"Evidence-based medicine has been hijacked:" A confession from John Ioannidis (interview)

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“Evidence-based medicine has been hijacked:” A confession from John Ioannidis

John Ioannidis is perhaps best known for a 2005 paper “Why Most Published Research Findings Are False.” One of the most highly cited researchers in the world, Ioannidis, a professor at Stanford, has built a career in the field of meta-research. Earlier this month, he published a heartfelt and provocative essay in the the Journal of Clinical Epidemiology titled “Evidence-Based Medicine Has Been Hijacked: A Report to David Sackett.” In it, he carries on a conversation begun in 2004 with Sackett, who died last May and was widely considered the father of evidence-based medicine. We asked Ioannidis to expand on his comments in the essay, including why he believes he is a “failure.”
Retraction Watch: You write that as evidence-based medicine “became more influential, it was also hijacked to serve agendas different from what it originally aimed for.” Can you elaborate?
John Ioannidis: As I describe in the paper, “evidence-based medicine” has become a very common term that is misused and abused by eminence-based experts and conflicted stakeholders who want to support their views and their products, without caring much about the integrity, transparency, and unbiasedness of science.
RW: You also write that evidence-based medicine “still remains an unmet goal, worthy to be attained.” Can you explain further?
JI: The commentary that I wrote gives a personal confession perspective on whether evidence-based medicine currently fulfills the wonderful definition that David Sackett came up with: “integrating individual clinical expertise with the best external evidence”. This is a goal that is clearly worthy to be attained, but, in my view, I don’t see that this has happened yet. Each of us may ponder whether the goal has been attained. I suspect that many/most will agree that we still have a lot of work to do.
RW: You describe yourself as a “failure.” What do you mean?
JI: Well, I still know next to nothing, even though I am always struggling to obtain more solid evidence and even though I always want to learn more. If you add what are probably over a thousand rejections (of papers, grant proposals, nominations, and other sorrowful academic paraphernalia) during my career to-date, I think I can qualify for a solid failure. Nevertheless, I still greatly enjoy my work in science and in evidence-based medicine..