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.

Why Has Orthodox Medicine Failed? - Section 2, Part 2

Science Today........Quackery Tomorrow

It 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.

Since medical authorities suggest that anything that is not based upon established scientific concepts or scientific evidence is quackery ( 56, 65 ), it is imperative that the nature of this evidence be examined in some detail. There are two aspects relating to scientific evidence which are of particular importance. The first of these relates to the inconsistency and changeability of scientific evidence over time, while the second aspect concerns the status of orthodox medicine today from a scientific point of view. While I will deal with the former aspect below, I will consider the latter aspect in the next subsection entitled "Medical Evidence or Medical Ignorance?"

No one would deny that science is forever changing. Especially in the medical world, scientific concepts come and go as if they were merely fashions. This creates a fundamental problem for science and medicine. Since scientific knowledge and beliefs can only ever be correct to a level which is consistent with mankind's knowledge and development at that particular point in time, how can scientific evidence be relied upon? What is correct today may become incorrect tomorrow, and vice versa ( 12, 12a, 141 ).

Since it is important that medicine has an appearance of an acceptable level of stability and consistency, this changeability of scientific knowledge tends not to be acknowledged, especially at a clinical level. On the other hand, it is vitally important that funds for continuing medical research are attracted by an appearance that scientific research is constantly advancing.

As a patient, my experience has been that the attitude of doctors reflects a desire not to acknowledge the changeability of science, especially when it comes to the use of of diagnostic tests. Test results are generally considered to be conclusive, as if the entire testing procedure had attained a level of perfection many years ago. In fact, even when obvious symptoms are present, a negative test result may falsely exclude a diagnosis for many years. Peculiarities and inconsistencies in test results, even in the presence of extensive clinical evidence, are commonly dismissed rather than question the efficiency and accuracy of testing procedures. Time and again doctors and medical scientists make the same glaring mistake - simply because something is not yet measurable or provable by current scientific methods does not mean it does not exist. While many lessons are learned from scientific progress, this fundamentally basic lesson it seems, is never learned. To the scientific community, that which is not scientifically provable today simply does not exist. This is a huge problem for medicine because it means that such fundamental things as common sense and vital energy simply do not exist.

Strange as it may seem, this refusal to acknowledge the limitations of, and changeability of, science, is a fundamental part of scientific thinking referred to as modernism ( 92 ). Whereas modernism and therefore scientific medicine, is based upon "universal optimism" ( 92 ) and a refusal to acknowledge the limitations of scientific knowledge, post modernism and alternative medical paradigms on the other hand, openly accept ignorance and the limitations of science ( 5, 92 ). The fact that scientists concede that the awareness of the limitations of science is a relatively recent discovery ( 96 ) is cause for serious concern, if not alarm. How is it, one may well ask, that supporters of reductionist science, which has been continuing for centuries ( 107, 108  ), could be unaware of the limitations of this fragmented tunnel vision view of reality ( 107, 108 ) which has little or no interest in the whole truth ( 106 ). It is interesting to observe the "universal optimism" of science ( 92 ), and the "excessive optimism" of the normal mind ( see Body Types page ).

The changeability of science means that at any point in time a percentage of medical beliefs will be totally incorrect. In other words, what is considered science today will become quackery tomorrow, and what is quackery today, will become scientific facts tomorrow ( 8, 12a, 141 ). This fashionable nature of medical science is graphically illustrated by the history of scientific medicine during the past 250 years.

In the 18th and 19th centuries, mainstream scientific medicine was characterised by the practice of bloodletting ( 12a, 57, 58, 59, 88a ). This was referred to as the age of "heroic medicine" ( 57, 58 ). Withdrawal of the patient's blood by whatever means, including venesection and the use of leeches ( 57, 58 ), was the accepted scientific treatment for all manner of illnesses, including, fever, pain, muscle spasms, congestion, inflammation, and mental disease ( 57, 58, 59 ). Heroic medicine also utilised the scientific practices of cupping, blistering, purging and sweating in an attempt to restore health ( 57, 58 ). The practice of blistering was performed by deliberately giving the patient a second degree burn and then draining the resulting sore (57, 58 ). Purging, which was done to cleanse the body of toxins or "irritants" ( 57 ), was performed by giving the patient as large a dose "as the patient will bear" ( 57 ) of mercuric chloride which of course subsequently caused mercury poisoning ( 57 ). Although patients objected to bloodletting because of "fear" ( 58 ), this practice of scientific medicine continued for "centuries" ( 55 ) before it was finally abandoned.

