Why most published research findings are still false
pemThe US spends nearly 20% of its GDP on health and publishes 3 million biomedical papers a year. So why is life expectancy stalling, or perhaps even falling? Stanford professor of medicine strongJohn Ioannidis/strong argues that vested interests and basic research mistakes are destroying biomedicine, and that two decades after his bombshell paper, “Why Most Published Research Findings Are False,” the situation has only worsened. AI is generating a new deluge of fraudulent research, and medicine is drifting ever further from quality evidence. In this interview with the IAI's Alasdair Craig, he lays bare the crisis, and suggests ways we might begin to fix it./em/pp /ppstrongAlasdair Craig:/strong strongYou’ve said that “we need to fight against medicine. It’s becoming really dangerous.” Why did you say that?/strong/ppJohn Ioannidis: Spending on health in the United States is a href="https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet" target="“_blank”"close to 20%/a of GDP, and in other countries it’s also increasing. We have about three million papers published in biomedicine every year. Most of them are probably subpar. Many of them are false or misleading. a href="https://link.springer.com/article/10.1007/s00210-025-04275-9" target="“_blank”"One study/a estimated that 5.8% of biomedical papers published in 2023 were entirely fake, and the proportion is increasing. a href="https://www.jclinepi.com/article/S0895-4356(22)00100-7/abstract" target="“_blank”"Another study/a has found that among 1,567 medical interventions, only 5.6% had high-quality evidence supporting their benefits (that is, over 94% lacked high-quality evidence supporting their benefits)./ppWe have lots of discussions that are misinformation and full of very weird thinking about medicine. So we’re entangled in a mess that is not leading to better health. In fact, a href="https://ourworldindata.org/life-expectancy" target="“_blank”"life expectancy in the United States has not really increased/a or has even gone down./ppWe see the same experience in many other countries. We are not getting what we should out of an enterprise that includes some amazing researchers and some very well-intentioned people./pp /ppstrongYou’ve argued that /stronga href="iai-academy/courses/info?course=medicine-the-need-for-a-new-paradigm" target="“_blank”"strongevidence-based medicine/strong/astrong has been “hijacked.” What do you think is going wrong in the research process?/strong/ppa href="video/why-most-published-research-findings-are-false-john-ioannidis" target="“_blank”"We have a lot of research that is not useful/a. I’m not talking about basic science, which we do need. Actually, we need more of it. By “basic science” I mean research that has practically no deliverables: we don’t really know what we will find and what domain or field or disease it might be useful for eventually./ppWhen I say that a lot of research is not useful, I’m talking about research that tries to generate evidence to enable us to treat specific diseases. Multiple factors make that kind of research very unreliable at times./ppFor example, there are very strong conflicts of interest. There is research that is run with a specific ideology in mind. There is very poor use of statistical methods and questionable research practices that lead to “significant” results that are not really significant. There is a lot of uncontrolled bias. There are a href="articles/medical-trials-are-not-the-whole-truth-auid-2989" target="“_blank”"poor study designs/a. There is fragmentation of research in small studies that are meaningless, where if they do get some signal, it’s very likely that it will be false./pp class="article-plus-content--header" style="text-align: center;"___/pp class="article-plus-content--header" style="text-align: center;"Evidence-based medicine has long become finance-based medicine, and it is moving towards becoming corruption-based medicine./pp class="article-plus-content--header" style="text-align: center;"___/ppAnd there is fraud that is probably getting worse, especially with the advent of artificial intelligence. We have a very large number of papers now that can be generated by AI, and that can be entirely false and fraudulent and fake—besides the classic fraud that we had in the past. a href="https://www.pnas.org/doi/10.1073/pnas.2420092122" target="“_blank”"A recent study/a found that scientific fraud is currently growing at much faster rates than the scientific enterprise as a whole./ppSo there are multiple threats to the research ecosystem that are making it very difficult to obtain reliable evidence./pp /ppstrongWhat is the solution to the problem of vested interests in medical research? Should we move to more state-funded medical research, or would that just produce its own biases?/strong/ppI think a href="video/medicine-magic-misunderstanding" target="“_blank”"we need more independent research/a, and public funding has a better starting point for being independent. When it comes to basic biomedical research, I think we do need public funding because, otherwise, who is going to fund it? If there’s no clear deliverable, it’s unlikely that for-profit enterprises will be willing to fund it./ppWhen it comes to evidence-based research, I would argue that, again, we need public funding if that can be coupled with independence. So, not public funding that some public officer would be controlling for the benefit of some industry sponsor, but genuinely independent investigators./ppWe should also have industry involved in this, of course. But I think that they should be focused on the translational path, meaning investing in delivering the best products in terms of interventions, diagnostic tests, devices, technologies, and then have independent researchers with public funds, who would be testing those rigorously and without bias./ppCurrently, what we see is the opposite. We see that industry is testing its own products, and of course, it has every vested interest in generating the results that will be best for its agendas. Meanwhile, government spending mostly focuses on delivering products for industry. So, there’s a misallocation of funds. a href="https://www.jclinepi.com/article/S0895-4356(16)00147-5/abstract" target="“_blank”"Evidence-based medicine has been hijacked/a by stakeholders who do not really focus on getting the best outcomes for society at large, but mostly for their own portfolios. Evidence-based medicine has long become finance-based medicine, and it is moving towards becoming corruption-based medicine./ppThere’s also the problem of people moving between government and industry. Officials, after they finish their government career, often move into industry, which I think is problematic, because even during their government tenure, they’re often thinking about their industry careers, and that affects their decisions and what kind of research they propose. So, publicly funded research is not a panacea./pp /ppstrongI’ve heard you say that medical scientists are shifting around our definitions of disease, and that this often makes people seem like they are sick when in fact they aren’t./strongstrong /strongstrongWhat made you say that? And how do we solve this problem?/strong/ppWe do see that for many conditions, there is a a href="video/the-diagnosis-delusion" target="“_blank”"widening of the definition of who is sick/a. This applies to almost any condition that you can think of that may have a large market, where products, interventions, devices and technologies may be sold and profited from. Information bombardment, a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2830758" target="“_blank”"including on social media/a, aims to make more people feel sick./ppThis doesn’t mean that these conditions do not need to be treated. For example, we know that diabetes is serious. However, one can a href="articles/naming-wont-solve-mortality-auid-3245" target="“_blank”"shift the definition/a of emprediabetes/em to increasingly lower thresholds. Likewise, we know that hypertension is a major problem and it needs to be treated. However, one can move the boundaries of what counts as hypertension and where we need to start with medical treatment as opposed to other ways of trying to control it./pp
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/ppSo, across the board, and especially for common conditions, we see that the definitions of who is in need of medicine—especially expensive medicine—are being widened a href="articles/cancer-screening-harms-more-people-than-it-saves-auid-3264" target="“_blank”"to make more people feel or believe that they are sick so that they need to be (expensively) treated/a./ppAgain, we have a major crisis in mental health, and we need more attention and more resources to deal with this. But many of the definitions that are being pushed are making practically a href="video/mental-hea
