evidence-based medicine:  who decides what constitutes evidence?

EVIDENCE-BASED PRACTICE: PICKING AND CHOOSING THE EVIDENCE

Unfortunately, the title of this post could have easily been, ‘The More Things Change, The More they Stay the Same.‘   According to his Facebook page, Dr. Brian Earp is a Yale-trained scientist who is both a research assistant at the Oxford Centre for Neuroethics and a visiting scholar at the Hastings Center Bioethics Research Institute.  He also writes for The Atlantic.  Listen to what he says in his most recent Facebook post.  “I’m sorry – I still can’t get over the fact that my grandpa published on the need to report negative results in 1927 in JAMA”  

A 90 year old issue of the Journal of the American Medical Association carried a letter to the editor from an Ohio physician discussing the need to report negative clinical results.   Why report negative results?

When negative findings are not reported by biomedical researchers, it dramatically skews conclusions, making results appear far better than they really are.  This is all too common practice leaves us with hundreds of thousands of studies that are widely known in the medical community as “INVISIBLE AND ABANDONED”.  It also happens to be the reason I am the current world record holder for consecutive free throws (HERE).  Also bear in mind that it can take an act of Congress to get these results released via sunshine laws (and only if the researchers took public monies). 

Unfortunately 50% of all medial studies started, are never finished; the research showing that it’s the negative results that are buried, which is merely the tip of the iceberg as far as the way peer review is being manipulated by industry (HERE and HERE). Not surprisingly, it’s why so many of today’s common medical practices go directly against the “BEST EVIDENCE“. 

When you read studies or articles about studies, be prepared to see terms like “evidence, best evidence, evidence-based practice, EBM, or evidence-based medicine” over and over again — often times to the point of being nauseating.  As to why so much of the evidence is not being followed, there are billions of reasons — all of them GREEN.   I want to take a moment to show you a few of the places that “BEST EVIDENCE” are not being followed by the medical community.

• FLU SHOTS:  In few arenas is the disregard for scientific evidence more blatant than with FLU VACCINES.  In fact the problem is so blatant that my brother, an emergency room physician (MD), wrote an article for a medical journal on the topic (HERE).  The latest meta-analysis’ by the Cochrane Review (the gold standard for analyzing medical research) shows that FOR THE MEDICARE POPULATION, the flu vaccine is just over 1% effective in a normal year, and 4% effective in a “matched” year (matched years only occur about once a decade).  FOR CHILDREN (those under 18) it’s even worse, with the data revealing that said shots are no better than placebo (sugar pills). We shouldn’t be surprised considering the FLU MIST was abandoned for being less than 3% effective for three years in a row.  And this is just for starters (click first link in this bullet point).  The fact is that according to peer-review, there is NO GROUP that benefits from flu vaccinations. Period.  Despite this fact, we continue to plunge ahead with ASININE CAMPAIGNS to force people (HERE) into getting vaccinated DIRECTLY AGAINST BEST EVIDENCE.  Big Pharma’s favorite Flu Vaccine slogan? “Bend Over and Take One For the Team“.  Lucky for you I put everything pertaining to Flu Vaccination is one big post called TWENTY REASONS YOU MAY WANT TO RETHINK THAT FLU SHOT.

• ANNUAL PHYSICALS:  To say anything unflattering about annual physicals is bordering on sacrilege.  Yet despite the fact that annual physicals are still a staple of medical practice, THE EVIDENCE SAYS they shouldn’t be; considering that since the decade of the 80’s, researchers have consistently shown they are a waste of time, energy, and money.  Hey; don’t get mad at me — I’m only telling you what peer-review says, and has been saying for at least three and a half decades.  Of course your doctor disagrees; what did you expect (HERE)?

• ROUTINE PROSTATE EXAMS, BREAST EXAMS, FEMALE EXAMS, COLONOSCOPIES, CANCER SCREENINGS, BLOOD WORK, ETC:   In like fashion to what we saw in the previous bullet point, we see something similar with PROSTATE EXAMS, MAMMOGRAPHY, ANNUAL FEMALE EXAMS, COLONOSCOPIES, etc, etc, etc.  Despite the fact that this topic seems to be making the 6 o’clock news on a regular basis, people continue to be convinced (USUALLY BY THOSE WHO SHOULD KNOW BETTER — THEIR DOCTORS) of the life-saving benefits of said tests (HERE).  Oh, the same thing could be said of both MRI’S and CT SCANS (not to mention BLOOD WORK). The brutal truth is that these tests lead to death by OVERDIAGNOSIS & OVERTREATMENT about as often as they happen to save someone via early detection.  In other words, for every person that the medical community or press holds up as a shining example of what early diagnosis can do, just as many others are dying as the direct result of messing with a problem that would have never been a problem in said person’s natural lifetime (or just as commonly through the all-to-common phenomenon of “false positive tests”. Although there are any number of things considered to be “PREVENTATIVE MEDICINE” click on the link to find out why more often than not, this is simply not true (the language has been hijacked), and why the practice of medicine as we know it has become totally UNSUSTAINABLE.

