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Drug Information Associates Drug Information Associates BRIEF: INFORMATION SERVICES IN AN ERA OF the use of new, expensive therapies (such as specialty UNPRECEDENTED EVIDENCE EXPANSION drugs, for example) be justified when compared to Heath Ford, PharmD, PhD | May 23, 2020 established practice?” In education, “can learners in certain outcome segments be expected to show Have you ever wondered … how effective is the statin improvement given new programs and substantial drug your doctor prescribed? Or the anti-depressant, increases in investment?” And in manufacturing, “are antipsychotic, or amphetamine? What about the recommended process improvements reasonable given expensive injectable medication your discount card or projected output expectations and investment costs?” drug coupon allows you to get every month for a low copay? And what about medical education (eg, medicine, These considerations validate the need for specialized nursing, pharmacy, dentistry)? Have you ever considered information services, specifically those centering on both the differences between your educational experience and retrieving and appraising scientific evidence. that of today’s professional students? How effective Information Retrieval & Appraisal Services in Medicine were educational strategies then compared to those employed today? In light of the extraordinary growth of the scientific literature, it is said that perhaps no industry is in greater The “Evidence Base” need of specialized information services than medicine. In all industries, especially medicine, the growing level of According to estimates, approximately 2.5 million experimentation and the pervasive expectation for an scientific journal manuscripts were published in 2009 in “evidence base” is very well established. Municipalities more than 29,000 journals.1 Between 1994 and 2001, and not-for-profit organizations, for instance, search for approximately 400,000 medical manuscripts were evidence-based interventions that address problems of published per year (on average),2 making medicine the homelessness, food insecurity, or public health. most “explosive field of journal publications worldwide.”3 Manufacturers seek evidence-based solutions for Current State of Evidence-based Medicine optimizing productivity and output. And increasingly, individuals seek evidence-based wellness strategies to John Ioannidis, professor of Medicine at Stanford improve their overall health. University and an internationally-recognized leader in evidence-based medicine, offers his own perspective on Value for Money the state of practice: (1) much of the published research Without doubt, the overall trend toward an evidence- is neither reliable nor useful; (2) most health base can be said to rest on two fundamental questions, professionals are neither (a) aware of this problem nor (b) which, when examined closely, may in fact be one: (1) possess the skills necessary to critically appraise scientific does the intervention work (or is it effective)? and (2) evidence; and (3) patients and caregivers are thus unable does the intervention represent “value for money?” (The to make informed decisions regarding the best use of value of an intervention rests in its effectiveness, and available interventions.4-8 Ioannidis writes: therefore the second question may be safely assumed to Critical appraisal skills matter greatly for assuring include the first.) In other words, can use of a novel optimal patient care. When practicing clinicians intervention be justified given its cost? In medicine cannot distinguish between valid and false (pharmaceuticals specifically), the question may be, “can www.druginformationassociatesllc.com results, they are at risk of delivering useless importance with the numerical growth of the literature. treatments, or worse, harming their patients. For In light of high-cost specialty drugs, for example, future example, evidence of a fourfold increased risk of endeavors, particularly by for-profit and not-for-profit myocardial infarction in patients receiving information service organizations, should center on rofecoxib (Vioxx, Merck, Whitehouse Station, NJ, mainstreaming their presence and importance within the USA) as compared to naproxen (Novopharm industry. Biotech, Toronto, Canada) was plainly available in References the abstract of the VIGOR trial. However, peer reviewers, editors and readers of the New 1. Boon S. 21st century science overload. Canadian England Journal of Medicine accepted the Science Publishing [Blog]. spurious argument that naproxen was http://blog.cdnsciencepub.com/21st-century- cardioprotective. The VIGOR investigators science-overload/ (accessed 25 May 2020). concluded that the increased risk of myocardial 2. Druss BG, Marcus SC. Growth and infarction with rofecoxib did not exist, stating decentralization of the medical literature: without any supporting evidence that the ‘… implications for evidence-based medicine. Journal results are consistent with the theory that of the Medical Library Association. naproxen has a coronary protective effect’. 2005;94(4):499-501. Millions of prescriptions were written before the 3. Garba S et al. Proliferations of scientific medical drug was withdrawn from the market in 2004, journals: a burden or a blessing. Oman Medical after several studies reported significantly Journal. 2010;25(4):311-314. increased risks of cardiovascular events and 4. Ioannidis JPA, Stuart ME, Brownlee S, Strite SA. death.4 How to survive the medical misinformation mess. European Journal of Clinical Investigation. Thus, the state of evidence-based medicine may not be as 2017;47:795-802. DOI: 10.1111/eci.12834 robust as the quantity of medical publications. So what 5. Ioannidis JPA. Why most clinical research is not can be done to address this problem? useful. PlOS Medicine. 2016;13(6):e1002049. Again, Ioannidis is helpful. Among a dozen DOI: 10.137/journal.pmed.1002049. recommendations for enhancing evidence-based medical 6. Ioannidis JPA. The mass production of redundant, practice, he includes (1) better training of scientific misleading, and conflicting systematic reviews workforce in methods and statistical literacy, (2) adoption and meta-analyses. The Milbank Quarterly. of replication culture and reproducibility practices, and 2016;94(3):485-514. (3) the reform of incentive and reward structures in 7. Ioannidis JPA. Why most published research is clinical, industry, and academic practices.8 Theoretically, false. PlOS Medicine. 2005;2(8):e124. all three strategies can be addressed, at the very least, 8. Ioannidis JPA. How to make more published within academia, with the first two augmented by research true. PlOS Medicine. specialized information service providers in both the for- 2014;11(10):e1001747. profit and not-for-profit sectors. Future Direction Specialized information services centering on both retrieving and appraising medical and scientific literature are critical today and will continue to increase in .
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