PUBLIC RELEASE DATE:

14-Oct-2014

Contact: Annmarie Christensen Annmarie.Christensen@dartmouth.edu 603-653-0897 The Geisel School of Medicine at Dartmouth

LEBANON, NH The foundation of evidence-based research has eroded and the trend must be reversed so patients and clinicians can make wise shared decisions about their health, say Dartmouth researchers in the journal Circulation: Cardiovascular Quality and Outcomes.

Drs. Glyn Elwyn and Elliott Fisher of The Dartmouth Institute for Health Policy & Clinical Practice are authors of the report in which they highlight five major problems set against a backdrop of "obvious corruption." There is a dearth of transparent research and a low quality of evidence synthesis. The difficulty of obtaining research funding for comparative effectiveness studies is directly related to the prominence of industry-supported trials: "finance dictates the activity."

The pharmaceutical industry has influenced medical research in its favor by selective reporting, targeted educational efforts, and incentivizing prescriber behavior that influences how medicine is practiced, the researchers say. The pharmaceutical industry has also spent billions of dollars in direct-to-consumer advertising and has created new disease labels, so-called disease-mongering, and by promoting the use of drugs to address spurious predictions.

Another problem with such studies is publication bias, where results of trials that fail to demonstrate an effect remain unpublished, but trials where the results are demonstrated are quickly published and promoted.

"We do not know when healthcare decisions are guided by sound interpretations of the evidence and whether patients are engaged in the process," say Elwyn and Fisher. "Rather we observe that in the United States, one of the most highly developed healthcare systems, consumer demand for healthcare is manufactured and manipulated, driving up cost, waste and harm."

And even if the synthesis is competent, they say, more evidence remains inaccessible and presented in a way that is difficult to translate into effective communication about harms and benefits.

"The problems of greatest concern to patients are often left uninvestigated, with emphasis given to research that expands market share," say Elwyn and Fisher.

See the article here:

Corruption of the health care delivery system