• BONE DENSITY SCANS:  Almost since the time I entered practice in the very early 1990’s, I have held the position that bone density scans are largely worthless, being used mostly as an effective scare tactic to sell women a lot of really crappy drugs. Crappy drugs?  Am I saying that drugs used for osteoporosis are crappy?  You see; the problem is that the drugs that women are being prescribed for OSTEOPOROSIS are actually causing more of the same — Osteoporosis (HERE). The truth is, the drugs-causing-what-they’re-supposed-to-be-curing is a fairly common theme in Evidence-Based Practice (HERE IS ANOTHER COMMON EXAMPLE).  Case in point, the next bullet.

• STATIN DRUGS:  There’s no argument that Statins have some serious side effects.  But what if I told you that it’s worse than you could ever have imagined?  What it you learned that the most current research available is pointing to this class of drug as a culprit (causal factor) in the epidemic of heart disease and hardening of the arteries (HERE)?  Isn’t it just peachy when the drugs you are prescribed by your physician cause the very problems they are supposed to be solving?  Sure, they lower your cholesterol.  Unfortunately, changing surrogate endpoints is being shown time and time again to have little if any bearing on morbidity or mortality.

• DIABETES:  Speaking of not dealing with underlying causes, TYPE II DIABETES is an epidemic in this country that is not being dealt with in any meaningful fashion.  It’s also another area where all we are really doing with the drugs is changing surrogate endpoints.  Sure people are being loaded up with drugs that do exactly what they are advertised to do — lower their blood sugar.  But the dirty little secret is that in similar fashion to Statins, Diabetes drugs don’t really do what they are almost universally touted to do — lower rates of heart attack, strokes, and/or death (HERE).  What’s the point?  To change another surrogate endpoint (BLOOD SUGAR), of course.

• CHRONIC PAIN CAUSED BY FASCIAL ADHESIONS:  Because it is the single most pain-sensitive in your body to begin with, fascial adhesions often times present what I call the “PERFECT STORM” of chronic pain.  Not only is SCAR TISSUE as much as a thousand times or more pain-sensitive than normal tissues, it’s not imaged well with standardized testing (HERE).  In fact, if you are interested in seeing why fascia is such a big deal, I have a post called 25 REASONS WHY FASCIA…
• ANTIBIOTICS, GUT HEALTH, MICROBIOME & FMT:  Firstly, we’ve erroneously convinced people that bacteria are not only “bad” but the chief cause of any number of diseases (HERE).   Furthermore, depending on whose research you believe, as many as 75% of all ANTIBIOTIC prescriptions are unnecessary (HERE).   These drugs are being causally linked to health problems like DEPRESSION, OBESITY, DIABETES, ASTHMA, HEART PROBLEMS, AUTOIMMUNE DISEASES, CHRONIC MUSCLE PAIN, as well as a WHOLE HOST OF OTHERS (or HERE).   On top of that, they are the prime culprits in our national epidemic of DYSBIOSIS — CANDIDA, H. PYLORI, etc, etc, etc.  Another example of a drug that is supposed to do one thing (“boost” the immune system), while doing something altogether different (KILLING IT).   This is nothing less than gross negligence.  And considering that so little has changed in the two and a half decades I’ve been in practice, I’m not holding my breath that it’s going to get substantially better.  On top of all this, I have had several of my patients repeatedly end up in the hospital with C. DIFF., which is treated with the very meds that caused it in the first place — Antibiotics.  Although Standards of Care say that these patients are supposed to receive an FECAL MICROBIOTA TRANSPLANT after their third bout of C. Diff, I have yet to see this happen — ever (especially grievous once you see how these are being used by the rest of the world to solve all sorts of chronic illnesses and inflammatory health issues).  Fortunately, our government stepped in to save the day (HERE).  If you are interested in seeing one post that puts our nation’s antibiotic problem in perspective, HERE it is. For all of our posts on GUT HEALTH, just click the link.

• NUTRITION AND EXERCISE:  When it comes to any number of health issues, there are only two things proven to actually change physiology — and neither one is drugs (HERE).  Despite the fact that DIET and EXERCISE are the hallmarks of creating real change in the disease states of patients, doctors continue to ignore both on whole-scale levels (HERE).  And when advice of this sort is given, it’s usually about 180 degrees off (HERE,  HERE , or HERE).