The use of blood letting and purging by mainstream medicine gave birth to the various forms of alternative medicine which were considered to be quackery ( 60, 61, 62 ). Although alternative practitioners or "quacks" also resorted to purging and sweating like scientific doctors, they rejected the practice of bloodletting and instead of toxic mercury based purgatives, they used non toxic vegetable compounds to induce purging ( 60 ). At that time, suggestions that nutrition or exercise could benefit health were also part of alternative medicine and were regarded as quackery ( 62 ). It is little wonder that doctors argued about the cause of beri beri for two hundred years!

While the era of heroic medicine is sometimes considered to have preceded the introduction of scientific medicine ( 8 ), as I have previously indicated, scientific medicine is generally considered to be a part of the modernist era which goes back at least to the mid 18th century, around the time the struggle to legally monopolise scientific medicine began ( 89 ). Medical scientists understandably often seek to distance themselves from the mistakes of the past by claiming every fifty years or so that a "new" form of scientific medicine, such as "biomedicine" ( 8 ) or "evidence based medicine" ( 50 ) has been developed. Of course, 100 years from now, the scientific medicine of today will also be ridiculed as the new scientific medicine emerges. In fact, the very hallmark of scientific medicine is its changeability and inconsistency.

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.

It is indeed interesting to note in this respect, the impact of the "violent" nature of interventionism over the past 200 years. Around 200 years ago, the "fear" patients experienced regarding the orthodox medical practice of bloodletting ( 58 ) was a central factor in the rising popularity of alternative medicine. Today however, 200 years later, patients are still turning to alternative medicine because of "fear" ( 93 ). The practice of grave robbing, which also adversely effected the popularity of orthodox practitioners in the 18th century ( 58 ), has long since been abandoned, only to be replaced today by the practice of organ stealing ( 117 ).

The traditional rejection of nutrition as quackery and the inability of science to embrace new concepts, particularly those which are considered to lie outside established medical doctrine, continues to retard progress in medicine today. The lesson which has yet to be learned by the scientific community, especially when it comes to health and nutrition, is that we should not be restricted by the knowledge of today ( 20 ). As has been noted by Challem ( 20 ), "at nearly every milestone in vitamin research, scientists have assumed they've reached the pinnacle of knowledge, only to later realise that new discoveries force a revision of older beliefs". Challem concludes ( 20 ): "our view and vision of nutrition may be limited by what we know today, but we should leave the door open for what we have not yet discovered".

It is not the awareness of what we currently know which makes a great scientist, but rather, an awareness of what we do not know. According to Kothari (13 ), the greatest scientists are also the most humble because they have this awareness of the limitations of their knowledge. While humility is associated with increased awareness, arrogance is always associated with blindness and indifference. The importance of this point is further highlighted by Anderson ( 141 ) during his consideration of the changeability and inconsistency of medical science. According to Anderson ( 141 ) one of the major problems is "the perception we know more than we know" which he describes as "a notion more dangerous than knowing what we don't know."

When it comes to nutrition, the common catchcry of doctors today is that everyone gets sufficient nutrients from their diet ( this belief has now been scientifically disproved - see B Vitamins page ), and therefore, as long as they consume the RDA of each nutrient it is virtually impossible for anyone to need nutritional supplements ( 20, 63, 64 ). Although, as I have previously indicated, the relevance of the RDA system has been rejected by eminent scientists ( 9, 99 ), I will briefly examine some recent developments regarding the RDA's.

