Let's talk about why  TTE  is calling for a halt on all medical research and what it could mean for the future of healthcare.

Thirty years ago, Doug Altman wrote about the Scandal of Medical Research in the BMJ, “We need less research, better research, and research done for the right reasons.” Altman considered vast sums of money were wasted on seriously flawed research that suffered from “inappropriate designs, unrepresentative samples, small samples, incorrect methods of analysis, and faulty interpretation.”

In the intervening years, we have seen the opposite. As we write this, PubMed contains 36,914,967 indexed results. In 1994, just under 440,000 articles were indexed, growing to 1,775,913  million in 2022. A paltry 26 million articles have been indexed in the intervening thirty years.     

Share Trust the Evidence

Over the past three decades, we've witnessed a concerning decline in the quality of research. It's become increasingly apparent that something needs to be done to address this issue and ensure we're producing high-quality, accurate evidence that we can rely on.

In 2005, John Ioannidis pointed out research is more likely to be false than true, particularly when effect sizes are small when too many outcomes are presented and when there are financial interests. Moreover, “with increasing bias, the chances that a research finding is true diminish considerably”.

In 2009, a Lancet series on avoidable waste in research estimated that 85% of research spending currently goes to waste.

In 2015, Dame Sally Davies, the chief medical officer of the time, recognised that the ongoing debate over statins – had dented the public’s faith. She wrote, “There seems to be a view that doctors over-medicate so it is difficult to trust them, and that clinical scientists are all beset by conflicts of interest from industry funding and are therefore untrustworthy too”. 

In 2017, we wrote the EBM manifesto to respond to systematic bias, wastage, error, and fraud in research underpinning patient care. It was clear that the quality of research was deteriorating, with too many poorly designed and executed studies.  

Furthermore, there have been substantial problems with the publication of research. Drug companies often hide evidence to the detriment of patient care. In 2004, an analysis of 102 randomised trials found that half of the efficacy and two-thirds of the harm outcomes were incompletely reported. The effects of reporting biases are widespread; they overestimate the benefits and underestimate the safety of treatments. For example, an analysis of 92 Cochrane reviews found that 86% did not include data from the primary harm outcome,

A substantial proportion of trials have ghost authorship, which often goes undisclosed and undermines results. Rofecoxib was withdrawn because of the increased risk of heart attack and stroke associated with its use. The manufacturer withheld information about the drug from doctors and patients for over five years. Legal disclosure revealed that sponsor employees authored the trial manuscripts but often attributed the first authorship to academically affiliated investigators who did not always disclose the financial support. The widespread financial and non-financial conflicts of interest among academic institutions and researchers exacerbate these problems. They are associated with pro-industry conclusions, restrictions on publication and data sharing and “private interests”.

Our antivirals series provided evidence that ghostwritten trials made unsubstantiated statements about the effects of influenza with the help of “authors” who had not seen the data but crafted the relevant WHO guidelines to ensure use and stockpiling at great public expense. Stockpiling at a colossal cost is continuing to this day.

If you're not concerned about the issues discussed so far, you might want to consider the criminal behaviour of the pharmaceutical industry. From 2009 to 2014, the sector faced fines totalling $13 billion for criminal behaviour and civil infringements – behaviour that largely went unnoticed. The three worst offenders were GSK (fine of $3 billion) for marketing Paxil to children and misleading the FDA; Pfizer ( $2.3 billion) for misbranding Bextra with “the intent to defraud or mislead,” and Johnson & Johnson ($2.2 billion) for illegal promotion of prescription drugs.  

TTE contends that given the systemic biases within research, we must halt healthcare research to redefine how we develop, produce, and publish it. 

In the meantime, while we work out how to deal with systemic waste and fraud, the research funding could be spent on fixing the dire problems within the NHS. This includes reducing the strain on A&E departments, shortening waiting lists, and expediting cancer treatments. Given the numerous issues present in research, it is currently evident that investing in implementation will yield much more significant benefits for health.