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Evidence Based Medicine and Quackery
This page contains the second part of Section 2 of "Why has Orthodox Medicine Failed?". Each subsection can be accessed directly by clicking the title link below, or by scrolling through the article. Science Today.......... Quackery TomorrowMedical Evidence or Medical Ignorance?For the concluding part of this discussion go to the Integrated Medicine page.
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Why Has Orthodox Medicine Failed? - Section 2, Part 2 |
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Science Today........Quackery TomorrowIt is claimed that the difference between orthodox or evidence based medicine and alternative medicine is that the former is based upon science and the scientific method while the latter is not. Although some may suggest that scientific medicine began around 150 years ago (
54 ), in fact the period of scientific medicine is generally considered
to correlate with the commencement of the modern era, a period which commenced around 1750 (
91 ), or even as early as 1600 (
90 ). It is this past 250 year period, the
era of scientific medicine, with which this discussion is concerned. There is absolutely no doubt that the practice of heroic medicine and bloodletting was part of orthodox scientific medicine of that period (
12a,
88a
) . The fact that a different "version" of science was used does not change this simple fact. Given the changeability of science since that period, this fact is perhaps better evidenced by utilising some of the more consistent identifying features of orthodox medicine, such as its
violent reductionist and interventionist nature and its aversion to natural therapies.
The assumption that orthodox medicine can only be identified by its
allegedly scientific nature is rather lacking in validity since it denies
the existence of other much more consistent and indisputable features of
this form of medicine. Throughout the various scientific changes of orthodox medicine, it is the
consistency of these underlying philosophical features which enables scientific medicine to be just as readily differentiated from alternative medicine today, as 200 years ago. Genetic contamination of our food supply of course, like previous pesticide and herbicide contamination, is profit motivated. Many scientists it seems, spend more time devoted to maximising profits than they do to improving public health. When scientists ultimately discovered that the toxic agricultural chemicals they had invented were poisoning the human race then they recommended that these chemicals should be restricted or banned. Now we are told genetic engineering represents the pinnacle of scientific achievement, making possible a whole new range of adulterated crops and the conquering of human disease by therapeutic cloning. When the consequences of genetic contamination of our crops becomes fully apparent however, will the scientists be able to reverse this as easily as chemical contamination? The promises of genetic engineering have been widely welcomed by an ailing medical profession confronted with spiralling increases in the incidence of many major Western diseases. Already however, cloning has been shown to have negative health effects, including, accelerated ageing ( 69a ), heart and blood defects ( 69c ), premature death ( 69a, 69b, 69c ), immune system defects ( 69b ), and other problems ( 69d, 69e ). Perhaps we should not be surprised. After all, genetic treatment of human diseases commonly represents a further abandonment of cause based medicine. It seems that scientists are disinterested in discovering why our hearts, livers, brains, pancreases, lungs, bones, etc., are failing as long as they can be replaced or genetically modified later. But if our brains are failing because of aluminium accumulation, or perhaps because of deficiencies of vitamins or antioxidants, how can this be rectified by genetics, surgery, or drugs? Will genetic engineering really permit us to consume unlimited amounts of aluminium without becoming ill? Perhaps it is true, perhaps the cause no longer matters. Interestingly, while research continues to suggest a link between
consumption of antioxidants and Alzheimer's
disease ( 135,
136
), scientists have confidently predicted that they will cure this
disease by genetic engineering. Although antioxidant research has prompted
Foley and White ( 137
) to comment that "we continue to hope that when the final answer
is established, it will be that the development of Alzheimer's disease can
be delayed or prevented by dietary intake", it would seem that
the promises of genetic engineering will make diet and antioxidants
unimportant. On the other hand, it seems that modern scientific
medicine is increasingly returning to "medieval" remedies such
as the use of leeches and maggots
( 143
). Genetic engineering may even be used to make stronger and more
effective maggots!!! ( 143
). Although wonder drugs can fall from grace very quickly once the
suffering of patients is eventually recognised by doctors, this suffering
is usually not recognised by clinicians but rather is left to research
scientists to discover by the use of clinical trials. We can see yet
another example of this as a result of the recent headlines regarding the
dangers of HRT therapy. In a recent consideration of this matter entitled
"therapy revered today may be shunned tomorrow", Anderson
( 141
) points out that doctors tend to simply follow the leader and believe
"falsely" that "the leader is leading from the
strength of solid knowledge." Anderson continues:"......we
have done a lot to our patients over the years that hasn't stood the test
of time, from excising carotid bodies to reduce asthma, implanting
intercostal arteries to perk up cardiac perfusion and freezing stomachs to
heal ulcers, to more recently, cleansing knees arthroscopically to improve
osteoarthritis." Anderson concludes: "but the mistakes we
make come at a price even as we like to think we are doing good." This is not a matter of which science and medicine should be proud since it indicates
quite clearly that it is established medical doctrine and not scientific facts which determine the direction of modern medicine. Enormous pressure is applied to ensure that medicine does not stray outside its rigid reductionist interventionist philosophy, in spite of the consequences to public health. How can we possibly move forward if we do not challenge commonly accepted beliefs? Challenging of
existing beliefs should be encouraged not punished. Those who oppose the
challenging of accepted beliefs, oppose progress.