The RDA system is subject to the same inconsistencies as occurs in other areas of science. Although, according to the Food and Nutrition Board in 1973, American adults required 45mg of vitamin C and 400mcg of folate or folic acid daily (109 ), by 1989 Americans required 60mg of vitamin C and only 180 - 200mcg of folate ( 66 ). Today these requirements have changed to 75 - 90mg of vitamin C ( 67 ), a 100% increase since 1973, and 400mcg of folate ( 68 ), which represents a 100% increase in ten years. As far as pregnant women are concerned, in 1973 they required 800mcg of folate daily (109 ) whereas in 1989 they only required half as much ( 66 ). Ten years later however, this had been increased to 600mcg ( 68 ).

It seems that not only do the amount of nutrients we all require vary over time, but further, the daily requirement also depends upon which country we happen to live in. Australian adults for instance, only need 40 - 50mg of vitamin C ( 69 ), around half of what Americans require, and 200mcg of folate ( 69 ), also half of the American requirement. Apparently Australians who travel to America would need to double their intake of vitamin C and folate.

In view of the attitude of medical scientists to nutrition it is hardly surprising that they have been responsible for some terrible mistakes, not only because they resisted the discovery of nutritional diseases, but further, even after the essential nature of vitamins and minerals were discovered, it was the scientists who also discovered how to process these essential nutrients out of our food. When people developed deficiency diseases from eating this impoverished food however, it was science that came to the rescue by enabling us to manufacture synthetic vitamins and add these back to the foods from which they had been removed by processing. This is apparently, all part of scientific progress..... and now they tell us they want to add the genes of fish to tomatoes.................  

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 ).

The changeability of medicine, within the confines of its own self imposed restrictive perspective, is perhaps best reflected by the constantly changing medical pharmacopeia. New drugs are constantly being introduced, often amongst a fanfare of publicity, only to be subsequently quietly restricted or withdrawn after their ineffectiveness and toxicity become fully apparent. Logic would dictate that if science is proceeding in a positive direction with respect to the drug treatment of disease, then the total number of drugs which are necessary, and hence the size of the pharmacopeia, should be decreasing. The truth of course is quite the opposite, as the total number of medical drugs increases, the more we seem to need more. There is absolutely no sign that the proliferation of prescription drugs which has occurred over the past 100 years has correlated with an improvement in health and the need for less drugs in future. The expanding size of the medical pharmacopeia correlates with a deterioration in public health, including an explosion in the incidence of iatrogenic diseases and an increasing incidence of all the major Western diseases. This matter goes to the very heart of the allegedly scientific basis and effectiveness of modern medicine.

A typical example of the failure of drug therapy is the use of benzodiazepines to treat anxiety and insomnia. This group of drugs, which include valium ( diazepam ), serepax ( oxazeparn ), xanax ( alprazolam ), mogadon ( nitrazepam ), rohypnol ( flunitrazepam ), and many others, were regarded as a general "panacea" ( 71 ), and were considered the wonder drugs of the latter half of the 20th century. This family of drugs reached a maximum of 32 million prescriptions annually in the UK ( 71 ) while in the US, between 1965 and 1985 a total of 1.5 billion prescriptions were written ( 70 ) making benzodiazepines the "most commonly prescribed drugs in the Western world" ( 72 ).

Although the introduction of benzodiazepines was no doubt based upon impeccable scientific evidence, the widespread use of these drugs was soon followed by some completely new but less publicised scientific evidence which suggested their use should be restricted. If taken for more than a few weeks, benzodiazepines were found to frequently cause dependence as well as anxiety and insomnia, the same symptoms for which they were prescribed ( 71, 72, 73 ).  It was also discovered that benzodiazepines tended to have pronounced and protracted withdrawal effects which may even occur during continued use if the dose is not steadily increased ( 71, 72, 73, 74 ). It has also been claimed that benzodiazepines may effect the next generation if taken during pregnancy ( 73 ). Ironically, it seems that it was the patients and not the doctors who first became aware of the chronic ill effects of these drugs ( 110 ).

