I looked through my files and found ten papers published in 2005 that
dealt directly or indirectly with EBM issues. I put these on my web
site. Look for the March 6, 2006 entry on my Research Methodology weblog
Three papers merit special attention, because they call into question
the very research database that we rely on for EBM.
1. Medical journals are an extension of the marketing arm of
pharmaceutical companies. R. Smith. PLoS Med 2005: 2(5); e138
2. Contradicted and initially stronger effects in highly cited clinical
research. J. P. Ioannidis. Jama 2005: 294(2); 218-28.
3. Randomized controlled trials of aprotinin in cardiac surgery: could
clinical equipoise have stopped the bleeding? D. Fergusson, K. C. Glass,
B. Hutton, S. Shapiro. Clin Trials 2005: 2(3); 218-29; discussion
The first article in the list, by Richard Smith, is one among a large
series of articles that identify how commercial interests have made the
entire research endeavor open to question. The second article, by John
Ioannidis also calls the entire research endeavor into question and
points out the many factors that cause incorrect conclusions to be drawn
in most published research findings. The third article by Dean Fergusson
and others, argues that we do too much duplicative research that just
confirms what is already well established. The authors cite a particular
example involving placebo controlled trials which raises serious ethical
concerns, because 64 trials were run, but clear and convincing evidence
emerged by the time the 12th study was published.
There are several other articles published in 2005 that corroborate the
problems cited by these three articles, but I could not easily locate
You could argue that these are not truly EBM articles, but I believe
that they raise important issues that anyone who uses EBM should be
Steve Simon, [log in to unmask], Standard Disclaimer.
Look for my book "Statistical Evidence in Medical Trials"
which has just been published. For more details, see