Problematic trials are contaminating the evidence ecosystem

As clinicians, we navigate complex decision making in our daily clinical practice. These decisions are based on our expertise, guided by clinical guidelines, and grounded in the most up-to-date evidence. An important part of evidence based medicine involves critically appraising emerging evidence from clinical trials and systematic reviews to provide valuable insights that inform clinical decision making. Research by our team published in The BMJ explores the potential contamination of evidence by problematic trials within the evidence ecosystem.1 Through this work, we aimed to understand how flawed or biased trials could distort the broader body of evidence. This project offered a sobering realisation: evidence contamination is an escalating issue that undermines the reliability of current evidence. This growing challenge poses a substantial threat to the integrity of evidence based clinical practice, potentially compromising the quality of care that is delivered to patients.