Questioning research is always a good thingMay 17, 2019
Medicine is a matter of trust. The patient has to believe the clinician can help them and the clinician / doctor has to believe that they can help the patient. But what if doctors do not believe the tools they have been given by medical academia and the medical industry are absolutely trustworthy? Many years ago, this lack of belief or even trust in the research of mainstream medicine lead to the formation of “alternative” medicine doctors groups. The American College for the Advancement in Medicine (ACAM) is one such group. Dr. Magaziner a former president of ACAM and has been a member of their Board of Advisors/Directors since 1994. It also lead to the founding of the Magaziner Center for Wellness in 1987.
Questioning research is always a good thing
Medicine is a practice. Medicine is not perfect. Medical research is also not perfect. Let’s look at a most recent example surrounding pediatric hypertension. This is but one example of doctors asking questions. In March 2019, Doctors at Oklahoma State University Center for Health Sciences published their opinion in the Journal of Hypertension (1) about research used to push forward clinical guidelines in pediatric hypertension. Pediatric hypertension is a serious concern and we discuss this in other articles on our website.
The Oklahoma State University doctors decided to “examine the quality of evidence supporting the Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents,” published by the American Academy of Pediatrics. According to the guideline authors, “This clinical practice guideline, endorsed by the American Heart Association, is intended to foster a patient- and family-centered approach to care, reduce unnecessary and costly medical interventions, improve patient diagnoses and outcomes, support implementation, and provide direction for future research.”(2)
The Oklahoma State University doctors found that much of the research used to support these guidelines (which include prescription use) did not meet high standards as measured by the AMSTAR or Assessing the Methodological Quality of Systematic Reviews scoring system or the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) scoring system. What does this mean?
To the Oklahoma State University research team: “This study further substantiates the call for more quality evidence-based research in pediatric hypertension. The overall methodological and reporting quality of the systematic reviews were lacking in the American Academy of Pediatrics Guideline. Assessment of risk of bias across studies, identification of an accessible protocol, full disclosure of the role of funding entities, funding of included studies, and a complete PICOS statement (how research questions present to patients were structured) were areas of greatest concern. These deficiencies should be addressed in future research in pediatric hypertension.”
Anxiety over trust
Is the researcher biased if they have financial interest in the positive or negative outcomes of a research study? This is open to debate.
In the journal Personality and Social Psychology Bulletin (3) researchers from Cornell University, Carnegie Mellon University, and the Yale School of Management presented these observations in their November 2018 study.
- “When expert advisors have conflicts of interest, disclosure is a common regulatory response. In four experiments (three scenario experiments involving medical contexts, and one field experiment involving financial consequences for both parties), we show that disclosure of a financial or nonfinancial conflict of interest can have a perverse effect on the advisor–advisee relationship.
- Disclosure, perhaps naturally, decreases an advisee’s trust in the advice.
- But disclosure can also lead to concern that failure to follow advice will be interpreted as a signal of distrust. That is, rejecting the advice could suggest that the advisee is insinuating that the advisor could be biased by the conflict of interest. We show that this insinuation anxiety persists whether the disclosure is voluntary or required by law and whether the disclosed conflict is big or small, but it diminishes when the disclosure is made by an external source rather than directly by the advisor.”
In other words, people and doctors feel better when there is some type of regulating agency looking into disclosure documents in medical research to make sure the results are not biased and are true indicators of results achieved in the research. But even when there are regulators there can be bias in reporting and that bias can change the way medicine is practiced.
The New England Journal of Medicine and Physicians’ skepticism of industry-funded research
The New England Journal of Medicine published an article lead by researchers at Brigham and Women’s Hospital and Harvard Medical School in its September 20, 2012 issue. This article examined how physicians interpreted data from research studies.
What the researchers found was that no matter how well the research was conducted, no matter how large the study, they found that “practicing internists understood and appreciated methodologic differences when they read abstracts describing hypothetical studies of new drugs. They found that doctors discounted small, poorly designed trials and assigned greater validity to large trials that tested clinical end points. They also found that respondents downgraded the credibility of industry-funded trials, as compared with the same trials randomly characterized as having National Institutes of Health funding or having no source of support listed. The magnitude of this reduction in perceived methodologic rigor was about the same as that for low-rigor trials as compared with medium-rigor trials.
Physicians’ skepticism of industry-funded research affected their responses to high-rigor and low-rigor trials similarly.
The researchers noted: “Well-publicized controversies related to industry-funded research may help explain these findings. Reports have emerged of trials that withheld critical data or that presented positive results while withholding negative results. Other concerns stem from reports of industry-financed articles that were ghostwritten or published primarily as instruments of marketing. Physicians’ skepticism of industry-funded research may be a response to such trends. . . . Pharmaceutical companies seeking to enhance the appropriate use of important new products or to expand the appropriate uses of existing products must address the attitudes that our survey revealed, so that the credibility of the results of industry-supported trials is more likely to be based on methodologic rigor than on funding sources.”
An eye on research and both eyes on the patient
When we opened the Magaziner Center, ‘holistic healthcare’ was not yet a household term in the U.S. In fact, many of our colleagues did not believe a center such as this could be a success. That was in 1987. Integrative medicine has since become widely known and sought after, as more and more Americans see the benefits of treating the body naturally, as a whole.
We avoid the traditionally Western approach of suppressing symptoms with drugs, and instead look for the root cause of the dysfunction and treat is at its source, using almost exclusively natural and scientifically valid methods. Almost weekly, we see an article about some prescription drug that actually causes the condition it was meant to cure, or how new research shows that one of the treatments we have been using for years has been found to be safer and more effective than the conventional treatment.
It is so wonderful to see the treatments and philosophy that we have been using since the beginning, finally getting recognition and becoming more widely understood and sought after.
1 Vaughn K, Skinner M, Vaughn V, Wayant C, Vassar M. Methodological and reporting quality of systematic reviews referenced in the clinical practice guideline for pediatric high-blood pressure. Journal of hypertension. 2019 Mar 1;37(3):488-95.
2 Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, De Ferranti SD, Dionne JM, Falkner B, Flinn SK, Gidding SS. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017 Sep 1;140(3):e20171904.
3 Sah S, Malaviya P, Thompson D. Conflict of interest disclosure as an expertise cue: Differential effects due to automatic versus deliberative processing. Organizational Behavior and Human Decision Processes. 2018 Jul 31;147:127-46.
4 Kesselheim AS, et al. A Randomized Study of How Physicians Interpret Research Funding Disclosures. N Engl J Med 2012; 367:1119-1127September 20, 2012