Can we rely on evidence based medicine in all patient care?
How does this reliance hurt our outcomes?
In Part 2 of this 3 article series, I’ll explore the limitations of evidence based medicine through two examples: chemotherapy studies and parachutes.
Evidence Based Medicine in a Perfect World
Evidence Based Medicine maintains that all decisions are made based upon research studies that:
- Require quantitative studies over qualitative and theoretical studies
- That all studies are based upon research studies, and
- That all studies are selected and interpreted according to a set of chosen norms that
- Disregard all qualitative and theoretical data and
- Use a narrow set of criteria that count as evidence.
EBM has its benefits and its limits in the real world of patient care. However, in a perfect world; EBM is one of many tools that can be used to improve upon outcomes. In an imperfect world; the business of research is not only plagued with bias; it is similarly skewed by questionable sources of funding (~80% of research performed is financed by the company producing the product), manipulation of data (increasing numbers of fraud cases in research), and an immense pressure to quickly generate the next market innovation.
The Imperfect World
Case in point: Bayer Pharmaceuticals recently repeated 60 studies of the most used cancer chemotherapy medications (from various companies) and only 15 of the studies were reproducible. These are medications that are commonly used and reimbursed for, and each was researched and FDA approved as effective. If we rely on EBM alone, we failed to show reproducible studies (evidence) in 75% of these medications and hence, theoretically killed 75% of our patients through dispensing ineffective or simply the wrong medication. Of further note, it was clinical observation and anecdotal evidence that questioned the proclaimed efficacy and validity of the original research and Bayer was one company who was bold enough to challenge the original studies.
There is a second case in point that involves the “parachute argument.” It is becoming common belief that the only good research is a randomized, double blind, controlled study to the point of throwing out the baby with the bathwater (disregard all qualitative and theoretical data per EBM mandates). In the parachute argument, a randomized, double blind, controlled study has never been performed on humans to determine if parachutes save lives. According to the standards established through EBM, parachutes are not evidence based. Why no controlled studies? Quite simply, it would be unethical to ask a control group to jump out of a moving airplane without a parachute.
Yes, EBM is critical for progress, but so are observations, logic and the cognitive skills of a professionally trained mind.
Join me next time, for the last article in this series, on the alternative to evidence based medicine and why it is better for your patients.
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About The Author
Dr. Frank Jarrell is the leading expert on spondylogenic reflex syndromes and is the founder and developer of Spondylogenic Reflex Analysis (also known as Spinal Reflex Analysis) and Spinal Reflex Therapy. Learn more about Dr. Jarrell.