The list has been filled with comments like this one:
> Since one’s main interest is to generate income, the primary objective
> of the research is to perpetuate itself, i.e. to ensure more grants.
> Patient outcomes and/or better allocation of limited public resources
> are irrelevant, let alone maximizing the health of populations.
I can't disagree more. In my book, I write about the value of things
like randomization, intention to treat analysis, blinding, etc. and then
I turn around and say that randomization is overrated, intention to
treat is overrated, blinding is overrated, etc. The reason for this
turnaround is that there is too much black and white mentality in the
EBM community--if a study is randomized, it is good, and if it is not,
the study is bad. Everything needs to be placed in context. A well
conducted observational study is far better than a shoddy randomized study.
The same is true with conflicts of interest. Conflict of interest is
overrated by many in the EBM community. It has to factored in, but you
can't disqualify a study just because there is a conflict of interest.
That's just as bad as disqualifying a study because it was not blinded.
A well conducted study is persuasive even if the authors have a
financial conflict of interest. The key is transparency of the methods
and objectivity in the approach. A financial conflict is a fatal flaw in
a subjective overview of the research, but it is not a fatal flaw in a
systematic overview. The systematic overview, with an open protocol and
objective ways to extract and combine the information from multiple
studies, is certainly defensible, even with a financial conflict of
interest.
Furthermore, to claim that the ONLY goal of academic researchers is to
ensure more grants is just not true. I know these people. I work with
them on a daily basis. They are concerned about getting grants, but that
is NOT to the exclusion of caring about their patients. In my
experience, what motivates medical researchers most is that they see a
problem in how health care is delivered and they want to fix it. Getting
the grants is a means to an end, and not the end itself.
The other problem with all of this discussion is a lack of appreciation
for the varying ranges of severity associated with conflicts. Everyone
has pressures that can influence how they conduct their research, but
some influences are minor and easy to resist, and others are major and
far more difficult to resist. Accepting a free trip from a drug company
makes you more conflicted than accepting a free meal. And non-financial
conflicts, while they can't be ignored, are less of a concern than major
financial conflicts of interest.
I believe that a skeptical attitude is mostly helpful in EBM, but too
much skepticism can be very harmful.
--
Steve Simon, Standard Disclaimer
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