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Cleaning up Medical Research

In an essay published in PLOS Medicine, John Ioannidis, a professor of medicine and of health research and policy at Stanford University, proposes a few modifications to current medical research practices that he believes will improve the accuracy of published results and cut down on wasted resources.

"Currently, major decisions about how research is done may too often be based on convention and inertia rather than being highly imaginative or evidence-based," he writes. "For example, there is evidence that grant reviewers typically have only modest CVs and most of the top influential scientists don't review grant applications and don't get funded by government funds, even in the United States."

"Non-meritocratic practices, including nepotism, sexism, and unwarranted conservatism, are probably widespread," he adds. "Allegiance and confirmation biases are powerful in scientific processes. For healthcare and clinical practice, while evidence-based medicine has grown stronger over time, some argue that it is currently in crisis and 'evidence-based' terminology has been usurped to promote expert-based beliefs and industry agendas."

The piece, which coincides with PLOS Medicine's 10th anniversary, is a response to issues concerning the medical research enterprise that he first raised in 2005, arguing that "most published research findings are false" and discussed the implications of his claim.

In his latest essay, Ioannidis suggests transplanting practices that have improved "credibility and efficiency" in other fields, for example, "adopting large-scale collaborative research; replication culture; registration; sharing; reproducibility practices; [and] better statistical methods," among others. Figuring out which of these interventions would best improve research practice "requires rigorous examination and experimental testing whenever feasible" and should "understand and harness the motives of various stakeholders," he writes.

He also argues that the current reward system and its associated "currencies" — publications, grants, promotions, and so on — needs to be modified in ways that are "better aligned with translatable and reproducible research."