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 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 naive 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.
Medicine is largely dominated by a small number of very large pharmaceutical companies that compete for market share, but are effectively united in their efforts to expanding that market. The short term stimulus to biomedical research because of privatization has been celebrated by free market champions, but the unintended, long term consequences for medicine have been severe. Scientific progress is thwarted by the ownership of data and knowledge because industry suppresses negative trial results, fails to report adverse events, and does not share raw data with the academic research community. Patients die because of the adverse impact of commercial interests on the research agenda, universities, and regulators.
The pharmaceutical industry’s responsibility to its shareholders means that priority must be given to their hierarchical power structures, product loyalty, and public relations propaganda over scientific integrity. Although universities have always been elite institutions prone to influence through endowments, they have long laid claim to being guardians of truth and the moral conscience of society. But in the face of inadequate government funding, they have adopted a neo-liberal market approach, actively seeking pharmaceutical funding on commercial terms. As a result, university departments become instruments of industry: through company control of the research agenda and ghostwriting of medical journal articles and continuing medical education, academics become agents for the promotion of commercial products. When scandals involving industry-academe partnership are exposed in the mainstream media, trust in academic institutions is weakened and the vision of an open society is betrayed (BMJ).
The corporate university also compromises the concept of academic leadership. No longer are positions of leadership due to distinguished careers. Instead, the ability to raise funds in the form of donations, grants, royalty revenue and contracts, dominates the requirements for University leaders. They are now must demonstrate their profitability or show how they can attract corporate sponsors.
As the US government, particularly NIAID controls a significant amount of the grants and contracts of most academic institutions in the USA, they also, can determine what research is conducted and who is funded to conduct that research.
The US government also controls the narrative. Take for example the use of the media, CDC and the FDA to control the narrative about early treatment for COVID-19. By now we should all know about the corruption of the early clinical trials of hydroxychloroquine. On the basis of these faked studies, one of the safest drugs in the world was recommended to not be used in an out patient setting – most likely, in order to increase vaccine acceptance. Or how our government used propaganda to control the use of ivermectin by such tactics as calling it unfit for human use and labelling it as a “horse wormer.” All indications are that these efforts by the US government were to dissuade early treatment to stop vaccine hesitancy.