WHY EVIDENCE-BASED MEDICINE FAILS
"Figures never lie, but liars figure." - Mark Twain
"Much of what medical researchers conclude in their studies is misleading, exaggerated, or flat-out wrong. So why are doctors - to a striking extent - still drawing upon misinformation in their everyday practice?" Dr. John Ionnidis from 2010's piece in the Atlantic called Lies, Damned Lies, and Medical Science.
"This puts in question the reliability of the formal medical journal published evidence base underpinning modern medical research and practice. The impact is on medicine and its practice is at every level internationally. Evidence-Based Medicine was doomed from its inception, lacking logical, scientific and theoretical foundations. Large scale RCTs [Randomized Controlled Trials] are used universally to prove the safety and efficacy of new drugs but commonly used to claim “small” treatment effects. This means in that in the majority of recipients, the drugs are shown to have no effect. In only small numbers are effects claimed and those claims are shown now to be based on flawed premises where even the claimed effect may not exist." - Clifford Miller, Evidence-Based Medicine or Ignorance-Based Evidence? from the September 28, 2011, issue of Clifford Miller's Law Blog (England).
"But how can "research" be biased? Let me give you one example out of thousands. A few years ago, the sugar industry published a study saying that high amounts of sugar did not cause behavior problems in children. If you are a parent, common sense will tell you otherwise. So where was the sleight of hand? The studies compared the behavior of two groups of children. Group I (the control) was given the sugar equivalent of about 18 cupcakes a day. Group II (the experimental group) was given not quite double that amount of sugar. When behavior problems were compared between the two groups of children, there was no statistical difference." - Dr. Russell Schierling from a post called "MORE ON STATIN DRUGS".
"What if 90% of the peer-reviewed clinical research, the holy grail of the conventional medical system, is exaggerated, or worse, completely false?" - Sayer Ji of Green Med Info.
Don't get me wrong. We should be using "evidence" to determine what sorts of medical treatments are the safest and most effective. Although you may be totally unaware of the fact, the problems with accomplishing this have proved all but insurmountable. One of the biggest is that we currently have a system where evidence / science is whatever the people with the most money say it is (HERE). And think about this for a moment; if practicing according to the 'evidence' is so great, doesn't it make you wonder about the billions of tax dollars used for research over the course of the past century, starting with the FLEXNER REPORT? I have written extensively about EVIDENCE-BASED MEDICINE and the fact that many in the scientific community believe it to be a pipe dream. Let me show you why it can never really work for many types of practices, including mine.
A while back I wrote about the various ways that the studies on Anti-depression drugs were tweaked to look much better than they really were. One of the chief ways this was accomplished was to make sure that the studies that didn't go as well as the drug companies had hoped, were never published. Another common ploy is to engage in something called "data dredging". After a study is completed, the authors hire statisticians to comb through the data and look for any conceivable way to twist it so that in some convoluted way, the drug looks statistically better than the placebo (this is actually fairly easy to do, depending on how a study is set up --- see the example from the top of the page). Or what about failing to include the people who drop out of the study due to side effects (sometimes as high as 25 or 30% --- HERE is an example of this with Infantile Colic, or you can just click on the Depression link above)? When Dr. Arif Khan of the Northwest Clinical Research Center in Washington State looked at over 50 clinical trials on antidepressant drugs performed between the years 1985 and 2000, he found that only about half showed that the antidepressant was better than the placebo. Khan's team did a similar study in 2012, looking at the effects of Anti-depression medications versus placebos versus "alternative methods" such as exercise and acupuncture in nearly 180 studies. Conclusions?
"Although antidepressants alone and psychotherapy alone did differ significantly from placebo controls.... they did not differ from alternative therapies such as exercise and acupuncture or active treatment control procedures...These alternative therapies themselves were not statistically superior to placebo." - Khan, et al, July 30, 2012 issue of PLOS One (a medical journal), A Systematic Review of Comparative Efficacy of Treatments and Controls for Depression.
The big knock against natural healing (the Chiropractic profession included), is that there is not enough 'evidence' to back up what we do. In other words, it is always claimed that the evidence for what we do tends to be anecdotal (subjective) as opposed to empirical (objective). But lets look at this for a moment. There actually is a great deal of SOLID RESEARCH on Chiropractic. But this problem goes far deeper than that. It's one thing to test a drug against a placebo (or another drug) in a double-blinded study. But how in the world would I test CHIROPRACTIC ADJUSTMENTS against a placebo? How would I test something intense like TISSUE REMODELING against a placebo? Particularly in the classic "double blinded" manner associated so strongly with science (neither the doctor nor the patient knows who is getting the real treatment and who's getting the sham). I would contend that the very nature of the way that I treat patients excludes blind / double blind placebo controlled studies. And since this is the "Gold Standard" of research, folks like me are automatically discredited and then lumped together and thrown over on the pile labeled "unscientific". In their minds, since I have little more than satisfied patients who refer their friends and family, and a whole bunch of those stupid VIDEO TESTIMONIALS, I'm a quack with no real evidence to back up what I do. I will delve deeper into this issue of "evidence" in a moment, but for now let's shift gears.
After Abraham Flexner's infamous report of the early 20th century (HERE), evidence has become an increasingly important part of what constitutes 'science'. Alternative healing methods are pointed to as quackery because they are not meeting the criteria for what constitutes Evidence-Based Medicine. But how could they? It takes very little digging to realize that the mainstream medical community is not meeting these criteria either. However, they are allowed to hide behind their white coats, test tubes, and Bunsen burners, while decrying everyone else as unscientific.
The conclusions of the January 2014 issue of the Mayo Clinic's online journal Mayo Clinic Proceedings published a large study (Systematic Analysis Underlying the Quality of the Scientific Evidence and Conflicts of Interest in Interventional Medicine Subspecialty Guidelines) that concluded, "Most of the interventional guidelines failed to grade the evidence. When present, most guidelines used lower-quality evidence. Furthermore, most guidelines failed to disclose COIs. When commented on, numerous COIs [Conflict of Interest] were present." Wow. Financially conflicted low quality evidence that wasn't even graded. How's that for Guidelines? In fact, when the Medical Guidelines for 149 different specialties / subsets of medicine were looked at, here's what Mayo found.
- Less than half (69 of 149) of the guidelines graded the quality of evidence.
- Of the 3425 recommendations reviewed, level A evidence supported only 364 of them --- just over 10% (Grade A evidence is defined as Randomized Placebo Controlled Trials --- often referred to as RCT's)
- Nearly two thirds of the guidelines (62% or 92 of 149) failed to mention financial Conflicts of Interest.
- Of those Guidelines that did disclose Financial Conflicts of Interest, over 90% (52 of 57) had them. In the "Conflicted" studies, there were nearly 6 "Conflicts" per.
- Prometheus Laboratories
- Alba Therapeutics
- Alvine Pharmaceuticals
- Abbott Laboratories
- Janssen Pharmaceuticals
- Warner Chilcott
- Given Imaging