Medical Research Fails to Meet Patients' Needs
Garber and colleagues did their own study of 83 patients with osteoarthritis of the knee. Half received ultrasound at a lower-than-usual level, and half received physical therapy, involving exercises done in the clinic and at home. Both groups were seen twice a week for a month.
After a year, only 5% of patients in the physical therapy group required knee replacement surgery, compared with 20% in the ultrasound group -- a finding that confirmed the value of manual therapy, Garber says.
"The allocation of research funds is really a complex matter," says Cary Gross, MD, an assistant professor at Yale University School of Medicine. Gross has studied how the National Institutes of Health spends its research dollars. "Unless you have a topic that is scientifically sexy" or results in a lot of deaths or costs to society, it's hard to get funding, he says.
He notes, for example, that funding for pancreatic cancer, a disease with a low survival rate, lags behind that for AIDS, which has seen tremendous advances in treatment. "Which comes first, the research productivity or the money? One could make the argument that progress follows money," Gross says.
But government funding is only half the equation: About 60% of research money comes from private sources, usually pharmaceutical companies.
Dieppe's group also found that 94% of the published studies had positive findings, meaning the researchers ended up endorsing the use of whatever it was they were studying. Dieppe says some journals don't want to publish studies that show therapies don't work, and adds that researchers often don't invest enough time trying to understand why some treatments are ineffective -- a failing he terms "a crime."
He also acknowledges that some pharmaceutical companies either suppress studies that turn out to be unfavorable to their products or insist that the researchers spin positive findings from their work.
Gross adds that the findings of many studies don't apply to the general population because the study patients are carefully selected and have uncommon medical conditions.
Dieppe is now conducting a study to see how well people do after knee replacement surgery, as little is known about when this surgery should be performed and whether it is better to wait, he says. "We are trying to follow the research priorities that emerged from the patients we studied," he says.