Evidence based practice and a scientific approach to healthcare, while being the best we have got, has numerous shortcomings. There are issues with publication bias, conflicts of interest, fraud, outcomes switching, academic paywalls, misrepresentation of data and much more.
- John Ioannidis famously declared that most published research findings are false
- Ben Goldacre has written entire books on Bad Science and Bad Pharma
- Trish Greenhalgh has published on evidence based medicine being a movement in a crisis
- Roger Kerry has analyzed the status of scientific truth in controlled rehabilitation trials and found underwhelming results.
These are not examples of how science is broken, however. On the contrary, they serve to showcase one of science’s greatest strengths. Among other things, a scientific approach is so valuable because science’s biggest critics and those with the most valid of concerns are scientists.
And from these critiques come solutions — like AllTrials which advocates for open research, with “all trials registered, all results reported” to stymie publication bias and outcomes switching. There is now the Public Library of Science (PLOS) which publishes seven different journals of research, open and free for anyone to access.
Described by Ben Goldacre as one of the greatest institutional innovations of the past thirty years”, the Cochrane Collaboration, has produced some of the highest quality systematic reviews and meta-analyses that have had a profound impact on the quality of care delivered to patients. Look no further than the story behind their blobbogram logo for evidence of this. In physical therapy we have PEDro (Physiotherapy Evidence Database), a “free database of over 32,000 randomised trials, systematic reviews and clinical practice guidelines in physiotherapy” each individually appraised for quality and risk of bias to help guide clinicians towards evidence that best informs clinical practice.
These organizations and individuals are illustrations of the self correcting nature of science. If science is broken (and it isn’t), we are lucky to have such great scientists who are so passionate about improving it.