Twenty years ago, a British statistician complained in the BMJ that much medical research was “seriously flawed through the use of inappropriate designs, unrepresentative samples, small samples, incorrect methods of analysis, and faulty interpretation.”
Today, says the BMJ’s former editor, the influential writer Richard Smith, the only word to be changed in that diagnosis is probably “much”. It should now be “most”. And he complains that the leaders of the medical profession are not interested in changing the situation.
Dr Smith is not the only one to ring warning bells about the quality of the enormous quantity of medical research. The acclaimed statistician John Ioannidis* has estimated that only 1% (1%) of thousands of studies which assert that there is a correlation between a particular gene and a medical condition are correct. Why? Ioannides says candidly, ““Most scientific studies are wrong, and they are wrong because scientists are interested in funding and careers rather than truth.”
Dr Smith lists five reasons for the enormous waste: research fails to answer questions that matter; studies are too small or never replicated; the research is not well managed; much research is never published; and much published research is “biased and unusable”.
Striking the same note, a special feature in The Lancet on wasted effort in medical research last month complained that the vast majority of promising finding never make their way into clinical practice. A 2009 article estimated that 85% of all biomedical research investment, ie, about US$210 billion in 2010, is wasted.
And in one stinging paragraph, the authors accuse scientists themselves, not just the economic and administrative systems in which they work, of responsibility for this failure:
Science is not done by paragons of virtue, but by individuals who are as prone to self-interest as anyone else. They can compromise their usually high standards of rigour when involved in commercial or otherwise conflicted relationships. When resources are scarce and competition is fierce they might seek the easiest and quickest—rather than the best—ways forward. They could judge that they would rather be first than be right. When their research hunch turns out to be wrong, many researchers move to the next one rather than going through the painstaking business of reporting negative findings. Finally, they could prefer research that they find interesting rather than research that addresses issues of importance to the users of research. These behaviours are compounded by the complacency and poor craftsmanship of some scientists.
* Apologies. This name was misspelled in the original text.
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