There has been an interesting string on a listserv I am a member of about EBM being highjacked and the poor quality of research and of how so much research goes unpublished.  Below are two responses that got me thinking about something:

I am not impressed by the recent declaration in BMJ just because it is about the bad studies and the need of new EBM. What new? The authors of the declaration published calls for new EBM almost annually.  And most the time the calls are to go beyond evidence, and to do good, not bad.

Yes, too many research are poorly designed and executed. Is it new finding? Was ever EBM quiet about the bad evidence?

“today’s world …so financially driven” – was it ever not like that? Can one name the Golden Age?

If not kill your self, one need to live in the real world and try to make it better. EBM is specifically about it: critical appraisal and education (in wide sense). It is about use of the best available evidence for the good of the patients. Best available, sic. To influence research, to improve research, to clean the publication practice is a good thing, but it is beyond EBM in pure sense.

and…

From the link, ” Too many research studies are poorly designed or executed. Too much of the resulting research evidence is withheld or disseminated piecemeal”. In short, medical research is not implemented correctly for a number of reasons. So my question is should we scrap medical research? OR RCT’s which are supposed to be the gold standard for trials should be dropped from research?

For me the most logical answer is better implementation. So the debate should how we can do this in today’s world which is so financially driven. In other words, the debate/discussions should not be about research or RCT’s are flawed and hence should be replaced.

Also, please don’t blame EBM for shoddy research practices. EBM has no control on what researchers like to do or don’t like to do. EBM can only make recommendations on how to do better research and interpret research.

My miniepiphany why reading this string was that academic medicine is partly to blame for some of the problems in the evidence base. In academics you have to garner grants to pay for yourself (or at least part of your salary) and you have to publish to get promoted. So we have a system that rewards quantity over quality. Lots of research is done because we have to do it to get promoted. But how much of it is worthwhile research? Not much. Many academics aren’t trained in proper research technique so they perform lower quality studies.

So one fix to “EBM” could be to restructure how we finance academics. We need to quit focusing on grants (especially considering governmental funding of these goes down every year) for compensation. Teaching (and yes medical schools need to actually pay adequately for the teaching we do) and clinical activities should be the primary funders of academics. Then research could be done on important things and by properly trained researchers.