A seminar “Deadly Devices and Dangerous Drugs, the secrets behind medical research” was hosted by the Centre for Evidence-Based Medicine and Kellogg College in the Natural History Museum during the University of Oxford’s 8th Alumni weekend.
The audience was challenged to consider aspects of medical research that have been kept hidden or perhaps purposely misunderstood. Consistent with the paradigm of evidence-based health care, scientific evidence was used to demonstrate significant flaws in the practice, evaluation, and application of medical research for safe and effective health care.
Professor Carl Heneghan opened with several examples of historical medical practice that today seem shocking; from craniotomy (making holes in skulls) through the use of arsenic in the pursuit of beauty, the use of X-rays to aid shoe fitting, and ultimately radioactive toothpaste and suppositories. Given that these historical practices now seem so absurd, he challenged the audience (via the twitter hashtag #DDDDOx) to predict current practices that in the future will also become outdated. Carl emphasised the importance of the science of epidemiology in documenting and analysing patterns. He highlighted the Oxford childhood cancer survey, conducted by Alice Stewart “the woman who [according to her biographer] knew too much”, which identified the risks to children of mothers having x rays during pregnancy. Sadly, it took over 20 years for the notification of these adverse events to change practice.
Deborah Cohen took the story of devices up to the current day. As investigations editor for the BMJ, she identified abnormally high revision rates for certain hip joints, and noted that surgeons have continued to use such devices, despite concerns about harms. To support her hunch that the market for the production and introduction of new devices was unregulated, she went under cover and successfully ‘launched’ a new, fake hip prosthesis! The audience was shocked at the limited transparency and the lack of systematic data collection and routine evaluation in current medical practice.
Jeff Aronson changed suit from deadly devices to dangerous drugs. He described the continuous use from 1848 to the 1980s of the anaesthetic drug chloroform, which is now considered to be dangerous. He shared stories of careful, devious, and dangerous uses of chloroform; from its secret administration to Queen Victoria during labour through to more recent criminal and recreational uses. However he questioned the continuing use of chloroform over the last 30 years, despite there being safer alternative drugs. In deciding when to take dangerous drugs off the market, careful research and documentation of adverse reactions is required. While we are getting quicker at detecting the first death from a drug, there has been limited improvement in the time to complete drug withdrawal following identification of serious hazards.
Ben Goldacre scared us with the dangers of being involved in clinical drug trials; some are flawed by design, and in some cases results are intentionally withheld, making it possible to under or over-estimate the effects of drugs being studied. This phenomenon, called publication bias, may lead to patients taking harmful or unnecessary drugs. He encouraged us all to sign the petition for Alltrials, which calls for the transparent registration of new trials, publication of methods and results, and shared access to clinical study reports.
After listening to all four speakers, the notion of evidence-based practice becomes more obvious and necessary. We need to be informed about the secrets of medical research, we need to be able to separate myths from facts, and we need to be able to confront bad clinical habits; all with relevant and high quality research. We also need transparent information and decision making, so that we can identify unexpected reactions to medical research, and ensure that the risks of harms are minimized and clinical practice is kept up to date.