DOI: 10.6084/m9.figshare.1093997.v19
title: Data (i.e., evidence) about evidence based medicine

description: Hypothesis: hierarchical levels of evidence based medicine are wrong Dear Editor, I have data to support the hypothesis described in the title of this letter. Before rejecting the null hypothesis I would like to ask the following open question:<br>Could you support with data that hierarchical levels of evidence based medicine are correct? (1,2) Additional explanation to this question: - Only respond to this question attaching publicly available raw data.<br>– Be aware that more than a question this is a challenge: I have data (i.e., evidence) which is contrary to classic (i.e., McMaster) or current (i.e., Oxford) hierarchical levels of evidence based medicine. An important part of this data (but not all) is publicly available. References 1. Ramirez, Jorge H (2014): The EBM challenge. figshare.<br>http://dx.doi.org/10.6084/m9.figshare.1135873 2. The EBM Challenge Day 1: No Answers. <strong>Competing interests:</strong> I endorse the principles of open data in human biomedical research Read this letter on The BMJ – August 13, 2014.<br>http://www.bmj.com/content/348/bmj.g3725/rr/762595<br>Re: Greenhalgh T, et al. Evidence based medicine: a movement in crisis? BMJ 2014; 348: g3725. ____________________________________ <strong>Fileset contents</strong> <strong>Raw data:</strong> Excel archive: Raw data, interactive figures, and PubMed search terms. Google Spreadsheet is also available (URL below the article description). <strong>Figure 1.</strong> Unadjusted (Fig 1A) and adjusted (Fig 1B) PubMed publication trends (01/01/1992 to 30/06/2014). <strong>Figure 2</strong>. Adjusted PubMed publication trends (07/01/2008 to 29/06/2014) <strong>Figure 3</strong>. Google search trends: Jan 2004 to Jun 2014 / 1-week periods. <strong>Figure 4.</strong> PubMed publication trends (1962-2013) systematic reviews and meta-analysis, clinical trials, and observational studies. <strong>Figure 5.</strong> Ramirez, Jorge H (2014): Infographics: Unpublished US phase 3 clinical trials (2002-2014) completed before Jan 2011 = 50.8%. figshare.<br>http://dx.doi.org/10.6084/m9.figshare.1121675 Raw data: "13377 studies found for: Completed | Interventional Studies | Phase 3 | received from 01/01/2002 to 01/01/2014 | Worldwide". This database complies with the terms and conditions of ClinicalTrials.gov: http://clinicaltrials.gov/ct2/about-site/terms-conditions Future analysis of these trials will be uploaded to this fileset. <em><strong>Supplementary Figures (S1-S6).</strong> <br></em>PubMed publication delay in the indexation processes does not explain the descending trends in the scientific output of evidence based medicine. <strong>Acknowledgments</strong> I would like to acknowledge the following persons for providing valuable concepts in data visualization and infographics: - Maria Fernanda Ramírez. Professor of graphic design. Universidad del Valle. Cali, Colombia. - Lorena Franco. Graphic design student. Universidad del Valle. Cali, Colombia. <strong>Related articles by this author (Jorge H. Ramírez)</strong> 1. Ramirez JH. Lack of transparency in clinical trials: a call for action. Colomb Med (Cali) 2013;44(4):243-6. URL: http://www.ncbi.nlm.nih.gov/pubmed/24892242 2. Ramirez JH. Re: Evidence based medicine is broken (17 June 2014). http://www.bmj.com/node/759181 3. Ramirez JH. Re: Global rules for global health: why we need an independent, impartial WHO (19 June 2014). http://www.bmj.com/node/759151 4. Ramirez JH. PubMed publication trends (1992 to 2014): evidence based medicine and clinical practice guidelines (04 July 2014). http://www.bmj.com/content/348/bmj.g3725/rr/759895 <strong> Recommended articles</strong> 1. Greenhalgh Trisha, Howick Jeremy,Maskrey Neal. Evidence based medicine: a movement in crisis? BMJ 2014;348:g3725 2. Spence Des. Evidence based medicine is broken BMJ 2014; 348:g22 3. Schünemann Holger J, Oxman Andrew D,Brozek Jan, Glasziou Paul, JaeschkeRoman, Vist Gunn E et al. Grading quality of evidence and strength of recommendations for diagnostic tests and strategies BMJ 2008; 336:1106 4. Lau Joseph, Ioannidis John P A, TerrinNorma, Schmid Christopher H, OlkinIngram. The case of the misleading funnel plot BMJ 2006; 333:597 5. Moynihan R, Henry D, Moons KGM (2014) Using Evidence to Combat Overdiagnosis and Overtreatment: Evaluating Treatments, Tests, and Disease Definitions in the Time of Too Much. PLoS Med 11(7): e1001655. doi:10.1371/journal.pmed.1001655 6. Katz D. A-holistic view of evidence based medicine<br>http://thehealthcareblog.com/blog/2014/05/02/a-holistic-view-of-evidence-based-medicine/