There is a disturbing trend occurring in the practice of medicine today: Medical journals publish poorly designed, poorly controlled and poorly reviewed clinical trial evidence, and the medical establishment accepts these negative and equivocal results to approve of and use folk medicine as evidence-based medicine (EBM).
Dr. Mark Crislip, M.D., an infectious disease specialist, sums up the problem very succinctly: “It is an oddity of medicine. I would wager that astronomy journals do not publish editorials touting astrology as a solution for difficult problems. Similarly, psychology journals do not look to psi and chemistry journals do not advocate the methods of alchemy. In medicine, the editors (of medical journals) have no problem with suggesting nonsense … .”
Modern medical procedures follow years of experimental testing and scientific research analysis. However, if this part of the scientific process is ignored and only clinical trials are used as evidence, then the scientific process is subverted and medicine is corrupted. In fact, being misled by clinical trial results is exactly what physicians did before the advent of modern medicine.
It is no surprise that the best and brightest physicians from several cultures around the world used bloodletting for more than 3,000 years. They followed only their corrupted clinical results and did no scientific experimentation. No matter how practiced and experienced the clinician, all clinical results are medical anecdotes.
“The plural of anecdote is not scientific evidence,” said Michael Shermer of The Skeptic’s Society.
Kimball Atwood, M.D., describes some of the problems of using clinical results as scientific evidence: “Compared to laboratory investigations, clinical trials are necessarily less powered and more prone to numerous other sources of error: biases, whether conscious or not, causing or resulting from non-comparable experimental and control groups, cuing of subjects, post-hoc analyses, multiple testing artifacts, unrecognized confounding of data due to subjects’ own motivations, non-publication of results, inappropriate statistical analyses, conclusions that don’t follow from the data, inappropriate pooling of non-significant data from several, small studies to produce an aggregate that appears statistically significant, fraud and more.”
“As currently practiced, EBM appears to worship clinical trial evidence above all else and nearly completely ignores basic science considerations, relegating them to the lowest form of evidence. This blind spot has directly contributed to the infiltration of quackery into academic medicine and EBM,” said Dr. David Gorski (sciencebasedmedicine.org).
To demonstrate how easy it is to systematically subvert the scientific process in the field of medicine, it is only necessary to pick a ridiculous form of “treatment” and see how poorly designed research can make even the ridiculous sound legitimate. We could postulate that water and sugar is curative but that fiction is already used all over the world. We could use voodoo, but sticking pins in invisible body parts is, incredibly, being more routinely accepted by the medical profession. Magnet therapy? Ear candling? It’s difficult to find a truly ridiculous therapy that is not published in the Cochrane Collaboration, the Natural Standard or Pubmed, and that everyone would agree is silly. Delving into our past, however, will give us the “art” and “science” of witch-doctoring!
Here are a few of the steps, which have been applied systematically and gradually, over a number of years, to subvert the evidence-based medical research process and get all sorts of folk medicine procedures published in medical journals:
» 1. Negative research results are still research results. Flood the journals and websites with meaningless studies comparing witch doctors to evidence-based medicine.
» 2. Always call for further research because we don’t know enough yet about witch-doctor efficacy rates.
» 3. Use vested interest/biased researchers instead of independent researchers. Independent researchers are not qualified witch doctors.
» 4. Use research from foreign institutions that have less rigorous research standards and already use witch-doctoring as a legitimate form of treatment. Use countries where the practice of folk medicine is tied to national pride and the centralized government will only allow positive research findings.
» 5. Use studies that confuse clinical results with experimental evidence. “I’ve done my anti-rhino virus witch-doctor dance thousands of times, and the cold always goes away. It works for me!”
» 6. Use “peer reviewers” from the same, unscientific field of study. Who better to evaluate a study on witch doctors than other witch doctors?
» 7. Use non-comparable experimental and control groups. For example, compare the side effects of chemotherapy and witch-doctoring. Witch-doctor dances have fewer side effects.
» 8. Use confounding data. Compare witch-doctoring to sham witch-doctoring. Which one is the placebo control group?
» 9. Use a small sample size with a high dropout rate.
Since the evidence-based medicine process has been routinely subverted by this type of pseudo-research, some M.D.s have come together to produce a standard of experimentation and research that cannot be undermined so easily by alternative medicine. That higher standard is called science-based medicine (SBM). SBM simply requires that research and experimentation be based on scientifically plausible (“prior plausibility”) mechanisms like the existing laws of physics, chemistry, biology, mathematics, etc.
Folk medicines based upon magical thinking, spiritual forces, invisible body parts, impossible mathematical dilutions, auras, psychic forces, vibrations and deceptive jargon would not even be considered as legitimate research topics.
The medical profession has had an off-handed attitude to these folk medicine procedures for two reasons. The first is the assumption that as long as the patient follows the science-based prescription that the other alternative practices can’t hurt. “What’s the harm?” is the often heard refrain. The second reason is the need to “please the patient,” which happens to be the direct translation of the word, “placebo” (I shall please ... the patient).
I’ve always thought that physicians had a higher calling than simply pleasing or comforting the patient. They are called upon to “heal,” and the procedure may not please the patient at all. Still, SBM takes great and extraordinary care to comfort patients before, during and after science-based medical intervention. That essential and critical part of SBM is the nursing profession.
M.D.s and RNs should make a concerted effort to keep their field of science-based medicine more proprietary. If they don’t, a visit to the doctor may soon look like this: Your first stop in the clinic will be to the “psychic advisor” who will help you understand that the money you are spending will come back to you tenfold and that your dearly departed love you and understand you. Next stop: “invasive distractions” — bloodletting, needle therapy and linen swallowing and regurgitation. “Hyper diluted pills and potions” are next. Then you go in for some “psychic surgery.” Finally, you get a massage, which is the only legitimate activity because it is WYSIWYG (what you see is what you get). Now, don’t you feel better after all that?
Of course, I’m exaggerating. It may be possible to keep psychic advisors from becoming funded as primary care providers, but some of those other folk medicines are already knocking on the door of the scientifically based medical profession.
— Victor Dominocielo, a California-credentialed teacher for 36 years, is the human biology and health teacher at a local middle school. The opinions expressed are his own.