“Frankly, our concept of ‘evidence’ in the medical realm has turned out to be a bit more demagogue than demigod.”
I was half-listening to National Public Radio the other week when the familiar phrase “evidence-based” flew in 1 ear and almost out the other. Expecting yet another forgettable report on alternative therapies, I cognitively tuned in expecting to find that another botanical carcass had been dispatched by a single, sexy journal study and tossed into a communal grave already inhabited by ephedra and echinacea. I was, to say the least, surprised to hear the voice of Secretary of State Hillary Clinton describing our newest strategy in combating terrorism: evidence-based surgical strikes against suspected training camps.
I do hope our military has more success in nailing the bad guys than our science has had in nailing down which therapeutic tactics are actually clinically effective. Or our martial campaigns may well last forever. Because frankly, our concept of “evidence” in the medical realm has turned out to be a bit more demagogue than demigod.
You see, we integrative types have retained conventional medicine’s hypothesis that research itself is the bastion of Truth, the gospel according to Science, the Holy Grail of health care. Our investigative facilities are the heart of every medical center, pumping data and dogma through the veins of academia and bringing lifeblood to both the classroom and the financial development office. Our belief in the power of the research study is biblical in nature: The journal said it. I believe it. That settles it.
But wait just an evidence-based minute. This particular journalist actually was a researcher for a few short years, a certified principal investigator for the National Center for Complementary and Alternative Medicine analyzing the effects of hippotherapy (physical therapy on horseback) on children with spastic cerebral palsy, culminating in 2 hard-earned publications in peer-reviewed journals. And I am figuratively here to tell you that our collective, integrative research data is not holy, but, in fact, full of holes. Despite our truest intentions, my fellow investigators and I walked into our studies brimming with bias. We had witnessed the benefits of our particular work for decades; they made perfect logical sense; and we were working with children and animals, for gosh sakes. The photos alone should convince anyone that this is good stuff, right?
Now don’t get me wrong – our methodology was solid, our data clean, and our composition included the requisite “the results of our study deserve further investigation” at the end of the Conclusion section. But I won’t pretend that we were neutral spectators. We believed in our therapies, and darn it, we were going to prove them authentic. But we weren’t going to admit that to the Institutional Review Board, and it is likely that I am the only one willing to admit to this even today.
But let’s get back to this sacrosanct matter of evidence. What exactly is it? Why do its conclusions seem to change every few months, whether regarding hormone replacement therapy or cardiac stents? Even cardiopulmonary resuscitation has been debunked as of late, with chest compressions alone proving as effective as compressions plus ventilations – meaning essentially worthless. If evidence can turn south so quickly, why do we bow before it in abject acceptance rather than give it equal standing with intuition and experience? The honest practitioner, in fact, will admit to making clinical decisions based more upon these latter 2 qualities than any directive touted by a peer-reviewed journal.
At this point I will step off my soapbox for a moment and announce my honest belief in the beauty and value of scientific research. As imperfect as it, and each of us, is, science is still one of our greatest tools in determining what arrows to place in our therapeutic quiver. Its beauty lies in the purity of its methodology and data, despite periodic adulteration by those who stand to benefit by 1 particular finding or another. But its conclusions are not Truth, merely one more finger pointing in the general direction of truth. As religion is meant to be a guide for our spiritual lives, research is a guide for our clinical lives, at times incomprehensible but still providing a light to follow in our human journey. If we take it literally and on faith alone, however, its contradictions and inconsistencies will drive us mad.
And a fundamentalist health care practitioner is not a pretty sight, especially if we are the one sitting on the examination table.
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A Re-Printed Commentary for Members
From THE BRIDGE Newsletter of OIRF
Published June 2013
© Copyright 2010, IMCJ, Dr. Bill Benda