Shortcomings in evidence based medicine? BMJ thread

[A Former User]

Why we need better evidence for better healthcare

http://evidencelive.org/manifesto/#disqus_thread

Problems include: poorly managed commercial and academic vested interests,6 bias in the research agenda, failure to take account of the patient perspective in research questions and outcomes, 7 poor research design, 4 the rising use of surrogate outcomes,8 lack of transparency, lack of independent scrutiny, ghost authorship,9 publication bias,10 reporting bias 11 including under-reporting of harms, 12 trials that fail to follow their protocols 13 or are stopped too early,14 and over-interpretation and misuse of the results of research, 15 uncorrected errors, 16 and undetected fraud. 17 5 These are just some ways in which our flawed system generates evidence that has reached the wrong result, or conclusions that don't matter to real world patients.18 studies suggest that most published research (including a range of study designs) is more likely to be false than true. 16

[A Former User]

These issues have been recently highlighted in the Chronic pain world with the issues surrounding the development of the CDC guildlines. The points of concern are serious issues, but I never hear anyone speak to the issue that evidence based decision making can not happen in a vacuum.

When exploring the evidence we must start also including investigation into the environment in which the decisions are being designed for. By changing environment the conclusions determined by evidence may change. If the evidence shows that day light is not an issue effecting quality sleep in general, but you apply the evidence to Alaska its likely going to be wrong. Overly simplified example.

We are seeing programs being created, decisions made, based on very good evidence, but no context. They are often calling short.

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