At the same time, the shift of Medicaid and Medicare patients to managed care plans meant less money for academic medical centers, who relied on these patients for their operating revenues. To remain competitive, they turned to private industry for funding, which in most cases meant the pharmaceutical industry. This relationship skewed the inherent bias in all research even further toward the positive, and meant that the emphasis would be placed on drug development rather than non-pharmacological management of disease and disease prevention. Those same researchers end up sitting on the expert panels that then write the guidelines that are supposed to guarantee quality care.
It doesn't help that medical journal editors are by and large undiscriminating in the papers they publish. They, too, have their biases, and publishing papers that show positive results is one of them. So is publishing papers that suggest a revolution in treatment - such as reducing heart disease by treating cholesterol. They don't give the data much scrutiny in the process. And they never question the spin the authors give their data. Even worse, they press release that spin to the media for direct consumption by the consumer.
And so we have our current system. A paper is published that suggests taking cholesterol lowering drugs cuts the risk of heart disease by 50%. In actuality, their data find that without the drug, 2 out of 100 people have a heart attack, while with the drug, only 1 out of 100 do. Their claim to a 50% reduction in risk is technically true, but misleading. The majority of people in both categories will do fine without the drug. But the authors have chosen to concentrate on the more impressive sounding relative risk reduction rather than the absolute risk reduction. It gets them more attention that way. The medical journal, and perhaps the author's institution as well, sends a press release to the media about these stunning findings. That week, the news is full of the amazing benefits of the drug. The company makes up television and print ads touting its benefits, too. Within the week, patients are asking their doctor about the cholesterol lowering drug that works saves so many lives. And the doctors? With any luck they'll read the abstract of the paper and conclude the drug must be beneficial, without ever noting the devil in the statistical details. And even if they did, they would have trouble convincing most people of the inadequacy of the drug given all the favorable publicity it's gotten. As a result, new drugs and treatments become accepted much more quickly than they otherwise would - and with much less scrutiny than they deserve.
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