlying science is sound, a lot of outlets and reporters
routinely (and sometimes willfully) get the facts wrong.

I attended a talk with Retraction Watch's Ivan Oransky, where he spelled out
how easy it is for well-intentioned journalists to exaggerate, over-
generalize, or misunderstand what a study says. It was eye-opening. And a
little frightening.

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dbt00
(2016)

------
pessimizer
> JI: A systematic review that combines biased pieces of evidence may
> unfortunately give another seal of authority to that biased evidence.

Basically the same problem as CDOs.

~~~
wallace_f
CDOs and the subprime mortgage crisis have some analogues to pre-Enlightenment
darkness in human intellectual history. The idea that authoritative figures
can use maths to give junk debt the midas touch is basically financial
alchemy.

There was no sound reasoning behind it. It was literally just "maths is really
powerful, and these people are the _Smartest Guys in the Room,_ which is not
really that much different from "these guys are really Holy, and also the
Smartest Guys in the Room" in previous generations of humanity. Just market it
with Math, and you can defraud the most powerful and prosperous society in
history.

------
EGreg
There is a much bigger problem in the methodology, which is why meta studies
won’t be the last word on it either

[https://slatestarcodex.com/2014/04/28/the-control-group-
is-o...](https://slatestarcodex.com/2014/04/28/the-control-group-is-out-of-
control/)

------
qrbLPHiKpiux
Case-in-point:

Perdue Pharma, Oxycontin

------
jshowa3
After reading the interview, it sounds like a lot of scare mongering about
bias without actually identifying specific things that are wrong with specific
examples. Sure, it's nice to be looking for these issues, but people obviously
have different opinions on what biases produce poor results and if biases are
actually necessary and helpful.

