Evidence-Based Medicine (EBM) is a relatively recent phenomenon. The term itself was not coined until 1991. It began with the best of intentions — to give frontline doctors the tools from clinical epidemiology to make science-based decisions that would improve patient outcomes. But over the last three decades, EBM has been hijacked by the pharmaceutical industry to serve the interests of shareholders rather than patients.

Today, EBM gives preference to epistemologies that favor corporate interests while instructing doctors to ignore other valid forms of knowledge and their own professional experience. This shift disempowers doctors and reduces patients to objects while concentrating power in the hands of pharmaceutical companies. EBM also leaves doctors ill-equipped to respond to the autism epidemic and unable to produce the sorts of paradigm-shifts that would be necessary to address this crisis.

In 2000, the GRADE (Grading of Recommendations Assessment, Development and Evaluation) Work Group began to meet. By2004 they published their framework and it is the opposite of transparent — it takes the different levels from the evidence hierarchy and converts them into a “quality scale” — “high, moderate, low, and very low.” At the top of their evidence hierarchy is RCTs. So according to GRADE, if a study is an RCT, it is considered “high quality”. I saw GRADE in use when I watched every meeting of the FDA’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) and the CDC’s Advisory Committee on Immunization Practices (ACIP) in 2022 and 2023. GRADE is a tool to give legitimacy to ANY medical intervention no matter how abysmal the data. For example, the FDA and CDC used GRADE to authorize:

• The use of the Pfizer Covid vaccine in adults even though more people died in the treatment than the control group;
• The use of Covid vaccines in children even though the clinical trial showed noclinically significant benefit to children; and
• Covid vaccine boosters for all age groups with no human testing whatsoeverand only 28 days of antibody results in six mice.

So within 13 years (from the first edition in 2002 to the third edition in 2015) the AMA went from the best-in-class evidence hierarchy that acknowledged individual difference to a cartoonish monstrosity, GRADE; that is just a tool for laundering bad data on behalf of the pharmaceutical industry. In the process the AMA sold out the doctors in their association and the patients in their care to the drug makers.

As EBM became more influential, it was also hijacked to serve agendas different from what it originally aimed for. Influential randomized trials are largely done by and for the benefit of the industry. Meta-analyses and guidelines have become a factory, mostly also serving vested interests. National and federal research funds are funneled almost exclusively to research with little relevance to health outcomes. We have supported the growth of principal investigators who excel primarily as managers absorbing more money….Under market pressure, clinical medicine has been transformed to finance-based medicine (Ioannidis, 2016, p. 82).