Myth: All medical recommendations are made based on research that is up-to-date, and absent of error.
Truth: Healthcare and medical research are flawed due to outside pressure and influence.
If you have been following our myth-busters, then you are aware that the information in them does not always align with the recommendations that come from credible organizations like the American Heart Association (AHA) and the American Diabetes Association (ADA). At Valley Schools, our intention is to provide the most up-to-date and factual information regarding health optimization and disease prevention. In curating this information, it is critical to illuminate the pitfalls of medical literature to facilitate an accurate analysis and interpretation for our readers.
A notable flaw in the utilization of medical research is the phenomenon known as the “knowledge to action gap” (1). This identifies the inconsistent and unorganized implementation of medical research. It is estimated that a mere 14% of all medical research is used to benefit patient care and that it takes an average of 17 years from the date of publication to make its way into clinical practice (1,2). As a result, conventional medical interventions in practice today are largely derived from outdated science.
Additional concerns include the influence that the external industry has on research; including study design, outcome reporting, and publication. This problem infiltrates the integrity of medical research and compromises its validity in several ways, including, but not limited to, the following:
Pharmaceutical Industry Influence
Pharmaceutical industries now spend more on medical research than the US publicly-funded National Institute of Health (NIH) does. A rigorous review of the literature has unveiled that industry funding correlates or predicts PRO-industry results (3, 4). Meaning, studies are designed and/or the results are manipulated to generate desired outcomes for the industry-specific drug or intervention.
Academic Pressure on Researchers
Many researchers are pressured by the academic culture to produce a certain volume of research in order to be considered for academic or scholarly positions. These pressures, along with financial incentives have been demonstrated to influence the researcher’s integrity; and have compromised quality and accurate research (6). Ioannidis (2005), states “Most scientific studies are wrong, and they are wrong because scientists are interested in funding and careers rather than truth.”
Most Research Fails to Address Questions That Matter
An effective research system should ask the questions that are relevant to patients and clinicians and address disease burden. However, an analysis of 334 studies revealed that only 9 compared the researcher’s priorities with those of patients and clinicians, and public-funded research is only modestly correlated with disease burden, if at all (5).
Inadequate Regulation and Management of Research to Validate Quality Assurance
In general, the quality assurance systems in place fail to identify flaws in the research proposals. There is little to no oversight or process that is achieved for industry-funded studies, leading to inconsistencies in disclosures, publication, study designs, and replications (5).
Poor Accessibility and Transparency of Published Research
Over half the studies that are conducted are never published. This is largely due to discontinuation by the industry of trials that demonstrate the opposite of what is desired; therefore what is published is inherently biased. Additionally, in studies that are published, outcome measures are “cherry-picked”, and do not disclose full results (5). Studies that are not published are hard to find, and often details and results are unavailable for review. This can lead to inaccurate assumptions about the safety and effectiveness of drugs and treatments available.
A relevant example of how these discrepancies disrupt medical care is in the case of heart disease. The current conventional treatment for heart disease is statin medications, despite the evidence that 90% of heart disease is caused by modifiable lifestyle factors (7) and statin medications pose significant risk concerns (8,9). The most current and accurate evidence supports that a more effective treatment for heart disease includes consuming a diet rich in a variety of whole, animal and plant foods with a reduction in refined carbohydrates and sugar (10) in conjunction with stress management (11), quality sleep (12,13), and daily physical activity (14).
Our intention for this myth-buster is to encourage our readers to be their own advocate and be empowered to question health claims made by organizations with influence and financial interest. We will continue to seek out the most up-to-date, unbiased, and accurate information and we encourage you to do the same!
If you have any additional questions regarding this topic, please submit them to asktheRD@wellstyles.org.
By Lauren Ruegg, DNP
- Morris, Z. S., Wooding, S., & Grant, J. (2011). The answer is 17 years, what is the question: understanding time lags in translational research. Journal of the Royal Society of Medicine, 104(12), 510–520. doi:10.1258/jrsm.2011.110180
- Solh, Z., Brouwers, M., & Florez, I. D. (2018). Knowledge translation in transfusion medicine. Part 1: The basics and the frameworks. Transfusion, 58(3), 629-632.
- Sismondo, S. (2008). How pharmaceutical industry funding affects trial outcomes: causal structures and responses. Social science & medicine, 66(9), 1909-1914.
- Lexchin, J., Bero, L. A., Djulbegovic, B., & Clark, O. (2003). Pharmaceutical industry sponsorship and research outcome and quality: a systematic review. BMJ (Clinical research ed.), 326(7400), 1167–1170. doi:10.1136/bmj.326.7400.1167
- Chalmers, I., & Glasziou, P. (2009). Avoidable waste in the production and reporting of research evidence. The Lancet, 374(9683), 86-89.
- Ioannidis, J. P. (2005). Why most published research findings are false. PLoS medicine, 2(8), e124.
- Yusuf, S., Hawken, S., Ôunpuu, S., Dans, T., Avezum, A., Lanas, F., … & Lisheng, L. (2004). Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. The lancet, 364(9438), 937-952.
- Thavendiranathan, P., Bagai, A., Brookhart, M. A., & Choudhry, N. K. (2006). Primary prevention of cardiovascular diseases with statin therapy: a meta-analysis of randomized controlled trials. Archives of Internal Medicine, 166(21), 2307-2313.
- Unit, E. S. (2005). Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90 056 participants in 14 randomized trials of statins. Lancet, 366(9493), 1267-1278.
- DiNicolantonio, J. J., Lucan, S. C., & O’Keefe, J. H. (2016). The evidence for saturated fat and for sugar related to coronary heart disease. Progress in cardiovascular diseases, 58(5), 464-472.
- Schneider, R. H., Grim, C. E., Rainforth, M. V., Kotchen, T., Nidich, S. I., Gaylord-King, C., … & Alexander, C. N. (2012). Stress reduction in the secondary prevention of cardiovascular disease: randomized, controlled trial of transcendental meditation and health education in Blacks. Circulation: Cardiovascular Quality and Outcomes, 5(6), 750-758.
- Knutson, K. L. (2010). Sleep duration and cardiometabolic risk: a review of the epidemiologic evidence. Best practice & research Clinical endocrinology & metabolism, 24(5), 731-743.
- Ayas, N. T., White, D. P., Manson, J. E., Stampfer, M. J., Speizer, F. E., Malhotra, A., & Hu, F. B. (2003). A prospective study of sleep duration and coronary heart disease in women. Archives of internal medicine, 163(2), 205-209.
- Huffman, K. M., Hawk, V. H., Henes, S. T., Ocampo, C. I., Orenduff, M. C., Slentz, C. A., … & Bales, C. W. (2012). Exercise effects on lipids in persons with varying dietary patterns—does diet matter if they exercise? Responses in Studies of a Targeted Risk Reduction Intervention through Defined Exercise I. American heart journal, 164(1), 117-124.