Bad science, new chapters

Jordi Varela
Editor

In July of last year I commented on a work by Paul Glasziou and Iain Chalmers that concluded that taking into account methodological shortcomings, unpublished studies and poorly explained ones, the waste of biomedical research could be of the order of 85%. According to these authors, only 15% of what is investigated reaches the clinic in conditions of quality and appropriate communication. A little over a year later, other sources insist that biomedical research, in general terms, does not show signs of recovery and, to make it understandable, I will follow the same scheme that I used in the post I have quoted.

The hidden curriculum: a matter of clinical safety

The medical hierarchy is a problem in medical education, and puts patients at risk. http://t.co/3fi2GmBWb5
— Lown Institute (@lowninstitute) February 12, 2014

Lown Institute, one of the organizations leading the movement "Right Care", is the author of this tweet that leads us to an article in the Health Affairs Journal, signed by Joshua M. Liao, a resident physician at Brigham and Boston Women's Hospital. Dr. Liao’s article speaks of the hidden curriculum concept described more than a decade ago by Frederic Hafferty, encompassing those masked values ​​conveyed through vocabulary, practices and habits, which end up having a powerful influence on the development of the trainees and, as such, even more than the diplomas contained in the formal curriculum.

"The Right Care Alliance" – The Statement of Principles

In 2012, The Lown Institute held a conference in Cambridge (Boston) with the motto "Avoiding Avoidable Care” which generated a statement aimed at creating a professional, academic and social movement in favour of a new health system that is sustainable, effective, rational, personalized and fair. You would think, of course, that the The Lown Institute refer only to the American system, which we all know is deeply unfair and expensive. And this would be so, if it wasn’t for the fact that, in a system like the Spanish, which is infinitely fairer than theirs, when we analyze it in detail we can also note the clinical practice’s undesirable variations of a scale comparable with the American’s.

For this reason, I think it's worth having a look at the statement promoted by The Lown Institute: "Declaration of Principles of the Right Care Alliance". Look at the following extract from the explanatory memorandum of the Declaration and judge whether they are timely or not:

• Modern medicine offers significant benefits, but at the same time also has a great ability to cause damage.
• The overuse of services is widespread and tacitly accepted by the modern healthcare system
• Overuse exposes patients to iatrogenic disease.
• Overuse distracts resources that could be used in real health needs or in investments in other non-health sectors that influence the health of people as social services, education, nutrition, etc.
• The health sector industry can distort clinical decisions to the point of betraying patients’ trust. 

Clinical Practice Guidelines of dubious ethical values feed malpractices

Clinical guidelines by authors with conflicts of interest = Anti-Evidence Based Medicine. Our latest Right Care blog: http://t.co/Zy3XY7BDok
— Shannon Brownlee (@ShannonBrownlee) June 24, 2013

Shannon Brownlee is the author of "Overtreated. Why too much medicine is making us sicker and poorer." This book is the most significant piece of literature in the academic and social movement that empowers valuable clinical practice. The tweet chosen this week refers to "The Right Care Blog". It is an institutional blog of the "Lown Institute" where Mrs. Brownlee is vice president.

Upon entering the blog, you will see that the recommended post is "Conflicted guidelines breed conflicted practice", a text that comments on an article by Jeanne Lenzer in the BMJ, where it is argued that the connivance between the promoters of clinical practice guidelines and the industry are feeding inadequate practices. And to illustrate it, the author selects two examples that have experienced these problems with negative health outcomes of affected patients. One example is TPA, a clot solvent, and the other a recommendation of high dose of corticosteroids for the treatment of spinal cord injuries.

Now that there are many people and many institutions involved in making possible the practice of evidence should reach all corners of the system, it is relevant that there aren’t any ethical questions about the scientific basis of clinical practice.


Jordi Varela

Editor