Only 1 in 10 Medical Treatments is Supported by High-Quality Evidence, Study Finds

When you take the medications your doctor has prescribed, you might assume that the treatment has solid evidence to support it. But you’re extremely wrong. One in ten medical treatments only is backed up by high-quality evidence, latest research shows.

The study, which is published in the Journal of Clinical Epidemiology, analyzed 154 Cochrane systematic reviews issued between 2015 and 2019. Out of this massive pile of medical reviews, only 15 of them – 9.9 percent – had superior evidence, called GRADE, or grading of recommendations, assessment, development, and evaluation.

Most Medical Treatments Have Almost No Evidence They Work

Among these, only two reports had statistically substantial results, which means that the results were improbable to have appeared due to random error, and were believed by the authors to be rather useful in clinical practice.

Employing the same system, 37 percent had average, 31 percent had low, and 22 percent had very low-quality evidence they work. The GRADE system considers things such as risk of bias; for instance, research that is ‘blinded,’ in which patients do not know whether they are consuming the actual treatment or a placebo, usually provide higher-quality proof than ‘unblinded’ studies.

Blinding is vital because people who know what kind of treatment they are receiving can see greater placebo effects than those who do not know what treatment they are receiving. Among other things, GRADE also looks at whether the studies were inaccurate because of differences in the manner the treatment was used.

In the 2016 review, scientists discovered that 13.5 percent (about one in seven) reports said that treatments were supported by superior evidence. Lack of high-quality proof, as per GRADE, means that future research might reverse the results.

There were a few constraints to the study – first, the sample size may not have been proxy, and other research has found that about 40 percent of medical treatments are likely to be effective in treating the symptoms.

Also, the sample in the study was not sufficiently big to verify if there were certain kinds of medical treatments that were better than others. It is also possible that the ‘gold standard’ for grading evidence is way too strict.

Too Many Low-Quality Studies

Numerous poor-quality trials are being issued, and this analysis merely reflected this situation. Because of the pressure to ‘publish or perish’ to survive in academia, more and more research is being conducted and published. 

The evidence-based medicine activity has been continuously asking for an improvement in the quality of research for more than 30 years now, but there is absolutely no proof that things have become better in spite of a proliferation of guidelines and guidance.

Back in 1994, Doug Altman, a professor of statistics in medicine at Oxford University, implored for less, but better research – the opposite has happened. Low-quality evidence is serious because, without solid proof, there’s no way of telling the treatments prescribed by doctors actually work. They can also do harm.

The GRADE System is Allegedly Too Harsh

The excuse that GRADE doesn’t provide accurate results should be used with caution. It is probably true that the system is too harsh for some particular contexts. For instance, it is almost impossible for any trial to analyze a certain exercise regime to be of high quality.

An exercise trial cannot be ‘blinded,’ as anyone doing the exercise will know they are in the exercise group. Also, it is rather difficult to make large groups of people to do exactly the same exercise, but it is easier to make everyone take the same pill.

The authors’ method was also strict. While the systematic reviews had numerous outcomes, they mainly focused on the primary one. Considering only the primary outcome prevents bogus findings, but if considering many outcomes, there is the possibility that one of them will be high quality by chance alone. That’s why, to alleviate this, the researchers also looked at the other outcomes and found that one in five treatments had superior evidence for any outcome.

Overall, the majority of medical treatments whose efficacy has been tested in systematic reviews are not backed up by high-quality evidence. The takeaway here is the blunt fact that we need less but better research in order to fix uncertainties and produce less harm with treatments that have no high-quality evidence they actually work.

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