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Modern Medicine & Scientific Certainty

Posted Apr 29 2011 1:44pm

When the issue of “alternative medicine” comes up, skeptics often invoke some version of the cliche uttered by Michael Shermer not long ago in an interview before a panel discussion with Deepak Chopra and others on “The Nature of Reality”: “There is no such thing as alternative medicine. There’s just scientific medicine, and all the unproven stuff. What Deepak is promoting is a sort of alternative, complimentary medicine, and most of that is woo-woo.”

The insinuation, of course, is that “scientific medicine” has been proven. But as we’ve written before , this just isn’t true. Most conventional medical practices are just as “unproven” as those Shermer dismisses as “woo-woo.”

The point is pounded home anew in an excerpt from Demand Better! Revive Our Broken Health Care System posted late last month on Scientific American‘s website. (Notably, Shermer writes a column for SciAm.) Dispelling the myth that “there is a high degree of scientific certainty in modern medicine,” the whole piece is definitely worth a read. Here are a few highlights:

We could accurately say, “Half of what physicians do is wrong,” or “Less than 20 percent of what physicians do has solid research to support it.” Although these claims sound absurd, they are solidly supported by research that is largely agreed upon by experts. Yet these claims are rarely discussed publicly. It would be political suicide for our public leaders to admit these truths and risk being branded as reactionary or radical. Most Americans wouldn’t believe them anyway. Dozens of stakeholders are continuously jockeying to promote their vested interests, making it difficult for anyone to summarize a complex and nuanced body of research in a way that cuts through the partisan fog and satisfies everyone’s agendas. That, too, is part of the problem.

* * *

The plain fact is that many clinical decisions made by physicians appear to be arbitrary, uncertain and variable. Reams of research point to the same finding: physicians looking at the same thing will disagree with each other, or even with themselves, from 10 percent to 50 percent of the time during virtually every aspect of the medical-care process—from taking a medical history to doing a physical examination, reading a laboratory test, performing a pathological diagnosis and recommending a treatment. Physician judgment is highly variable.

* * *

The public has little idea that physicians are playing a sophisticated guessing game every single day. That is a scary thought. We hope that one day we’ll look back, for example, on cancer chemotherapy the same way we look back at the use of leeches, cupping and bloodletting.

* * *

But just how comprehensive is the available scientific evidence for effective clinical practices? It is slimmer than most people think. Slice a pie into five pieces, and remove one piece. That slice represents the roughly 20 percent of clinical-care practices for which solid randomized, controlled trial evidence exists. The remaining four-fifths represent medical care delivered based upon a combination of less reliable studies, unsystematic observation, informed guesswork and conformity to prevailing treatments and procedures used by most other clinicians in a local community.

* * *

Instead, physicians frequently base their decisions on shortcuts, such as the actions of the average practitioner (“if everyone is doing it, the intervention must be appropriate”); the commonness of the disease (“if the disease is common, we have no choice but to use whatever treatment is available”); the seriousness of the outcome (“if the outcome without treatment is very bad, we have to assume the treatment will work”); the need to do something (“this intervention is all we have”); and the novelty or technical appeal of the intervention (“if the machine takes a pretty picture, it must have some use”).

Drug prescribing is another blatant example of medical practice that is often evidence-free. Drugs that are known to be effective may work well for only 60 percent of people who take them….Physicians prescribe drugs well over a million times a year with little or no scientific support.

You can read the full excerpt here .

Again, the point is not to argue that complementary, holistic and/or traditional therapies are somehow vindicated because of the lack of evidence for conventional, corporate medicine. Such an argument is based on fallacy. The point is that it’s just as wrong to dismiss holistic therapies for lack of rigorous evidence when conventional medicine likewise lacks evidence – or to claim that case studies and other “anecdotal” proof are invalid for holistic medicine but valid for conventional practice.

More research is needed all ways round. And one standard of judgment is needed.


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