Dear Martin, Good question. The pharmaceutical companies do invest *much* more in research than government and not-for-profit groups (in the UK this is about 5:1). However, often the research is me-to or marketing research that doesn't answer our clinical questions. So the research relevant to clinicians may be better balanced. I can't tell you how many of the 20,000 new randomised trials published each year are non-pharmaceutical interventions, but in a review of things we picked for the EBM journal we found about a 50:50 split over 3 years. The split we found is similar to the split you can find in Figure 3 of a recent UK analysis of non-commercial trials: Chalmers I, Rounding C, Lock K. Descriptive survey of non-commercial randomised controlled trials in the United Kingdom, 1980-2002. BMJ. 2003 Nov 1;327(7422):1017. Cheers Paul Glasziou At 09/03/2006, you wrote: >I have been an observer of this listserv for a >couple of months as I get acquainted with the >main papers dealing with EBM. I am just >starting a PhD which involves general >practitioners use of online evidence resources, >so the ‘Best EBM methods papers’ is extremely useful for me - thanks > > > >I don’t know whether this listserv is used for >much ‘discussion’, but I am interested to >followup on what Steve was highlighting and ask for comments… > > > >Question: if research studies are biased to >pharmaceutical interventions, and EBM relies on >exploring the available evidence, then EBM will >also be biased to pharmaceutical interventions. > >I know this is a bit simplistic, but is this >true? Is there any solutions to counter this problem? > > > >Regards > > > >Martin > > > > > > > >Martin Halperin MBBS MPH > >Academic GP Registrar and Lecturer > >Department of General Practice > >Monash University > >867 Centre Rd > >EAST BENTLEIGH Vic 3165 > >Phone: (03) 8575 2289 > >Fax: (03) 8575 2233 > >[log in to unmask] > > > > > > > > > >"Simon, Steve, PhD" <[log in to unmask]> wrote: > > > 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 > > > at: > > > > > > http://www.childrens-mercy.org/stats/weblog.asp > > > > > > 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 > > > 229-32. > > > > > > 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 > > > them. Sorry! > > > > > > 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 > > > aware of. > > > > > > 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 > > > http://www.childrens-mercy.org/stats/evidence.asp > > > > > > Paul Glasziou Department of Primary Health Care & Director, Centre for Evidence-Based Practice, Oxford ph: 44-1865-227055