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The Mythology Of Evidence-Based Medicine

The Mythology Of Evidence-Based Medicine

The Chiro.Org Blog


SOURCE:   The Huffington Post ~ 2-25-2011

Dr. Larry Dossey, Deepak Chopra and Dr. Rustum Roy


The current healthcare debate has brought up basic questions about how medicine should work. On one hand we have the medical establishment with its enormous cadre of M.D.s, medical schools, big pharma, and incredibly expensive hospital care. On the other we have the semi-condoned field of alternative medicine that attracts millions of patients a year and embraces literally thousands of treatment modalities not taught in medical school.

One side, mainstream medicine, promotes the notion that it alone should be considered “real” medicine, but more and more this claim is being exposed as an officially sanctioned myth. When scientific minds turn to tackling the complex business of healing the sick, they simultaneously warn us that it’s dangerous and foolish to look at integrative medicine, complementary and alternative medicine, or God forbid, indigenous medicine for answers. Because these other modalities are enormously popular, mainstream medicine has made a few grudging concessions to the placebo effect, natural herbal remedies, and acupuncture over the years. But M.D.s are still taught that other approaches are risky and inferior to their own training; they insist, year after year, that all we need are science-based procedures and the huge spectrum of drugs upon which modern medicine depends.

If a pill or surgery won’t do the trick, most patients are sent home to await their fate. There is an implied faith here that if a new drug manufacturer has paid for the research for FDA approval, then it is scientifically proven to be effective. As it turns out, this belief is by no means fully justified.

The British Medical Journal recently undertook an general analysis of common medical treatments to determine which are supported by sufficient reliable evidence. They evaluated around 2,500 treatments, and the results were as follows:

* 13 percent were found to be beneficial

* 23 percent were likely to be beneficial

* Eight percent were as likely to be harmful as beneficial

* Six percent were unlikely to be beneficial

* Four percent were likely to be harmful or ineffective.

This left the largest category, 46 percent, as unknown in their effectiveness. In other words, when you take your sick child to the hospital or clinic, there is only a 36 percent chance that he will receive a treatment that has been scientifically demonstrated to be either beneficial or likely to be beneficial.

This is remarkably similar to the results Dr. Brian Berman found in his analysis of completed Cochrane reviews of conventional medical practices. There, 38 percent of treatments were positive and 62 percent were negative or showed “no evidence of effect.“

For those who have been paying attention, this is not news. Back in the late 70’s the Congressional Office of Technology Assessment determined that a mere 10 to 20 percent of the practices and treatment used by physicians are scientifically validated. It’s sobering to compare this number to the chances that a patient will receive benefit due to the placebo effect, which is between 30 percent and 50 percent, according to various studies.

We all marvel at the technological advances in materials and techniques that allow doctors to perform quadruple bypass surgeries and angioplasties without marveling that recent studies indicate that coronary bypass surgery will extend life expectancy in only about three percent of cases. For angioplasty that figure sinks to zero percent. Those numbers might be close to what you could expect from a witch doctor, one difference being that witch doctors don’t submit bills in the tens of thousands of dollars.

It would be one thing if any of these unproven conventional medical treatments were cheap , but they are not. Angioplasty and coronary artery bypass grafting (CABG) alone cost $100 billion annually. As quoted by President Obama in his drive to bring down medical costs, $700 billion is spent annually on unnecessary tests and procedures in America. As part of this excess, it is estimated that 2.5 million unnecessary surgeries are performed each year.

Then there is the myth that this vast expenditure results in excellent health care, usually touted as the best in the world (most recently by Rush Limbaugh as he emerged from a hospital in Hawaii after suffering chest pain). But this myth has been completely undermined. In 2000 Dr. Barbara Starfield, writing in the Journal of the American Medical Association, estimated that between 230,000 and 284,000 deaths occur each year in the US due to iatrogenic causes, or physician error, making this number three in the leading causes of death for all Americans.