It seems, according to established scientific evidence, that for nearly 100 years doctors have been falsely diagnosing a bacterial infection as a personality disorder. How is this possible?
How could so many scientists, from all over the world and over such a long period of time, make such a blatant error? What has been done to ensure that this type of mistake can never happen again? The answer to these questions
are far more important than the discovery of the cause of ulcers because they relate to the
fundamental reliability of science and scientists.
We must address, as a matter of absolute urgency, those aspects of our current system which makes possible the occurrence and perpetuation of such gross errors.
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Medical Evidence or Medical Ignorance? |
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We have seen that the definition of scientific evidence is always changing, so much so in fact, that it seems that this term can only ever be defined for one point in time. In spite of this fact it appears that orthodox medicine, for the most part, may not be based upon scientific evidence at all ( 40, 81, 86, 87, 107 ). The fundamental importance of this stems from the fact that orthodox medicine has only achieved legitimacy because of the claim that it is scientific. According to Willis in this regard ( 114 ): "conventional medicine has had difficulty claiming it was more successful than alternative medicine, but it has always been able to claim that its paradigm was more scientific. It has thus been legitimated through science and able to have its paradigm about illness accepted as the paradigm. The claim that alternative medicine is unscientific then, serves political ends to justify the lack of legitimacy accorded to it." Let us explore what medical authorities themselves have to say about the scientific basis of medicine. The poor quality of medical research has been further highlighted by the following comments of Rennie in 1986 ( 138 ):
These extremely disturbing comments were updated by Rennie 16 years later ( 139 ), in 2002, when he stated that although some progress had been made "an unbiased reader, roaming at random through a medical library, would find in abundance all the problems I described in 1986." Altman ( 140 ) has also recently pointed out, in regard to the widespread problems in the quality of medical research, that "many published reports of randomized controlled trials ( RCT's ) are poor or even wrong." It seems that modern day medical authorities are confirming the thoughts of Roger Williams three decades ago when he said (
9 ):
"when science becomes orthodoxy, it ceases to be science". In the
media, and even in medical literature, it seems we are continually
confronted with "scientific" surveys that suggest a statistical
correlation is evidence of causality. With this type of reasoning the
mistake ridden history of medical science is not too surprising. Statistics,
as has been noted by Kothari and Mehta ( 12
), are "an outstanding failure in modern medicine." 1. Outcome or therapy based - not cause based It makes absolutely no sense whatsoever to consider the virtues or shortcomings of evidence based medicine without first considering the reasons for its introduction. Clearly, evidence based medicine is intended to address inadequacies in our health care system and we must therefore define these inadequacies in detail prior to proposing logical changes. Since I have outlined throughout this article various weaknesses of orthodox medicine which need to be addressed, it is from the perspective of this research that I will consider the shortcomings of evidence based medicine. The three essential fundamental qualities of a health care system are that it is cause based, it is effective, and will do no harm. Evidence based medicine fails to address these needs. In fact, since evidence based medicine is firmly based upon the use of clinical trials, it is outcome based rather than cause based, and it represents a consolidation of the traditional symptomatic approach to health care which is a feature of reductionism and interventionism. Since evidence based medical treatments are evaluated by clinical trials rather than real life clinical practice ( see below ), those treatments which offer rapid suppression of symptoms will be deliberately favoured while slower acting cause based therapies will be deemed to be ineffective ( see also discussion about clinical trials ). In fact, the drug company funding of clinical trials ensures that evidence based medicine is biased against the study of disease causation ( 131 ).Evidence based medicine is also disease oriented rather than health oriented, and it therefore has as its focus the treatment of disease rather than preventative medicine or the maintenance of optimum health ( 128 ). For these reasons, unless nutritional supplements can compete with drugs in producing a rapid symptomatic response, evidence based