Since withdrawal from benzodiazepines may cause symptoms which are similar but more severe than those for which treatment was initially prescribed ( 72 ), many doctors who are not aware of these withdrawal effects ( 73 ), may re-prescribe these drugs in the false belief they are treating an anxiety disorder rather than the withdrawal effects ( 71, 74 ). These facts have led to recent warnings about the prescription of benzodiazepines ( 75 ).

It seems ironic, that as doctors are busily prescribing benzodiazepines in their various clinics, other clinics have to be established in order to try and take patients off these highly addictive drugs ( 73 ). Since the recovering benzodiazepine addict may need additional drugs to enable him/her to endure the recovery process, which can last for twelve months or more, there is only one winner in all of this and that is the drug companies. Of course, the entire benzodiazepine saga has been based upon scientific evidence, as was the case also with the predecessors of the benzodiazepines, namely the barbiturates, which also suffered a similar fate.

The reader who wishes to read about how easily addiction to prescription drugs can occur, is advised to read Carol's story ( 76 ).

When it comes to the adverse effects of prescription drugs, particularly congenital effects, it should never be forgotten that complete knowledge of these effects is acquired by doctors only by clinical use and first hand observation of human suffering, both in this generation and the next. Since there are "few drugs or operations that are not in fact experimental" ( 12 ), patients unwittingly become human guinea pigs in medical experiments. Patients and their offspring must be made to suffer if doctors are to learn the ill effects of each new drug. The most amazing thing about all this is that doctors rarely seem to question the intrinsically violent nature of prescription drug treatment. This same lesson must be learned repeatedly with the introduction of each new drug.

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."

Another interesting example of medical progress occurred recently when it was discovered that peptic ulcers are commonly caused by an infection. In 1982 Australian doctors Barry Marshal and Robin Warren caused a revolution in medical thinking by discovering that infection with Helicobacter pylori was a causative factor in the formation of stomach ulcers ( 77, 78, 79, 111 ). This discovery was so revolutionary that their findings were rejected and scoffed at by their medical colleagues, so much so in fact that Marshall resorted to deliberately infecting himself with H. pylori in order to prove his point ( 79, 111 ). H. pylori infection was subsequently found to be the cause of 80% of stomach ulcers and 90% of duodenal ulcers ( 78 ). In spite of overwhelming scientific evidence, it was not until 1994,12 years after this discovery, that H. pylori infection was officially recognised as the cause of most peptic ulcers ( 78, 79 ).

This 12 year period during which the findings of Marshal and Warren were rejected and ridiculed in spite of overwhelming scientific evidence, clearly represents a traditional part of the process of change within the medical community ( 9, 35, 80 ). Any scientist, no matter how reputable, who makes a significant medical discovery will be subjected to this tirade of criticisms and insults which will be directly proportional to the importance of their discovery and the degree to which it challenges established medical dogma ( 35, 80 ). In other words, the more important the discovery, the more intense will be the condemnation from the remainder of the medical profession ( 9, 35, 80 ). Furthermore, this condemnation will occur even if the scientist concerned can produce conclusive scientific evidence of his discovery ( 9, 35, 80 ). So prominent is this ideological rigidity of modern medicine that it has even been suggested that the initial rejection of a scientific discovery by the scientific community should become a prerequisite for the granting of a Nobel Prize! ( 80 ) 

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.

The whole history of ulcer treatment and medical theories about the cause of ulcers, provides a fascinating insight into the nature of science and scientific evidence. Prior to the discovery of H. pylori infection in 1982, scientific evidence  indicated that ulcers were caused by stress, personality, and excessive secretion of acid ( 78, 79, 112, 113 ). Initially it was considered that stress was the main cause and ulcer patients were advised to "relax", "avoid worry and arguments", eat regular small meals and have plenty of sleep ( 79 ). As scientific evidence accumulated however, it was found that the ulcer patient had a certain type of personality which was described as the "ulcer personality" ( 79, 112, 113 ). Although initially the ulcer personality was commonly considered to be typified by the "hard driving executive" ( 79 ) or the person with repressed emotions ( 112 ), scientific research eventually discovered that the ulcer patient suffered from an "oral dependent psychic conflict" ( 113 ) which was characterised by an "excessive desire to be fed and loved" ( 113 ).

