In the course of a succinct account of the linked papers relating to the problem of missing data from clinical trials, Lehman and Loder [1] make some sharp, but entirely warranted, criticisms of the state of medical research today.
While the failure to publish data – either in whole or in part – deserves censure, this issue is of secondary importance to the reliability and the value of the conclusions drawn from randomised trials. To their credit, Lehman and Loder allude to this in their opening remarks. But it deserves greater emphasis.
Unreported studies are of concern only if the rest of the research is of value. This, though, is not the case. The so-called advances in medicine delivered by large-scale RCTs and epidemiological studies are based on flawed methods and, in any case, are of little worth to individual patients. [2] In general, the medical profession is unaware of this state of affairs and, needless to say, patients remain totally in the dark.
The BMJ has begun the New Year well. It is to be hoped that it takes a step further and turns the spotlight on the dubious foundations of modern medical research. After all, the rewards on offer are considerable.
Rapid Response:
Re: Missing clinical trial data
Sir,
In the course of a succinct account of the linked papers relating to the problem of missing data from clinical trials, Lehman and Loder [1] make some sharp, but entirely warranted, criticisms of the state of medical research today.
While the failure to publish data – either in whole or in part – deserves censure, this issue is of secondary importance to the reliability and the value of the conclusions drawn from randomised trials. To their credit, Lehman and Loder allude to this in their opening remarks. But it deserves greater emphasis.
Unreported studies are of concern only if the rest of the research is of value. This, though, is not the case. The so-called advances in medicine delivered by large-scale RCTs and epidemiological studies are based on flawed methods and, in any case, are of little worth to individual patients. [2] In general, the medical profession is unaware of this state of affairs and, needless to say, patients remain totally in the dark.
The BMJ has begun the New Year well. It is to be hoped that it takes a step further and turns the spotlight on the dubious foundations of modern medical research. After all, the rewards on offer are considerable.
James Penston
james.penston@nhs.net
References
1. Lehman R, Loder E. Missing clinical trial data. BMJ 2012;344;d8158.
2. Penston J. Stats.con – How we’ve been fooled by statistics-based research in medicine. The London Press. London, November 2010.
Competing interests: No competing interests