medicine will further perpetuate the traditional medical bias against nutrition and preventative medicine. Throughout this discussion I have drawn attention to the existence of the longstanding medical bias against nutrition ( see also Medical Bias page ). The continuation of this anti-nutrition bias indicates quite clearly that scientific evidence per se is unimportant to evidence based medicine. In fact, since orthodox medicine readily embraces treatments for which there is little or no scientific basis (12a ), what is acceptable is clearly determined by factors other than scientific evidence. It seems that therapies that have been introduced by members of the medical profession, irrespective of supporting scientific evidence, are traditionally considered acceptable while therapies introduced by "outsiders" are automatically rejected ( 12a, 86a ). Since the emergence of evidence based medicine correlates with the corporatisation of medicine, it is hardly surprising that some see this as just another step in the commercial exploitation of health. It is claimed that evidence based medicine is based upon the establishment of prescribing guidelines from reviews of the scientific literature which enable doctors to quickly access a cross section of the available evidence ( 107 ). However it seems that these guidelines are increasingly being prepared by drug companies who of course favour their own products ( 107 ), a fact which leads to publication bias and attempts to suppress negative trial results ( 118, 119, 120, 121, 122, 123, 124 ), and even a refusal to participate in trials which would compare non drug therapies with drug therapy ( 119, see also Medical Bias page ). In other words there is a deliberate preference for certain types of "evidence", especially evidence which "would guarantee high profile publication or sufficient pharmaceutical sales" (50 ). Evidence based medicine is therefore based upon the most potentially profitable evidence ( 129 ) rather than the "best evidence" ( 50 ). The existence of medical bias in a profession which claims to be scientifically based is fundamentally inconsistent and unacceptable. Medical bias is rooted in commercialisation, deception, and contempt for public health, hardly the traditional qualities of science and scientists. Clearly, the existence of medical bias effectively negates any claim that evidence based medicine is scientific. In this respect the practice of evidence based medicine seems little different to the traditional practices of drug companies promoting their products to doctors by the use of various incentives ( 107, 125 ), and the use of the media by drug companies to promote various diseases which are treatable with their products ( 107 ). The use of clinical trials to establish prescribing guidelines for evidence based medicine has been criticized by medical experts as being "ad hoc" ( 107, 115 ), since such trials have little relevance for the individual patient in the real world ( 107, 115 ) and they tend to promote a reductionist perspective ( 107 ). While randomised controlled trials may have their "own place in causal research, the complexity of outcomes research renders it almost irrelevant as the primary design for health care services policy purposes, in which effectiveness (ie, real world experience) matters more" ( 88 ). Suggestions that clinical trials should be supplemented by surveys of the outcome of real life clinical practice in hospitals and doctors surgeries have been rejected by doctors as an attack on their "clinical freedom" ( 107 ). The term "clinical freedom" it seems, is used by doctors "as a cloak to hide a lack of knowledge about how treatments really impact on patients, and can represent an avoidance of individual accountability" ( 107 ). Given the cost of conducting clinical trials there is also increasing concern that treatment options will be reduced by the failure to utilise untrialed methods. According to Hulinsky ( 107, 116 ), "by discouraging the use of less researched treatments EBM can in the long term lead to cheap and mediocre practice of medicine with less scientific progress." This of course would be a concern for alternative treatments which would not be favoured by expensive clinical trials. As is noted by Moynihan ( 107 ), "in a world of evidence based medicine, it will be those who can afford to research, produce and promote the evidence who will influence the sort of health care being delivered." Moynihan continues: "hence the current bias in medical research, education and practice towards chemical and technological solutions to health problems could well intensify." The significance of this problem is highlighted by the fact that it costs around US$500 million to introduce one new drug ( 130 ). Another difficulty with evidence based medicine, according to Chan and Chan ( 50 ), is its tendency to dehumanise, and fail to understand "the individuality and uniqueness of each patient". Priority is apparently given