According to Spiro, in his authoritative text on gastroenterology ( 112 ), the ulcer patient can be described thus: "in psychiatric jargon, the duodenal ulcer patient has developed a conflict related to the persistence of strong infantile wishes to be loved and cared for and a repudiation of those wishes by the adult ego or external circumstances. In this view, milk is love and the mother; a peptic ulcer makes it possible to be taken care of and mothered in a respectable fashion!" It is indeed difficult to believe that such bizarre unscientific theories were promoted only 20 years ago, particularly by those who claimed that nutrition was quackery. Now of course, the desire to be loved has been replaced by the desire for antibiotics! How many other examples of such erroneous beliefs are there that we have yet to discover?

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.

Over time we have been told that the practices of bloodletting and poisoning patients with mercury based laxatives is scientific while nutrition is quackery, we have been told that vitamin deficiency diseases such as beri beri and pellagra are actually caused by infections, and we have been told that H. pylori infection is actually a personality disorder caused by a desire to be loved. Medical history is littered with mistakes made by scientists who refused to accept the limitations of their knowledge. Both their perception of what they did not know and their awareness of what constitutes scientific evidence was hopelessly distorted. These mistakes were initiated by a few scientists and then repeated and perpetuated by others without any real evidence. 

Evidence considered throughout this discussion reveals that a percentage of what we know today as established scientific and medical facts, will be shown in the years to come to be sheer quackery. The willingness of doctors and scientists to openly admit this today is a measure of their honesty and their greatness.

Medical Evidence or Medical Ignorance?

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.

According to Brighthope ( 40 ), who quotes from an editorial in the British Medical Journal, around 85% of medical treatments are not supported by solid scientific evidence and only about 1 % of medical journal articles are "scientifically sound". Medical journal articles it seems, are of insufficient standard or quality to serve as a basis for "evidence based medicine" ( 40 ). Brighthope continues ( 40 ): "there is a poverty of medical evidence to support the majority of medical practices". Interestingly, it seems that when it comes to evaluating the scientific quality of medical journal articles, it is not just the scientific substance of the article itself which is important, but additionally the name of the journal in which the item is published also adds to, or subtracts from, its credibility ( 54 ), if not its scientific substance.

Similar concerns have recently been reiterated by the Royal Australian College of General Practitioners ( 81) who claim that in "both orthodox and unorthodox medicine it would seem there is no evidence for many commonly used practices and little evidence for others". It appears, according to the College ( 81 ), that standard medical practices are "only loosely based on evidence". The College also notes that orthodox medicine normally expects that alternative therapies should be more soundly based on evidence than are the practices of orthodox medicine. Orthodox medicine it is claimed, should be a "little more self critical" ( 81 ). The fact that many treatments used by orthodox medicine have not been "rigorously tested" has also been noted by Barrett ( 10 ) who acknowledges that this needs to be rectified.

In a revealing discussion about the orthodox versus alternative debate, Burne ( 95 ) refers to medical evidence which reveals that 60 % of orthodox medical treatments "have never been subjected to proper trials." Burne cites two recent examples of medical treatments which have caused thousands of deaths, in one instance, this was simply because of the refusal to publish negative trial results. According to Burne ( 95 ): "there is a strong whiff of hypocrisy in OM's* assertion of high scientific principles: its own record of untested and dangerous treatment dwarfs anything achieved by CM+." When medical authorities themselves refer to the poor quality of medical research as being a "scandal" ( 118 ), there is clearly need for urgent action.

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".

Further confirmation of the unscientific nature of orthodox medicine is evidenced from the fact that "scientific" health care is dependent upon a statistical approach  ( 54, 95 ) rather than scientific evidence as such. According to Smith ( 54 ), the aim here is to determine which therapy has the "greatest odds of helping".

