Conflicts of interest in science-based medicine

[HuckleB]

http://www.sciencebasedmedicine.org/?p=2466

This piece is mildly long, and includes some very good analysis of COI.

I am offering the conclusion here, but recommend that you read the entire piece.

"...

The bottom line is that COIs do matter. Because science is a human endeavor, it will never be perfectly pristine, because nothing humans do is perfectly pristine. Moreover, SBM hasn’t always understood or handled COIs, both disclosed and undisclosed, real or perceived, very well, to the point where new regulations by the government may well be necessary. Moreover, there are always more intangible COIs, such as pride of ownership of research, the desire to be proven right, and the respect of one’s peers that, unlike financial COIs, can’t be quantified. As Young says in his article, the “objective of a literature relatively free of bias remains a pious but distant hope.”

Even so, I’ll paraphrase Winston Churchill’s (in)famous comment about democracy in describing SBM by saying that science-based medicine is the worst form of medicine, except for all those others that have been tried. In particular, that includes dogma-based medicine or anecdote-based medicine, two dominant forms of medicine that have been practiced since the days of ancient Egyptian physician-priests to ancient shaman medicine men through the days of barber-surgeons using bleeding as a treatment for almost everything to the physician of 200 years ago advocating purging and treatments with toxic metals like cadmium and antimony. Progress in medicine was glacial, with few advances over decades or even centuries, until science was seriously applied to medical investigation in a serious and systematic way beginning in the 19th century and exploding in the 20th. The last 50 years have seen incredible advances in medical care, thanks to science.

True, SBM is not perfect. Financial interests, COIs, and the pride of individual practitioners undermine it, and there are a depressing number of ills that it offers too little for. But it’s so much better than any alternative we have tried before. It works, and, although it does so in fits and starts, sometimes all too slowly, it’s getting better all the time. Dealing more effectively with COIs will only help it to continue to do so."