EBM and industry

This week’s BMJ is a theme-based issue on Evidence-Based Medicine. It contains the expected articles on how to judge whether or not EBM is living up to its promise, how best to implement it, and so on. There is one aspect of EBM, however, that is not addressed: its effect on the drug and device industries.

An implicit subtext of the evidence-based movement is that it helps counter the millions of dollars of industry propaganda and hype that wash over us every year. And EBM does, indeed, provide tools to judge drugs and interventions more objectively than we think the industry would like us to. But the drug and device industries have evolved along with (or ahead of) their customers.

Pharmaceutical companies have responded to EBM by carefully designing trials destined to apply to as wide a population as possible, while still obtaining (p<0.05) benefit. Then, armies of drug reps sally forth armed with reprints, while researchers are sent out to spread the gospel of statistical significance. EBM has made us particularly avid of hard data (while relegating clinical significance to a somewhat subordinate role). This emphasis on statistically significant data has been digested by industry and is now used to sell drugs and devices.

Evidence is good. Evidence-based methodologies are better. But they aren’t magic bullets. And EBM is a tool whose use is not restricted to pure and virtuous clinicians. Caveat lector.

5 thoughts on “EBM and industry

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  2. John

    I’m not sure I understand the implication here. If EBT is designed to weed out hype, and if the pharmaceutical companies are now using it to promote their products, does it not therefore follow that the data they are putting forth means that their communications are accurate? I’m not defending the industry as a whole, but aren’t they the ones that make the drugs that save patients’ lives? Must we assume that everything they touch is tainted?

  3. mjmd

    If we demand data, and the pharmaceutical companies deliver that data, why am I criticizing them?

    My point is really more about EBM than about the pharmaceuticals. What I’m saying is that EBM is not a magic bullet, and drug companies can adapt quite well to it, thank you.

    I don’t want to get into the attack/defend pharmaceutical companies thing, here. I just think that proponents of EBM sometimes tout it as almost a magic potion. It’s not. As the saying goes, “lies, damn lies and statistics”. Statistics aren’t lies, but they’re not a guarantee of the unvarnished truth, either.

  4. mjmd Post author

    Very apropos this post is an item posted on DB’s medical rants on April 21 about pharmaceutical information companies planting articles in the medical literature.

  5. A MD

    Dude.

    It’s easy to lie with statistics.

    It’s also far easier to lie without them.

    PS. The best stance to take re: Big PhRMA is that proposed by Lee Green MD MPH.

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