Evidence-based Bias

Through all of my training, one question from staff physicians has been constant, “Where's the evidence?” In fact, this evidence-based medicine (EBM) approach has become the most popular weapon against the integrative holistic movement. “The evidence does not support that," or, my personal favorite, “I don’t believe in that who-ha,” which is an actual quote from a physician according to one of my recent patients. The scrutiny is relentless.

When you look, really look, there is a plethora of evidence supporting proper nutrition, mind-body medicine, spirituality and herbal therapy. Evidence casting a negative light on certain products, always seems faulty in some major way: Wrong dose, wrong form, not studied against a medical standard. I think conventional physicians use these accusations purely out of ignorance. It’s easy to play the EBM card, continuing to refute the possibility that there might actually be things outside of prescription medications that can help people.

Additionally, where does all of this “evidence” come from? In 2003, the Journal of the American Medical Association reviewed results of 370 clinical trials to determine any bias in drug company-sponsored research and concluded that industry-sponsored studies were significantly more likely to reach conclusions that were favorable to the sponsor than were non-industry studies [Source: Als-Nielson]. So what we learn is, a lot of this evidence is born of for-profit funding. Seems like a slight conflict of interest.     

All of this leads me to a report by the British Medical Journal Clinical Evidence, released in May 2008. This group is responsible for reviewing medical literature and putting out evidence-based recommendations for nearly all conditions. The journal considers itself, "the international source of the best available evidence for effective health care.” Around 2,500 commonly used medical treatments were reviewed by BMJ, revealing this overall assessment [Source: BMJ]: A staggering 46 percent of common medical therapies have unknown effectiveness! Who’s practicing true evidence-based medicine now? I also find it a bit alarming that 4 percent of therapies are likely to be ineffective or harmful.

So, we don't know if a) a common treatment is effective, or b) whether the evidence we have was determined by the same pharmaceutical company that's trying to make a profit off the product. Concerned yet?

It’s not all about the evidence. People aren't study subjects. The value in truly listening to a patient, understanding them and making a decision not based solely on evidence is being lost. Each person is unique and doesn't fit into the parameters of a study protocol. Rather, they need individualized recommendations based on a holistic assessment.

Don’t get me wrong, evidence is important. It’s one tool in the bag doctors use to guide people to health. Good common sense, experience and love are a few of the others. I think Dr. Ralph Moss, an authority in complementary and alternative therapies for cancer, sums it up well on his Web site, “When evidence-based medicine becomes a means of strangling diagnostic skill and reducing patients to algorithms or numbers on a checklist, medicine can no longer call itself the art of healing [Source: Cancer Decisions].”

Lots More Information

Related ArticlesSources
  • Bodil Als-Nielsen, M.D. (2003). Association of Funding and Conclusions in Randomized Drug Trials, A Reflection of Treatment Effect or Adverse Events? JAMA, 290:921-928.
  • How Much Do We Know? BMJ Clinical Evidence. Accessed May 9 2008:http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp
  • http://www.cancerdecisions.com/051108.html