Update — December 7, 2014. – Evidence-based medicine (EBM) is not working for many reasons, for example: 1. Incorrect in their foundations (paradox): hierarchical levels of evidence are supported by opinions (i.e., lowest strength of evidence according to EBM) instead of real data collected from different types of study designs (i.e., evidence). http://dx.doi.org/10.6084/m9.figshare.1122534 2. The effect of criminal practices by pharmaceutical companies is only possible because of the complicity of others: healthcare systems, professional associations, governmental and academic institutions. Pharmaceutical companies also corrupt at the personal level, politicians and political parties are on their payroll, medical professionals seduced by different types of gifts in exchange of prescriptions (i.e., bribery) which very likely results in patients not receiving the proper treatment for their disease, many times there is no such thing: healthy persons not needing pharmacological treatments of any kind are constantly misdiagnosed and treated with unnecessary drugs. Some medical professionals are converted in K.O.L. which is only a puppet appearing on stage to spread lies to their peers, a person supposedly trained to improve the well-being of others, now deceits on behalf of pharmaceutical companies. Probably the saddest thing is that many honest doctors are being misled by these lies created by the rules of pharmaceutical marketing instead of scientific, medical, and ethical principles. Interpretation of EBM in this context was not anticipated by their creators. “The main reason we take so many drugs is that drug companies don’t sell drugs, they sell lies about drugs.” ―Peter C. Gøtzsche “doctors and their organisations should recognise that it is unethical to receive money that has been earned in part through crimes that have harmed those people whose interests doctors are expected to take care of. Many crimes would be impossible to carry out if doctors weren’t willing to participate in them.” —Peter C Gøtzsche, The BMJ, 2012, Big pharma often commits corporate crime, and this must be stopped. Pending (Colombia): Health Promoter Entities (In Spanish: EPS ―Empresas Promotoras de Salud).   3. Misinterpretations New technologies or concepts are difficult to understand in the beginning, it doesn’t matter their simplicity, we need to get used to new tools aimed to improve our professional practice. Probably the best explanation is here in these videos (credits to Antonio Villafaina for sharing these videos with me). English https://www.youtube.com/watch?v=pQHX-SjgQvQ&w=420&h=315 Spanish https://www.youtube.com/watch?v=DApozQBrlhU&w=420&h=315 ----------------------- 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: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.– 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. http://dx.doi.org/10.6084/m9.figshare.1135873 2. The EBM Challenge Day 1: No Answers. Competing interests: I endorse the principles of open data in human biomedical research Read this letter on The BMJ – August 13, 2014.http://www.bmj.com/content/348/bmj.g3725/rr/762595Re: Greenhalgh T, et al. Evidence based medicine: a movement in crisis? BMJ 2014; 348: g3725. ______ Fileset contents Raw data: Excel archive: Raw data, interactive figures, and PubMed search terms. Google Spreadsheet is also available (URL below the article description). Figure 1. Unadjusted (Fig 1A) and adjusted (Fig 1B) PubMed publication trends (01/01/1992 to 30/06/2014). Figure 2. Adjusted PubMed publication trends (07/01/2008 to 29/06/2014) Figure 3. Google search trends: Jan 2004 to Jun 2014 / 1-week periods. Figure 4. PubMed publication trends (1962-2013) systematic reviews and meta-analysis, clinical trials, and observational studies.   Figure 5. Ramirez, Jorge H (2014): Infographics: Unpublished US phase 3 clinical trials (2002-2014) completed before Jan 2011 = 50.8%. figshare.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 Supplementary Figures (S1-S6). PubMed publication delay in the indexation processes does not explain the descending trends in the scientific output of evidence-based medicine. Acknowledgments 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. Related articles by this author (Jorge H. Ramírez) 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  Recommended articles 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 medicinehttp://thehealthcareblog.com/blog/2014/05/02/a-holistic-view-of-evidence-based-medicine/  ---