The problem is not unique to medical research. Many physicists and climate scientists have warned of a similar self-reinforcing dynamic resulting in unsound scientific and policy conclusions with respect to “global warming.”
However, one unique danger of the growing corruption of medical research is that it will lead to a corruption of medical practice.
Under ObamaCare, physicians will be increasingly pressured with financial carrots and sticks to adhere to centralized “practice guidelines” established by “comparative effectiveness research.” But any such practice guidelines are only as good as the underlying science.
Even worse, the investigators in the New York Times piece found that, “The higher a journal’s impact factor… the higher its retraction rate.” Some of the most prestigious medical journals (such as the New England Journal of Medicine) had the highest retraction rates. Yet these are supposed to be the most authoritative sources for practice guidelines.
A 2009 article in the Journal of the American Medical Association reviewed 53 cardiology practice guidelines and 7196 recommendations issued between 1984 and 2008. The authors found that these guidelines were too often based on potentially biased opinions from experts, without solid scientific foundation. And they warned that this problem has steadily worsened over the years. In their words, “The proportion of recommendations for which there is no conclusive evidence is also growing.”
The science is becoming demonstrably less trustworthy. And there’s no reason to think this problem is confined solely to cardiology.
Furthermore, compelling physicians to practice according to centralized guidelines is not some “unintended consequence” of ObamaCare but rather an explicitly desired goal. As Dr. Donald Berwick (President Obama’s former head of Medicare) wrote:
The primary function of regulation in health care, especially as it affects the quality of medical care, is to constrain decentralized, individualized decision-making.
Hence, the combination of government-funded research and government-mandated practice guidelines based on that research will increasingly foist bad medical treatments onto unsuspecting patients.
Fortunately, the solution to this problem of government corruption of medical research and practice is simple — get government out of the way.
In a recent Atlantic article, Shaywitz describes how privately funded research foundations can promote clinically relevant research free from the corrupting influence of government money. For instance, he cites the Myelin Repair Foundation as an entrepreneurial “contract research organization for multiple sclerosis, capable of validating and robustifying preclinical assays, and developing and analyzing potential biomarkers for use in clinical studies.”
Such privately funded organizations are accountable to donors for money spent in a way that creates a powerful incentive for them to ensure there’s no scientific fraud or misconduct. In contrast, the recent GSA scandal has shown how government bureaucrats in charge of taxpayer dollars can too easily allow that money to be wasted. Privatizing biomedical research won’t completely eliminate the problems of flawed science, but it would be a step in the right direction.
Similarly, the problem of government-mandated clinical guidelines can be addressed by limiting the role of government in physician decision-making. This will require electing politicians committed to repealing ObamaCare in its entirety (unless the US Supreme Court overturns it first).
Just as Americans have become increasingly skeptical of “global warming” policy proposals based on questionable government-funded climate science, they should be skeptical about mandatory medical practice protocols based on increasingly questionable government-funded medical research. You don’t want Michael Moore and Al Gore telling you what kind of car you can drive or what kind of “green” light bulbs you must purchase. Why should you let their bureaucratic equivalents tell you and your doctor what kind of medical care you can receive?