Dr Goldacre, who has been appointed by health secretary Matt Hancock to head up a new tech advisory board, said there was often ‘unwarranted variation’ in the way drugs were prescribed.
He said his work developing the Openprescribing.net website, which allows users to see what GPs, practices and CCGs are prescribing, had showed ‘interesting patterns in the dissemination of knowledge in the medical profession’.
He cited examples relating to drug switches to either a better or generic treatment, which showed variations in when and how quickly CCGs had switched.
‘This is not about bad doctors, it’s about bad knowledge structures,’ he said. ‘We need a coordinated machine for disseminating knowledge to frontline decision makers that goes well beyond [medical optimisation] teams that are sometimes great, but can be variable, with variable skills in different places.’
Pharmacists, doctors, software engineers, epidemiologists, patients, writers and editors need to be involved if you are to disseminate knowledge to people, Dr Goldacre argued.
‘It’s not enough to do clinical trials and then publish it in a journal read by absolutely nobody – nobody cares. You need to get knowledge into action. You get knowledge into action by paying people salaries, to go out there and get knowledge into action,’ he said.
‘That is not to say that academics are of no consequence or value. These problems all require deep knowledge of data analysis, epidemiology, statistics, research methods, clinical trials and patient care.
‘What they require is that funders and universities pay people who have those skills to analyse data, to spot problems, to fix them. But not with the goal being to produce an academic paper, but with the goal being to produce an amazing machine that disseminates knowledge and finds the best way of disseminating knowledge. A machine that looks for practice variation, not just in prescribing.’
Dr Goldacre said that there was no one currently funding ‘that kind of thing’, which he said was ‘utterly deranged’.
‘We need patients and coal face clinicians to tell funders and universities that we don’t care how many papers they publish in obscure, paywalled, low impact journals,’ he concluded. ‘We demand better service.’