In 2005 the Centers for Disease Control and Prevention reported that out of the 2.4 billion prescriptions written by doctors annually, 118 million were for antidepressants. It is the number one prescribed medication, whose use has doubled in the last ten years. You would think, therefore, that a remarkable endorsement is being offered for the efficacy of antidepressants. The theory behind standard antidepression medication is that the disease is caused by low levels of key brain chemicals like serotonin, dopamine, and norepinephrine, and thus by manipulating those imbalanced neurotransmitters, a patient’s depression will be reversed or at least alleviated.

This turns out to be another myth. Prof. Eva Redei of Northwestern University, a leading depression researcher, has discovered that depressed individuals have no depletion of the genes that produce these key neurotransmitters compared to people who are not depressed. This would help explain why an estimated 50 percent of patients don’t respond to antidepressants, and why Dr. Irving Kirsch’s meta-analysis of antidepressants in England showed no significant difference in effectiveness between them and placebos.

You have a right to be shocked by these findings and by the overall picture of a system that benefits far fewer patients than it claims. The sad fact is that a disturbing percentage of the medicine we subject ourselves to isn’t based on hard science, and another percentage is risky or outright harmful. Obviously, every patient deserves medical care that is evidence-based, not just based on an illusory reputation that is promoted in contrast to alternative medicine.

We are not suggesting that Americans adopt any and all alternative practices simply because they are alternative. These, too, must demonstrate their effectiveness through objective testing. But alternative modalities should not be dismissed out of hand in favor of expensive and unnecessary procedures that have been shown to benefit no one absolutely except corporate stockholders.

5 comments to The Mythology Of Evidence-Based Medicine

  • This is staggering. I will be re-posting this article for my patients. Thank you for sharing this.

  • This is an interesting and scary article. It makes me think that now, more than ever, we need to get the word out about chiropractic medicine and the fact that while some see it as “not real medicine” It can do the trick where pills and other things can’t. Sometimes it seems hard to convince people of the validity of a Chiropractic Practice.

  • If we stopped doing anything that isn’t “evidence-based”, we would be leaving a lot of people without some great options for care.

    It used to bother me that some chiropractic work isn’t supported by good research, but I’ve seen so many great things in my office that would be hard to explain by “evidence” that I’ve stopped caring so much if what I’m doing is a little weird. I don’t think that I should be stopped from helping people just because some of the techniques I use aren’t considered legit.

    As long as we keep the patients health and happiness as our top concern, always do no harm, and work from research AND clinical experience, then I really don’t see the need for all of this objective testing.

    If we keep trying to fit ourselves into the medical, evidence-based model of health-care, we’ll end up in the same place as them, pretending to be evidence-based. Chiropractic is different, and that is a good thing. When it comes to health care, there’s a lot of stuff that will probably never be explained

    Our focus should be helping people, and what amount of research and testing will it take to improve the health of our nation? I think the value of a peer-reviewed article is overrated. It may just help us more politically than clinically.

  • There definitely needs to be more light drawn onto the fact that there thousands of people out there gaining relief from alternatives methods when everything else “evidence-based” had failed them. Alternatives which can be safer, less invasive, and gentler on the body.
    Once we stop giving away our health to “experts” or pharmaceut­ical medicines and focus on different options out there and on what is best for each individual’s body then we can begin to develop true health.

    Great Article, definitely re-posting!

  • The attempt to practice EBM will destroy the practice of medicine. Statistics prove the practice of medicine is not based on a preponderance of the evidence, yet it’s the chiropractic profession that is categorized as unscientific. Besides, as these horrendous stats become more widely known to the public, the public will seek alternatives that are not only safe but proven effective.

    Great news, the Practicing Chiropractors’ Committee on Radiology Protocols (PCCRP) was recent accepted into the National Guideline Clearinghouse (www.ngc.gov). This guideline provides the highest level of evidence in support of radiography for subluxation detection and correction. It’s evidence based and a slap in the face of those who consider chiropractic unscientific and who hope to keep hard working Americans from seeking effective and non-invasive alternatives to medical care. Why waste your hard earned money on unproven therapies folks!

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