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‘Why Most Clinical Research Is Not Useful’ yet tsunami of news about it

Within the quotation marks in the headline above is the title of a new paper in PLoS Medicine by Stanford’s John Ioannidis.

He again holds up a mirror for scientists, journals, policymakers, journalists and the general public.  Excerpt:

“There are many millions of papers of clinical research—approximately 1 million papers from clinical trials have been published to date, along with tens of thousands of systematic reviews—but most of them are not useful. Waste across medical research (clinical or other types) has been estimated as consuming 85% of the billions spent each year. I have previously written about why most published research is false and how to make more of it true. In order to be useful, clinical research should be true, but this is not sufficient.”

Tsunami and manInformation tsunami on non-newsworthy research

Since many papers on clinical research spawn, in turn, dozens or hundreds of news stories, one can easily see how a tsunami of not-ready-for-prime-time medical research news and information drowns the public daily. Ioannidis makes this link with one line in his article – “Public media and related commentators of health news [53] may also help by focusing on the need to obtain clinically useful research and not compromise for less.”  That citation is a paper we published about our work.

OBSERVATIONAL-STUDIES-298x300But there are other connections between Ioannidis’ observations and our work.

He writes: “Observational studies often add more confusion rather than filling the information deficits.”  We write frequently about the limits of observational studies and the need for communicators of all sorts to put these in context. We offer a primer on how the words matter – words that should emphasize that association does not necessarily mean causation.

Helping physicians and patients hone healthy skepticism, critical thinking

Ioannidis writes: “…training physicians in understanding research methods and evidence-based medicine may also help improve the situation by instilling healthy skepticism and critical thinking skills.”  By publishing our reviews of media messages making claims about interventions, and going to great lengths to explain what we think could be improved and how and why, we are trying to train the public to be healthy skeptics and to improve their critical thinking skills.

He writes: “Useful research is patient centered [20]. It is done to benefit patients or to preserve health and enhance wellness, not for the needs of physicians, investigators, or sponsors. Useful clinical research should be aligned with patient priorities, the utilities patients assign to different problems and outcomes, and how acceptable they find interventions over the period for which they are indicated. Proposed surrogate outcomes used in research need to closely correlate with real patient-relevant outcomes for patients in the clinic.”

We believe that our project is patient-centered, aiming to improve media messages so that they address questions that patients should be asking – and getting answers for – about claims made about health care interventions.  We have a primer on how surrogate makers or outcomes may not tell the whole story.

We are big fans of the work of Ioannidis and colleagues.  We did a podcast interview with him a few months ago.  I love this quote:

“With millions of brilliant people engaged in research, I am very optimistic about the future. We have to continue doing things amazingly wrong to make no major progress! I am sure we can avoid this sad scenario.”

That statement could apply to health/medical/science journalism as well as it does to research science.  I, too, am optimistic about the future, or I wouldn’t stay at this work.

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