Peter J. Pitts, president of the Center for Medicine in the Public Interest, wrote a negative commentary in the Washington Times on evidence based medicine (EBM). Dr. Roy Poses, blogging at Health Care Renewal, offered a rebuttal. I’m not going to take sides in this debate, as good points were offered by both. Correctly noting that Mr. Pitts used a straw man argument (Pitts unfairly portrayed EBM as “one size fits all” medicine) and explaining what EBM really is (or is supposed to be) Dr. Poses then went on to base much of his own argument on an ad hominem attack against Mr. Pitts (it seems Pitts has ties to Big Pharma, who may not be happy with EBM’s objective evaluations of their new and expensive drugs).
“One size fits all medicine”, while not a core notion of EBM, is one of EBM’s popular distortions. We’ve seen it many times. Older and cheaper drug A performs as well in the latest systematic review as newer and more expensive drug B. Ergo, drug A is the drug of choice for all patients. This type of thinking may drive an agenda behind government funded research. Pitts cites the CATIE trial. An even better example (or at least one more familiar to me) might be ALLHAT. (DB of Med Rants has a great post on the apparent agenda behind ALLHAT here).
A larger issue is conflict of interest. Dr. Poses has written a great deal on conflicts of interest inherent in pharmaceutical industry funded research. But government funded research is conflicted too. The government has an interest n promoting cheaper drugs. Cheaper drugs are sometimes, but not always, better for patients.
Via Kevin M.D.
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