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“Medicine” Is That Which Has Been Proven to Work?

Posted Jan 17 2011 9:02am

A while back, we posted an article on the “alternative medicine” canard and the double standard of proof that holistic health practices are often held to. In it, we quoted from a paper by Kenneth R. Pelletier of Arizona State University and UC San Francisco – a passage worth repeating here as we look to the latest news from the world of “evidence-based” corporate medicine:

To provide a baseline against which to measure complementary and alternative medicine (CAM), it is important to point out that as much as 20–50% of conventional care, and virtually all surgery, has not been evaluated by RCTs [randomized clinical trials]. According to Richard Smith, editor of the British Medical Journal, “Only about 15% of medical interventions are supported by solid scientific evidence… This is partly because only 1% of the articles in medical journals are scientifically sound and partly because many treatments have never been assessed at all.”

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In addition, a frequently cited report from 1978 by the Office of Technology Assessment found that only an estimated 10–20% of allopathic medical interventions are empirically proven. That figure remains accurate nearly 25 years later.

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Again, the focus here is upon conventional medicine only since advocates of an evidence-based approach consistently cite conventional practice as the gold standard. Therefore, it is entirely appropriate to gauge the standard that is clearly found to be grossly deficient in a rigorous evidence base.

To a number of people in the health care establishment we talked with about these statistics, the figures seemed unbelievable. But now a new study published in the thoroughly mainstream and major Annals of Internal Medicine gives further credence to the claim that when it comes to scientifically proven medical treatment, conventional medicine falls far short of its own standard.

Even when following medical guidelines to the letter, doctors often use treatments that have little or no scientific support, U.S. researchers said Monday.

They found only one in seven treatment recommendations from the Infectious Diseases Society of America (IDSA) – a society representing healthcare providers and researchers across the country – were based on high-quality data from clinical trials.

By contrast, more than half the recommendations relied solely on expert opinion or anecdotal evidence.

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[Lead author Dr. Ole] Vielemeyer said the findings are likely to apply to other areas of medicine as well, and mentioned an earlier study that found similar results in cardiology.

Doctors across the world look to guidelines when deciding how to treat patients, and insurance companies may use them in coverage decisions.

Because they are drafted by leading experts in the field, they are generally understood to reflect the best medical knowledge available. “People commonly associate guidelines with practicing evidence-based medicine,” said Vielemeyer.

But often the relevant clinical studies simply haven’t been done. In the absence of evidence, the recommendations end up depending largely on who’s on the guideline-drafting panel and any assumptions or opinions they may bring to the process.

Of course, the lack of evidence for conventional medical treatment doesn’t validate acupuncture, homeopathy, naturopathy or any other holistic or traditional practice. Nor does it imply that conventional medical treatment is worthless.

It’s just a reminder that we all have our glass houses.

 

Images by Dey and Lorenia , via Flickr

 


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