to impersonal "knowledge" and an awareness of medical literature and specific diseases rather than the practical application of knowledge to an individual patient. In this regard, Chan and Chan claim that "in teaching EBM to medical students, there is a danger of 'dumbing-down' medicine to the lowest common denominator of understanding facts and applying treatment algorithms ". Chan and Chan continue ( 50 ): "the emphasis placed upon acquiring medical knowledge may produce practitioners who have no understanding of the uniqueness of each patient". The relevance of evidence based medicine to the individual patient has also been questioned by Greenhalgh ( 129 ). According to Greenhalgh in this respect: "the sample of participants in a randomised controlled trial is typically drawn from those deemed most likely to benefit from the intervention. It usually excludes the very young or old, the 'non-compliant, and those with co-existing illness." Greenhalgh notes that while the evidence obtained from such clinical trials may apply to the sample of trial participants, it may have little relevance for the individual patient in the real world ( see also Medical Bias page ). Evidence based medicine, according to Vickers ( 94 ), is lacking a firm scientific basis. Vickers ( 94 ) also notes that the term evidence based could equally be applied to alternative medicine. Given these facts and the previously mentioned limitations of clinical trials which form the basis of evidence based medicine, it seems entirely inappropriate to regard "the randomised trial, and especially the systematic review of several randomised trials" ( 127 ) as being the "gold standard for judging whether a treatment does more good than harm" ( 127 ). Until both medical bias, and the ability of drug companies to use clinical trials as a tool to promote their products, have been completely eliminated, trial results should clearly be interpreted with some caution. They should certainly not be the gold standard by which medicine is assessed. Evidence based medicine it appears, represents a change in name more
than anything else. What is needed is for doctors to have more "insight
that springs from understanding" ( 107 ) rather than technological
gadgetry and clinical trials. The definition of what
constitutes scientific evidence urgently needs to be updated thus:
"a remedy can be shown to satisfy the criteria for scientific
evidence for a therapeutic substance if it can be shown by scientific or
epidemiological studies to prevent or contribute to a reversal of the
cause of a condition and its mode of action can be scientifically
explained. Any treatment which lacks this cause based effect and merely
has a symptomatic effect should be clearly distinguished from cause based
remedies and should therefore be relegated to a separate and inferior
class of therapeutic substances. Such a definition would of course
provide an extra incentive for the development of cause based remedies. Perhaps the unscientific basis of modern medicine is now becoming more widely recognised. According to Hilda Bastian ( 107 ): "as consumers become more skilled in assessing the quality of scientific evidence it will be easier for them to see who are the snake oil salesman of today." According to medical experts, one of the reasons for the sort of problems I have outlined throughout this discussion, is the high level of medical ignorance which exists in the medical community ( 13, 106 ). Recently, Kothari (13 ), during an interesting discussion of medical ignorance, has noted that "the biggest discovery of the 20th century is the discovery of human ignorance." According to Thomas ( 106 ) in this regard: " I wish there were some formal courses in medical school on Medical Ignorance; textbooks as well, although they would have to be very heavy volumes. We have a long way to go." The concerns expressed by Kothari and Thomas further confirms the point I made previously that medical scientists tend not to be aware of the limitations of their knowledge. It is an indictment against modern medicine if doctors need to be taught the limitations of their knowledge. At the risk of being severely admonished for stating the obvious, I could not refrain from noting the possible connection between the necessary thickness of medical ignorance textbooks and reductionism. Is the necessary thickness of such books not directly related to the fact that modern medicine expresses no interest in the "whole truth", and actively seeks to exclude more and more information from the study and treatment of health and disease? If so, we do indeed have a long way to go. The question is, are we going in the right direction? *Orthodox Medicine + Complementary Medicine To access the concluding part of this discussion and recommendations for positive change, refer to the Integrated Medicine page.
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| Links and References | |||
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