The failure to fund trials is combined with a suffocating dominance of the perspective of self-styled ‘evidence-based medicine’ (EBM) - including the groundless notion that only mega-trails should be taken seriously. . . Since the vast majority of randomized trials are industry funded, EBM has meant that industry has a de facto monopoly on ‘reputable’ therapeutic knowledge.
Delivering us into the hands of Big Pharma was not - of course - intended by the socialistic founders of EBM, but it has happened nonetheless.
This reminds me of something one of my students said. We were discussing male/female differences — in particular, the observation that women are more religious than men. One student said that in her experience, guys were either not religious at all or very religious.
I agree with her. I think this is why EBM has the form it does. Its male founders — not understanding the tendency that my student pointed out — went from one extreme (medical orthodoxy, unrelated to evidence) to another (evidence-based medicine). Reliance on evidence is a good idea, yes, but the founders of EBM couldn’t help making it resemble a religion. You might think that relying on evidence is the opposite of religion but they made the whole thing as religious as possible. EBM became just another way — just another excuse, really — to sneer at people.