Betrayal of the Severely Ill?
Appendix 1: Bitter Pills for Peers
Published by The Sydney Morning Herald.
"The truth drug is not always what the doctor orders as bogus medical research papers show."
Sometimes you almost have to feel sorry for members of the medical profession. Consider the strife they're in. The profession's authority is derived largely from its claim to scientific legitimacy: that what it does has been proven to work and is therefore better than what homeopaths, nurses or any other competitors do.
But these claims have copped a bashing in recent years, partly as a result of the international movement for evidence-based medicine. This collaboration of health professionals and consumers has argued long and loud that many medical practices are not supported by solid scientific evidence. Sometimes, treatments stay in use long after being shown to do more harm than good. Others are ignored long after they are proven effective. It is estimated, for example, that many tens of thousands of premature babies died or suffered because doctors were slow to act on research showing the benefits of giving some expectant mothers a course of drugs called corticosteroids.
Now, a big question mark hangs over another of the basic tenets underpinning modern medicine: peer review. This process is supposed to make the work published in medical and scientific journals credible because it has been scrutinised by the researchers' peers to weed-out bad-quality work, mistakes, exaggerations and lies. Doctors have been ardent advocates of peer review because they know only too well that they can't always believe what colleagues say.
Recent examples: a Scottish doctor forged consent forms and data while conducting a clinical trial; a leading British obstetrician was struck off after publishing two papers describing work which never took place; a Scottish authority on chronic fatigue syndrome was accused of "cooking" research; and several AIDS studies were withdrawn in the US after fraud allegations.
A less sinister, but more pervasive, problem is researchers' tendency to push a particular agenda in reporting their findings or to award "gift authorship" to colleagues who did not contribute to the research. (The editor of the British journal which published the fraudulent obstetrics papers had accepted co-authorship.)
Some who attended the recent third international congress on peer review in Prague concluded the practice can't be trusted. "The central message from the conference was that there is something rotten in the state of scientific publishing and that we need radical reform," said the editor of the British Medical Journal, Dr Richard Smith.
Delegates were told of a study in which researchers inserted eight deliberate errors in a paper about to be published in the BMJ. Of more than 200 experts who reviewed the paper, 16 per cent spotted no errors and nobody found more than five. The median number identified was two.
Smith, who is known for his provocative sermons to the profession, said: "The problem with peer review is that we have good evidence on its deficiencies and poor evidence on its benefits. We know that it is expensive, slow, prone to bias, open to abuse, possibly anti-innovatory and unable to detect fraud. We also know that the published papers that emerge from the process are often grossly deficient."
Two years ago a British government committee caused international panic by releasing unpublished research suggesting some contraceptive pill brands increased the risk of blood clots. Three thousand more women than average had abortions in England and Wales alone in the first three months of last year, presumably as a result of the massive media scare. The risk of blood clots for the brands involved was put at 30 per 100,000 a year for non-pregnant non-users. This sad story is a salutary reminder to evaluate carefully what you are told by doctors. And journalists."
Return to the AHMF Letter to the RACP.
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