The Sickness Of Evidence-Based Medicine

heart murmur in dogs

It seems that whenever we post controversial topics, the skeptics always ask for research and evidence.  Often we can back our claims up with research, but sometimes research fails or is glaringly absent – but the common sense behind the issue prevails.  It seems there is a large chasm between good old common sense and the supposedly ‘gold standard’ of science – evidence based medicine.  The reasons for this might surprise you.

In a ground-breaking report, Steve Hickey, PhD and Hilary Roberts, PhD expose evidence-based medicine as unscientific and explain why it is falling out of favor with health care professionals.  The authors state that evidence-based medicine (EBM), “fosters marginally effective treatments, based on population averages rather than individual need. Its mega-trials are incapable of finding the causes of disease, even for the most diligent medical researchers, yet they swallow up research funds. Worse, EBM cannot avoid exposing patients to health risks. It is time for medical practitioners to discard EBM’s tarnished gold standard, reclaim their clinical autonomy, and provide individualized treatments to patients.”

Furthermore, evidence-based medicine is found to be unscientific for the following reasons:

“Historically, physicians, surgeons and scientists with the courage to go against prevailing ideas have produced medical breakthroughs. Examples include William Harvey’s theory of blood circulation (1628), which paved the way for modern techniques such as cardiopulmonary bypass machines; James Lind’s discovery that limes prevent scurvy (1747); John Snow’s work on transmission of cholera (1849); and Alexander Fleming’s discovery of penicillin (1928). Not one of these innovators used EBM. Rather, they followed the scientific method, using small, repeatable experiments to test their ideas. Sadly, practitioners of modern EBM have abandoned the traditional experimental method, in favor of large group statistics. “

“There is a further problem with the dangerous assertion implicit in EBM that large-scale studies are the best evidence for decisions concerning individual patients. This claim is an example of the ecological fallacy, which wrongly uses group statistics to make predictions about individuals. There is no way round this; even in the ideal practice of medicine, EBM should not be applied to individual patients. In other words, EBM is of little direct clinical use. Moreover, as a rule, the larger the group studied, the less useful will be the results. A rational patient would ignore the results of most EBM trials because they aren’t applicable.”

“EBM breaks other fundamental laws, this time from the field of cybernetics, which is the study of systems control and communication. The human body is a biological system and, when something goes wrong, a medical practitioner attempts to control it. To take an example, if a person has a high temperature, the doctor could suggest a cold compress; this might work if the person was hot through over-exertion or too many clothes. Alternatively, the doctor may recommend an antipyretic, such as aspirin. However, if the patient has an infection and a raging fever, physical cooling or symptomatic treatment might not work, as it would not quell the infection.In the above case, a doctor who overlooked the possibility of infection has not applied the appropriate information to treat the condition. This illustrates a cybernetic concept known as requisite variety, first proposed by an English psychiatrist, Dr. W. Ross Ashby. In modern language, Ashby’s law of requisite variety means that the solution to a problem (such as a medical diagnosis) has to contain the same amount of relevant information (variety) as the problem itself. Thus, the solution to a complex problem will require more information than the solution to a straightforward problem. Ashby’s idea was so powerful that it became known as the first law of cybernetics. Ashby used the word variety to refer to information or, as an EBM practitioner might say, evidence.

“The gold standard in science is called Solomonoff Induction, named after Ray Solomonoff, a cybernetic researcher. The power of a scientific result is that you can easily repeat the experiment and check it. If it can’t be repeated, for whatever reason (because it is untestable, too difficult, or wrong), a scientific result is weak and unreliable. Unfortunately, EBM’s emphasis on large studies makes replication difficult, expensive, and time consuming. We should be suspicious of large studies, because they are all but impossible to repeat and are therefore unreliable. EBM asks us to trust its results but, to all intents and purposes, it precludes replication. After all, how many doctors have $40 million dollars and 5 years available to repeat a large clinical trial? Thus, EBM avoids refutation, which is a critical part of the scientific method.”

“Diagnosing medical conditions is challenging, because we are each biochemically individual. As explained by an originator of this concept, nutritional pioneer Dr. Roger Williams, “Nutrition is for real people. Statistical humans are of little interest.”Doctors must encompass enough knowledge and therapeutic variety to match the biological diversity within their population of patients. The process of classifying a particular person’s symptoms requires a different kind of statistics (Bayesian), as well as pattern recognition. These have the ability to deal with individual uniqueness.The basic approach of medicine must be to treat patients as unique individuals, with distinct problems. This extends to biochemistry and genetics. An effective and scientific form of medicine would apply pattern recognition, rather than regular statistics. It would thus meet the requirements of being a good regulator; in other words, it would be an effective approach to the prevention and treatment of disease. It would also avoid traps, such as the ecological fallacy.Personalized, ecological, and nutritional (orthomolecular) medicines are converging on a truly scientific approach. We are entering a new understanding of medical science, according to which the holistic approach is directly supported by systems science. Orthomolecular medicine, far from being marginalized as “alternative,” may soon become recognized as the ultimate rational medical methodology. That is more than can be said for EBM.”

If you are interested in researching nutrition and treatment options for your dog, keep this work in mind.  Although evidence-based medicine is in its relative infancy, people are already starting to question its long term efficacy and are looking for alternate solutions that better embrace the concept of health.  Homeopathy as a form of medicine is growing by 20% every year as people struggle to escape the cycle of disease that modern day medicine can cause.

For the full article and a glimpse into the future of medicine, read here.

Related Posts

Popular Posts