The problem with this approach however, is that a statistical correlation does not prove cause and effect ( 82 ) and frequently gives incorrect results ( 95 ). Diabetes for instance, is often associated with obesity, but does this mean that obesity causes diabetes, or is it the cause of the obesity that causes diabetes? Similarly, peptic ulcers were long thought to have been caused by a personality disorder because of an alleged statistical correlation. This has been described as the "post hoc fallacy" ( 82 ) and it is this type of reasoning which is said to be responsible for many "superstitious and erroneous beliefs" ( 82 ). According to Williams ( 9 ): "statistics have a lamentable tendency to give answers only to those questions that are genuinely unimportant or that are so obvious that they hardly needed asking. The result is that all too often our attention is deflected from what might be significant to what is patently insignificant."

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."

In spite of the fact that medical authorities claim that there is generally little or no scientific basis for the various practices of orthodox medicine, it appears that medicine has now become "evidence based" ( 12a, 50, 83, 84, 94, 107, 126, 127 ). Although evidence based medicine is claimed to relate to each stage of health care, from diagnosis through to treatment ( 126, 127 ), its primary application is in the use of clinical trials to determine treatment strategies ( 12a ). According to Dalen ( 12a ) in this regard, evidence based medicine involves the use of therapies that have "been shown to improve well-defined patient outcomes by well designed appropriately powered, randomised, controlled clinical trials." Since it is frequently claimed that evidence based medicine is "scientific" while alternative medicine is unscientific, it is important that we explore the merits of evidence based medicine in some detail. Evidence based medicine is characterised by various shortcomings, the most important of which I have listed below.

1. Outcome or therapy based - not cause based
2. Excessive reliance upon clinical trials favours a symptomatic reductionist perspective.
3. Favours therapies supported by commercial interests prepared to fund research and clinical trials.
4. Does not emphasise nutrition.
5. Disease oriented - not focused upon optimum health.

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.

From the point of view of a patient who was medically treated before medicine became evidence based, it is very disturbing to learn now that the medical treatments which were prescribed for me were based upon "authority" ( 83, 107 ) and not evidence. Patients were not informed of this fact.

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.

The continuing invention of new forms of allegedly scientific medicine such as "biomedicine", "evidence based medicine", and "integrative medicine", raises questions as to precisely why these various forms of medicine were invented, which one is the most scientific, and how many more versions will there be? Of course, all these different versions were invented because of the failure of the previous version and the desire of doctors and scientists to distance themselves from the mistakes of the past. It would be inconceivable to scientists for instance, to think that the practice of bloodletting occurred under the same version of scientific medicine as is practised today. Throughout all these name changes however, the fundamental reductionist interventionist philosophy of medicine which was responsible for the practice of bloodletting, remains essentially unchanged.

There is, as I have previously indicated, considerable resistance within the medical community to any change to the fundamental philosophy of medicine, and herein lies an enormous problem for future advancement. The idea that an existing paradigm can be continually patched up as its shortcomings are realised is lacking in any reasonable level of common sense or logic. Continuing failure of a paradigm necessitates that changes must be fundamental and not just peripheral. In spite of this however, there is a continuing determination to avoid significant changes to medicine's reductionist interventionist philosophy.

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?

According to medical authorities themselves, orthodox medicine is unscientific and biased and involves a considerable degree of medical ignorance, a burden which rests squarely upon the shoulders of our medical educators. As a lay person I must admit that it is indeed difficult to disagree with this stance. Even a casual examination of orthodox medicine, from bloodletting to the present day, leaves one with the distinct impression that whatever orthodox medicine is based upon, it is certainly not science. To suggest otherwise would be to label science as profit driven, erratic, inconsistent, unreliable, misleading, and downright dangerous.

*Orthodox Medicine                      ⁺ Complementary Medicine

To access the concluding part of this discussion and recommendations for positive change, refer to the Integrated Medicine page.