Most of the public and the media suggest that modern medicine is practiced as “evidence-based medicine,” which is commonly defined as “the integration of clinical expertise, and the best research evidence into the decision making process for patient care.” This “clinical expertise” is based on the practitioners’ cumulative experience, education and skills, while the “best evidence” is grounded in clinically relevant research that has been conducted using a sound methodology.
It is important to note that the evidence does not necessarily dictate a specific course of action for any given individual patient but is designed to assist clinicians in assessing the risks and benefits of specific treatments and ensure the best practices and outcomes are available.
There also exists the idea that most forms of natural or alternative medicine are practiced with anecdotal evidence and intuition and are less effective than modern practices. In response, there are an increasing number of clinicians in the field of alternative medicine who are conducting randomized, controlled trials and obtaining more definitive data to support their therapeutic modalities. Many of these trials involve a disease or symptom response to acupuncture treatment as evidenced by a biochemical or physiologic change. Clearly, gathering more evidence on any given medical condition, from any medical tradition, is an important step as we seek to use the best signals for the best science to make clinical decisions. But, is this really the only solution?
So, what is the state of evidence-based medicine today? Prasad et al. published an article searching the best medical journals and found that of the original papers making claims about a particular medical practice, 137 represented reversals of current medical practice. In other words, between 1 in 7 and 1 in 8 new and superior studies contradict current practice. How is this possible? First, the gold standard for clinical studies is comprised of randomized-controlled-trials or “RCTs.” RCTs are designed to take a relatively small group of pre-specified study subjects and studying the effort of a drug or intervention of an outcome (i.e., the effect of drug X on reducing high blood pressure and subsequent strokes). The reasoning is to take a specific observation and make a general inference to the general population. This has repeatedly been shown to be flawed, particularly when based on a few studies without lengthy follow-up periods.
One of many prominent examples of such a reversal was the estrogen plus progestin component of the Women’s Health Initiative (WHI) study, which included more than 16,000 healthy post-menopausal women randomized to estrogen plus progestin or placebo. After five years of follow-up, investigators found that the associated health risks of the combination hormone therapy (increased risks of heart attack, stroke, embolism and breast cancer) outweighed the benefits.
So, it is so very important for patients to understand that clinical trials provide us with probabilities, not fact. With this in mind, it should also lead practitioners to consider that it takes more than just a new clinical trial result to proffer effective medical treatment. In alternative medicine, we also layer on and emphasize experience and intuition along with new approaches to understanding physiology on a “systems-level” rather than an “organ level.”
The best we can do for ourselves and for our patients is use the best of both worlds by becoming familiar with the growing literature in both modern and alternative fields of medicine and practice a more comprehensive form of integrative medicine based on our deepening base of knowledge and experience. Tackling many of the major health challenges of our times, such as cancer, autoimmune diseases, Alzheimer’s, heart and neurological diseases, depression and addiction, will be best served using this approach. And, when Health Care Reform begins to value treatments that provide the best results as primary measures of success, rather than high-tech procedures as measures of US dominance in health care, we will find ourselves able to reduce health care expenditures to more reasonable and sustainable levels.