Experts set out plan to tackle “questionable integrity” of medical evidence

A plan to tackle "serious flaws in the creation, dissemination and implementation of medical evidence" is set out by experts from The BMJ and Oxford University’s Centre for Evidence Based Medicine.

Their manifesto for evidence based medicine (EBM) sets out steps required to develop trustworthy evidence – and is an open invitation to contribute and join a movement towards better evidence for better healthcare.

Poor design

"Too many research studies are poorly designed or executed", argues Professor Carl Heneghan, editor in chief of the journal Evidence Based Medicine, in an editorial with The BMJ’s editor in chief, Dr Fiona Godlee, and colleagues.

Quality over quantity

Too much of the resulting research evidence is withheld or disseminated only piecemeal, they add, and as the volume of clinical research activity has grown, the quality of evidence has often worsened, which has compromised medicine’s ability to provide affordable, effective, high-value care for patients.

 As a result, a host of organisations have sprung up to help clinicians unpick what evidence means and offer advice on how they should act. But Heneghan argues that "these too are beset with problems such as untrustworthy guideline production, regulatory failings, and delays in the withdrawal of harmful drugs."

Avoidable harm

Collectively, he says, "these failings contribute to escalating costs of treatment, medical excess and avoidable harm."

The manifesto aims to solve these issues. Developed by people engaged at all points in the research process, patients and the public, it identifies nine steps towards more trustworthy evidence.

They include expanding the role of patients, health professionals and policy makers in research, reducing questionable research practices, bias and conflicts of interests, ensuring drug and device regulation is robust, transparent and independent, and producing better usable clinical guidelines.

Solutions

Heneghan acknowledges that tackling these issues will take time, resources and effort, but says the focus will be on the tools and strategies most effective at delivering change, "so that we can all work together to improve healthcare using better quality evidence."

Fiona Godlee says: "Through our work on the manifesto, we know of substantial problems, but also progress and solutions. This manifesto is an open invitation to contribute and join a movement towards better evidence. Its aim is to complement and unite existing efforts as well as create new ones.

The BMJ believes that better evidence is key to improving the quality of healthcare and creating a healthier world."