We need more science in health care

"Science is the best thing that has happened to human beings, and well-conducted research is key for securing and enhancing the future of mankind" — so says Dr. John Ioannidis, a professor of medicine, health research and statistics at Stanford University.

Dr. Ioannidis' says this, even though he also believes — rightly — that most clinical research regarding medicines, tests and procedures is misleading and erroneous. His talk at the Lown Institute in 2016 summarizes the flaws of medical research that is overwhelmingly financed by corporations that profit from positive outcomes and researchers who are rewarded by them. "In order to publish in science, you need to say something different, you need to say something new, you need to say something exciting," says Dr. Ioannidis. Hence, much of medical research is geared to show the benefit of interventions rather than accurately assessing their worth.

On April 22, I am marching in Washington, D.C., with the Right Care Alliance, a group of concerned people seeking to curb the proliferation of the costly and dangerous over-treatment that emanates from our current medical research culture. I am a geriatric physician, and although I write extensively about health care, most of my education has occurred in the setting of patient care. I see what works and what does not, not only from what I read, but also from what I experience every day through my interactions with patients.

When studies suggest that certain dementia drugs improve memory in 40 percent of people, and I consistently find nothing ever changes, I wonder how these scientists reached conclusions so disparate from what reality has taught me. When I read studies of the newest osteoporosis drug, and they claim that without treatment 7 percent of patients will have fractures in the spine every year, I wonder why I am only seeing one or two of such events a year among my 2,000 patients. Blood pressure medicines that are supposed to save my patients' lives and have no side effects per research somehow cause them to be dizzy, tired and more confused. Research cardiologists state that statin cholesterol medicines induce no significant increase in muscle pain, but many of my patients seem to experience that very symptom to a degree that impairs their lives.

According to Dr. Ioannidis, the vast majority of clinical research is being sponsored by 15 pharmaceutical companies. Nintey-seven percent of such research shows "statistically significant" results, and 96 percent of the time when a drug company pays for a study to compare its drug to another, its drug proves superior. No wonder that at least 40 percent of study results are reversed soon after initial publication; the initial studies are not accurate. But when industry oversees science, when study design can be manipulated to produce desired results and when academic researchers more easily succeed when they direct industry-sponsored studies, who would expect anything else?

Under current conditions, medical research is not science. It is deceptive. Even when results are positive they are presented in a misleading way to exaggerate their benefit. We hear that the newest cholesterol drug Repatha cuts down heart attacks by 20 percent, which sounds impressive, but in fact after two years only 15 out of 1,000 people benefit, and no lives are saved in this industry-sponsored study — numbers buried by the study's authors. The drug costs $14,000 a year. This is not science, it is a commercial for the drug.

Many of us advocate for less biased medical research conducted by organizations like the NIH. But currently Donald Trump's budget is calling for a $1.2 billion cut in NIH funding, meaning that even more research will be in the purview of the very industries that profit if results are geared to meet their needs. With $750 billion of health care dollars squandered by interventions that do not help patients and that may actually harm them, and with 40 to 50 percent of medical interventions considered low value in that they are ineffective, we are perpetuating a health care system that delivers poor quality at high cost. We need to know what works and what doesn't, yet we are hampered because so many useless interventions that are given validity by deceptive medical studies.

How can doctors, patients and policy makers know how to fix our system, what drugs and tests are best for them and how to stay healthy longer unless we inject more science into health care? It seems obvious that, as Dr. Ioannidis says, science is essential to the future of mankind. March with us on April 22 and lend your support to that necessary truth.

Dr. Andy Lazris is a physician in Columbia, Md., author of "Curing Medicare" and co-chairman of the Right Care Alliance primary care council. His email is alazris@ppcmd.com.

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