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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