In 1990, a paradigm shift occurred in the development of new medicines and treatments. An idea so big, that it was supposed to encompass the whole of medicine. It was to start initially at the level of pre-clinical and clinical trials and work all the way through the system to the care and management of individual patients. This new concept for how medicine would be developed and conducted is called evidence-based medicine (EBM). Evidence-based medicine was to provide a more rigorous foundation for medicine, one based on science and the scientific method. Truly, this was to be a revolution in medicine – a non-biased way of conducting medical research and treating patients.
Evidence-based medicine
Evidence-based medicine is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” The aim of EBM is to integrate the experience of the clinician, the values of the patient, and the best available scientific information to guide decision-making about clinical management.
So, what the hell happened?
There is a big flaw in the logic of evidence-based medicine as the basis for the practice of medicine as we know it, a practice based on science; one that determines care down to the level of the individual patient. This flaw is nestled in the heart and soul of evidence-based medicine, which (as we have seen over the last two years) is not free of politics. It is naïve to think that data and the process of licensure of new drugs is free from bias and conflicts of interest. In fact, this couldn’t be any farther from the truth. The COVID-19 crisis of 2020 to 2022 has exposed for all to see how evidence based medicine has been corrupted by the governments, hospitalists, academia, big pharma, tech and social media. They have leveraged the processes and rationale of evidence-based medicine to corrupt the entire medical enterprise.
Evidence based medicine depends on data. For the most part, the data gathering and analysis process is conducted by and for the pharmaceutical industry, then reported by senior academics. The problem, as laid out in an editorial in the British Medical Journal is as follows:
The release into the public domain of previously confidential pharmaceutical industry documents has given the medical community valuable insight into the degree to which industry sponsored clinical trials are misrepresented. Until this problem is corrected, evidence based medicine will remain an illusion.
This ideal of the integrity of data and the scientific process is corrupted as long as financial (and governments) interests trump the common good.
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