Evidence in Medicine - The Common Flaws, Why They Occur and How to Prevent Them

High-quality evidence is the foundation for effective treatment in medicine. As the vast amount of published medical evidence continues to grow, concerns about the quality of many studies are increasing. Evidence in Medicine is a much-needed resource that addresses the 'medical misinformation mess' by assessing the flaws in the research environment. This authoritative text identifies and summarises the many factors that have produced the current problems in medical research, including bias in randomised controlled trials, questionable research practices, falsified data, manipulated findings, and more.
 
This volume brings together the findings from meta-research studies and systematic reviews to explore the quality of clinical trials and other medical research, explaining the character and consequences of poor-quality medical evidence using clear language and a wealth of supporting references. The text suggests planning strategies to transform the research process and provides an extensive list of the actions that could be taken by researchers, regulators, and other key stakeholders to address defects in medical evidence. This timely volume:
* Enables readers to select reliable studies and recognise misleading research
* Highlights the main types of biased and wasted studies
* Discusses how incentives in the research environment influence the quality of evidence
* Identifies the problems researchers need to guard against in their work
* Describes the scale of poor-quality research and explores why the problems are widespread
* Includes a summary of key findings on poor-quality research and a listing of proposed initiatives to improve research evidence
* Contains extensive citations to references, reviews, commentaries, and landmark studies
 
Evidence in Medicine is required reading for all researchers who create evidence, funders and publishers of medical research, students who conduct their own research studies, and healthcare practitioners wanting to deliver high-quality, evidence-based care.

List of contents

Preface 4
 
Aims of this book 5
 
Chapter 1 The rationale for treatment: a brief history 7
 
Conclusion 14
 
References 15
 
Chapter 2 Sources of bias in randomised controlled trials 18
 
Method of treatment allocation 18
 
Problems in measuring the outcome 20
 
Follow-up and missing outcomes 22
 
Missing outcome data and intention to treat 23
 
Other methodological concerns 24
 
Conclusions 26
 
References 27
 
Chapter 3 Wasted and unhelpful trials 34
 
Wasted Studies 34
 
Neglected areas of research 35
 
Unhelpful outcome measures 35
 
Lack of generalisability 37
 
Weak and misleading evidence 39
 
Conclusion 40
 
References 40
 
Chapter 4 Can the analysis bias the findings? 46
 
The p-value problem 46
 
Questionable research practices 48
 
Ensuring high quality analysis: the Statistical Analysis Plan 50
 
Conclusions 51
 
References 52
 
Chapter 5 Systematic reviews and Meta-analysis 56
 
Introduction 56
 
Identifying relevant trials 57
 
Extracting trial data 59
 
The quality of primary trials 61
 
Pooling effect sizes across trials 62
 
Other methodological issues 63
 
Conclusions 65
 
References 66
 
Chapter 6 Fabrication, falsification and spin 73
 
Fabrication 73
 
Falsification 75
 
Questionable Research Practices 76
 
Spin 76
 
Retractions 78
 
Discussion 78
 
References 79
 
Chapter 7 Why do researchers falsify data or manipulate study findings? 83
 
The research environment 83
 
Research oversight 86
 
Conflict of interest 88
 
Individual level explanations for research misconduct 90
 
How honest people rationalise misconduct 91
 
Discussion 93
 
References 94
 
Chapter 8 Developing a strategy to prevent poor quality and misleading research 103
 
Research environment 103
 
Research transparency 105
 
Research oversight 106
 
Research integrity 107
 
Essential elements of a transformational strategy 108
 
Implementing a programme for action 112
 
References 113
 
Appendix 1 Summary of the key findings on poor quality research 118
 
Problems in the design, conduct, analysis and reporting of studies 118
 
Frequency of data fabrication and falsification 120
 
The causes of poor quality and misleading research 120
 
The findings in perspective 121
 
References 122
 
Appendix 2 Initiatives to improve the quality of research 123
 
Change the research environment 123
 
Improve training 125
 
Increase research transparency 126
 
Quality of trial methodology 128
 
Trial registration 130
 
Reporting of the methods of systematic reviews 130
 
Increasing access to and use of reporting guidelines 132
 
Implement vigorous research oversight 132
 
Promote research integrity 136
 
Examples of coordinated initiatives 140
 
References 141
 
Index

About the author

Iain K Crombie is Emeritus Professor of Public Health at Dundee University, UK. He has published more than 160 research papers as well as books on critical appraisal, research methods, grant applications, and clinical audits. He has extensive experience teaching both undergraduate and postgraduate courses in epidemiology, medical statistics, and research methods.

Summary

High-quality evidence is the foundation for effective treatment in medicine. As the vast amount of published medical evidence continues to grow, concerns about the quality of many studies are increasing. Evidence in Medicine is a much-needed resource that addresses the 'medical misinformation mess' by assessing the flaws in the research environment. This authoritative text identifies and summarises the many factors that have produced the current problems in medical research, including bias in randomised controlled trials, questionable research practices, falsified data, manipulated findings, and more.

This volume brings together the findings from meta-research studies and systematic reviews to explore the quality of clinical trials and other medical research, explaining the character and consequences of poor-quality medical evidence using clear language and a wealth of supporting references. The text suggests planning strategies to transform the research process and provides an extensive list of the actions that could be taken by researchers, regulators, and other key stakeholders to address defects in medical evidence. This timely volume:
* Enables readers to select reliable studies and recognise misleading research
* Highlights the main types of biased and wasted studies
* Discusses how incentives in the research environment influence the quality of evidence
* Identifies the problems researchers need to guard against in their work
* Describes the scale of poor-quality research and explores why the problems are widespread
* Includes a summary of key findings on poor-quality research and a listing of proposed initiatives to improve research evidence
* Contains extensive citations to references, reviews, commentaries, and landmark studies

Evidence in Medicine is required reading for all researchers who create evidence, funders and publishers of medical research, students who conduct their own research studies, and healthcare practitioners wanting to deliver high-quality, evidence-based care.

Additional text

"Evidence in Medicine: The Common Flaws, Why They Occur and How to Prevent Them will open your eyes to the squishy underbelly of clinical research. Given the numerous pitfalls for the unwary -- and overly ingenious -- investigator, it is no surprise that "possibly 85 percent of clinical research is wasted."' - Journal of Clinical Research Best Practices

Report

"Evidence in Medicine: The Common Flaws, Why They Occur and How to Prevent Them will open your eyes to the squishy underbelly of clinical research. Given the numerous pitfalls for the unwary -- and overly ingenious -- investigator, it is no surprise that "possibly 85 percent of clinical research is wasted."' - Journal of Clinical Research Best Practices

Product details

• Authors: I Crombie, Iain Crombie, Iain K Crombie, Iain K. Crombie, Iain K. (University of Dundee Crombie
• Publisher: Wiley, John and Sons Ltd
• Languages: English
• Product format: Paperback / Softback
• Released: 30.06.2021
• EAN: 9781119794141
• ISBN: 978-1-119-79414-1
• No. of pages: 272
• Subjects: Natural sciences, medicine, IT, technology > Medicine > General; Medizin, Evidenzbasierte Medizin, Medical Science, Evidenzbasierte Forschung im Gesundheitswesen, Evidence-Based Health Care, Medical Professional Development, Perspektiven in medizinischen Berufen, Medical Statistics & Epidemiology, Medizinische Statistik u. Epidemiologie