Abstract
This is a confession building on a conversation with David Sackett in 2004 when I
shared with him some personal adventures in evidence-based medicine (EBM), the movement
that he had spearheaded. The narrative is expanded with what ensued in the subsequent
12 years. EBM has become far more recognized and adopted in many places, but not everywhere,
for example, it never acquired much influence in the USA. As EBM became more influential,
it was also hijacked to serve agendas different from what it originally aimed for.
Influential randomized trials are largely done by and for the benefit of the industry.
Meta-analyses and guidelines have become a factory, mostly also serving vested interests.
National and federal research funds are funneled almost exclusively to research with
little relevance to health outcomes. We have supported the growth of principal investigators
who excel primarily as managers absorbing more money. Diagnosis and prognosis research
and efforts to individualize treatment have fueled recurrent spurious promises. Risk
factor epidemiology has excelled in salami-sliced data-dredged articles with gift
authorship and has become adept to dictating policy from spurious evidence. Under
market pressure, clinical medicine has been transformed to finance-based medicine.
In many places, medicine and health care are wasting societal resources and becoming
a threat to human well-being. Science denialism and quacks are also flourishing and
leading more people astray in their life choices, including health. EBM still remains
an unmet goal, worthy to be attained.
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Article info
Publication history
Published online: February 28, 2016
Accepted:
February 18,
2016
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
