A Muse on EBM

Marcy McCall MacBain in conversation with Bennett Holman a visiting Fellow from Yonsei University, South Korea.
Bennett gives a A Philosopher’s Muse on Evidence-Based Medicine (and the very serious problem of an asymmetric arms race).

I’m a philosopher interested in studying the reliability of medical evidence.  My current project is focused on articulating how standards of scientific evidence must be altered in areas of science that are heavily influenced by industry funding.  Specifically, in areas such as medical (especially pharmaceutical) research: How should we evaluate and interpret evidence given that it is not produced as a good-faith effort by a community of truth-seekers?  How can including the social dimension of knowledge production bring to light problems that are obscured by focusing trial design?  Finally, what are the ethical implications of the new role that scientific evidence is playing in medical decision making?  My work brings the tools of history, philosophy, statistics, and game-theory to bear on this question.

The research at the center of this interview examines the way that pharmaceutical companies manipulated the patient meetings at the FDA around what was then called “female sexual dysfunction.”  In this paper we find that women brought into the meeting by the pharmaceutical company reported experiences that no woman who came to the meeting on their own accord reported.  We then trace how the FDA used the patient experiences reported in the meeting.  We find that the experiences of women who attended the meeting on their own accord ultimately dropped out of regulatory reports.  The result is that the only voices remaining to influence decision makers were the women brought to the event by the pharmaceutical industry. 

The paper also discusses my theory of asymmetric arms races.  The research is forthcoming in Philosophy of Science and an advance print of the paper ” Sex Drugs and Corporate Ventriloquism: How to Evaluate Science Policies Intended to Manage Industry Bias” can be found here.

In the interview we discuss numerous resources that examine the effects of industry-funding on scientific research.  A colleague Kevin Elliott and I have just written an accessible and quick summary of the research which is currently under review, but we’re happy to share it by request (please send a brief email to me at bholman@yonsei.ac.kr).  There is also a Cochrane review on industry sponsorship and research outcome which can be found here and the Centre for Evidence-based Medicine’s catalogue of bias project which can be found here.  Resources for non-medicalized accounts of low sexual desire can be found here and here and here.

Some resources for medical evidence that try to avoid conflicts of interest with the pharmaceutical industry include The Medical Letter.  A group that promotes evidence-based prescribing and educates healthcare professionals about pharmaceutical marketing practices is PharmedOut.  The Alltrials movement promotes the publication of every trial, good, bad or indifferent.

Trust the Evidence is a new podcast series presenting conversations with individuals interested in improving healthcare through the use of better evidence.

Send us your thoughts and feedback: cebm@phc.ox.ac.uk. You can also listen to previous episodes here.

Edited and produced by Marcy McCall MacBain.

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