Zealots of Evidence Based Medicine

Evidence Based Medicine (EBM) is being weaponized against those who don't align with mainstream medical paradigms. It is brandished against those who practice alternative forms of medicine and against those for whom natural medicine is integrated within their culture. The RCT first approach puts science before the patient. And the following has become cult-like costumed with blinders towards the weak areas in medical research, medical policy and practice. The contest between EBM dogmatists and alternative forms of medicine is a distraction from medical advancement.

The term Evidence Based Medicine (EBM) is relatively new having only been published for the first time in 1992. The innovation of EBM is largely credited to Dr. Sackett and colleagues who began refining EBM in response to Dr. Cochrane's challenge that a critical summary of the medical profession was much needed. As well as in accordance with a problem-based learning methodology that would be taught at McMaster. It began as a series of articles explaining basic concepts, then evolved into courses and finally into the ideology that it is today. In the original 1992 article EBM is described as follows:

"Evidence-based medicine de-emphasizes intuition, unsystematic clinical experience, and pathophysiologic rationale as sufficient grounds for clinical decision making and stresses the examination of evidence from clinical research. Evidence-based medicine requires new skills of the physician, including efficient literature searching and the application of formal rules of evidence evaluating the clinical literature."

And so here starts the emphasis upon clinical randomized control trials and the assumption that observational or other studies should be discredited.

Peer review as a screening method for the publishing of randomized control trials became the gold standard without much evidence as to it's effectiveness. In fact, what research does exist finds the opposite. It has only been recently, in the field of biomedicine, that there has been any research conducted into the role and competencies of editors and peer reviewers. This research finds that peer review ethics are not maintained, peer review does not produce better quality published research and the only thing close to a system-wide standard in this regard is the 'Ethical Guidelines for peer reviewers' from the Committee on Publication Ethics (COPE). Read a more in depth summary on this topic HERE. Despite being common practice, analysis suggests the reliable reputation of peer review RCT's is currently false.

Second, observational studies have their place and for good reason. Observational studies are intended to be undertaken when RCT’s would be unethical. Many important nutritional studies have been observational. Some of the most cited observational studies include “prevention of birth defects with folic acid” and “controlling obesity and insulin resistance through activity and diet.

”From the outset, there was criticism towards the anti-qualitative sentiments of EBM. Feinstein, one of the contributors to EBM’s development, rightly highlighted in one example that both insulin for diabetic acidosis and penicillin for bacterial endocarditis were introduced through single study articles and therefore would never have been. He argued that EBM proponents have an over-reliance on the RCT. RCTs are simply a comparison of one treatment to another treatment, not some superior form of truth. In relying on these epidemiological tools, EBM does not incorporate the “soft” data that clinicians use to formulate diagnoses and treatments. These “soft” data include type and severity of symptoms, and rate of growth of illness. He argued that additionally, social and political contexts within which patients live are equally not addressed in EBM.

Importantly, critiques of EBM cite the potential for abuse of the label “best available evidence.” Health care policy makers and both government and private payers can coerce and justify reimbursement based on the “best available evidence” and marginalize practice that does not conform to these standards.

Followers of EBM seem to forget that the medicine and pharmaceuticals of today are often derived or inspired by centuries old Herbal, Ayurvedic or Chinese Medicine with most pharmaceutical medicines being derived from fungi, bacteria, herbs and soil.

If you ask, for example, a Medical Herbalist Practitioner or patient “what is medicine?” To them, the answer is “herbal medicine.” Herbal medicine IS medicine.

The point being, that there are many types of medicine. Many of which were founded upon centuries of observational studies or perhaps even ephemeral methods which are less understood by the Western Scientific Community.

Regardless of methodology, these ancient medicine systems have fed into the birth of medicine as we know it today. There is a difference between treating scientific method as dogma and utilizing it for the tool that it is, meanwhile understanding where it falters. With blinders on and contest to distract the ego, much needed refinement of medical policy, research and practice is being delayed. With government and health care policy makers being susceptible to coercion, and medical practitioners being too emotionally involved in such petty contests as EBM vs. alternative, who can we trust to methodically and rationally refine policy and methodology on behalf of public healthcare? What do you think?

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