This column likes evidence-based medicine. It is impossible to defend anything else: to pretend there is no need for evidence – or to ignore it – means ignoring the duty to ensure patients get the best possible care.

It would be nice to think that medical research has now got its act together, after many shameful episodes of wilful, look-away ignorance – advising parents to put babies to sleep on their tummies, for example, which substantially increases risk of cot death. But standards are still nowhere near where they should be.

A terrific paper on this subject was published recently in The Lancet, written by two heroes of mine: Sir Iain Chalmers, editor of the James Lind Library, and Paul Glasziou, of the Department of Primary Care at the University of Oxford. It is a scathing rebuke to those who feel that developments in research standards have gone far enough.

They quote a medical researcher who sought information about treatment for his bone marrow cancer. He was looking for published research in relation to possible treatments he had seen presented in a conference abstract, a summary of a research presentation. Years later, the full data remained unpublished. “Why was I forced to make my decision knowing that information was somewhere but not available?” he said. “Was the delay because the results were less exciting than expected?”

A paper last year in the journal Oncologist found that fewer than one in five studies in cancer that had been registered on the website www.clinicaltrials.gov (a global register that ensures that current trials are in the public domain) was subsequently published. This led the researchers to ask if they were “practising on the tip of an information iceberg”.

Chalmers and Glasziou are also concerned that new research is “too often wasteful”, with badly designed trials meaning that the outcomes will not be clinically helpful. Even the purpose of the research itself can fail patients – patients with knee osteoarthritis were found to be most interested in research into physiotherapy and surgery, not drug interventions, on which the bulk of the research is focused.

Many journals now insist on publishing trials only if they have been registered at www.clinicaltrials.gov. This ensures that there is a record of what research is being done. However, with only a fraction of research being published, together with question marks over what kind of research we are prioritising, complacency is not an option. Unsuccessful trials are still less likely to be published and although some pharmaceutical companies have pledged to publish all research, this is neither compulsory nor standard practice. This is a scandal: there is information out there about treatment interventions and it is not being used to benefit patients.

Margaret McCartney is a GP in Glasgow
margaret.mccartney@ft.com

For lively discussion of the latest medical issues go to Margaret McCartney’s blog at www.margaretmccartney.com/blog