• TENDINITIS / TENDINOSIS:  Because doctors don’t care to grasp the fact that nearly 100% of what is currently diagnosed as Tendinitis is actually Tendinosis, numerous patients continue to suffer and deal with the side-effects of the drugs they are given for a problem they don’t actually have — a problem that the medical research community largely says doesn’t even exist (HERE).  Oh, but be warned because ANTIBIOTIC-INDUCED TENDINOPATHES are common enough that media outlets are at least starting to talk about it.

• WHO KNOWS HOW MANY KINDS OF SURGERY:  Back in 1995, the US government commissioned the actuarial firm Milliman & Robertson to research and create “Evidence-Based” guidelines for 25 of the most common types of surgery.  I’ll not go into detail, but suffice it to say that according to their conclusions, 60% of all surgical procedures in the US are unnecessary. Even if you cut this number in half, it means that nearly one out of three surgeries does not meet the criteria for having said surgeries.  Have these numbers gotten better over the course of the last two decades?  Surely you jest?   Someday I might create a whole post just devoted to this topic (I already have SEVERAL on spinal surgeries), but lets simply look at knees.  After several huge studies and meta-analysis, one of the most common surgeries for knees (using an arthroscope to “CLEAN THINGS UP” or repair torn meniscus) was shown to be no better than placebo.  Hey; don’t get mad at me — I didn’t do the studies.

• SPEAKING OF GUIDELINES:  Suffice it to say that MEDICAL GUIDELINES should actually be called “Medical Suggestions” as in most cases they are totally optional.  On top of this, the committees and individuals creating said guidelines are so financially conflicted, they make Hillary’s multi-million dollar speeches look like a bargain.  Think I’m being too harsh?  Click the link!   Speaking of our government…..

• THE INCESTUOUS RELATIONSHIP BETWEEN BIG PHARMA AND OUR GOVERNMENT:  HERE it is folks; in all its blazing glory.  If you really think you can TRUST THE DRUG COMPANIES TO POLICE THEMSELVES, I have this bridge in Brooklyn I’d love you to take a look at.  This goes for the FDA, the USDA, the CDC, and any other organizations who go by their initials.  Those who think the steady stream of industry payoffs doesn’t effect the quality of your healthcare need to take a look at THIS.  And if you were to start flipping through titles of our scores of posts on EVIDENCE-BASED MEDICINE, you’ll not only see how bad this problem really is, but make sure to do so with a barf-bag handy as it will probably make you physically ill.

• ANTI-DEPRESSANT MEDICATIONS:  Despite the fact that we know how much the research has been jimmied in this arena (OVER HALF of all studies on Depression are INVISIBLE & ABANDONED), doctors continue to prescribe this crap like candy.  What does the “evidence” really say about these drugs?  Plainly stated, it tells us that Depression is one of the many problems caused by Inflammation (HERE or HERE).  But it’s always easier (and more lucrative) to continue to cover symptoms instead of making even a half-hearted attempt to deal with underlying causes.  Antidepressants are part of what I call “THE BIG FIVE” and if there is a more evidence-based-medcine-run-amok example of big pharma’s big fraud than ANTI-DEPRESSANT MEDICATIONS, I’m not sure what it is.  Just remember that it is this class of drugs that led to the RIAT ACT.

• NON-CELIAC GLUTEN SENSITIVITY:  We’ve come to the point where most physicians recognize that Celiac Disease is a serious problem.  Statistics tell us that Celiacs constitute about 3% of the American population.  Yet despite the mountain of studies proving otherwise, most doctors refuse to recognize GLUTEN SENSITIVITY IN NON-CELIACS — even though it’s more common than CD by at least an order of magnitude (HERE).

• CHILDHOOD EAR INFECTIONS & COLIC: I’ve already shown you that for most health problems, antibiotics are a huge “Fail”.  One of the great all-time examples of this is CHILDHOOD EAR INFECTIONS.  For Pete’s sake, the medical Standards of Care say to avoid giving kids (or adults for that matter) antibiotics!  The chief statistical difference between kids that get antibiotics for ear infections and kids that don’t is that the kids who get antibiotics tend to get recurrent infections.  I promise that parents who have had their children on this MEDICAL MERRY-GO-ROUND will give me an amen and top it off with a hallelujah.  What works in most cases — without any side effects?  Try THIS on for size.  And considering doctors can’t even tell you what COLIC really is, we could say the same thing about it as well.  Speaking of side effects………

• DRUG AND VACCINE SIDE EFFECTS:  Another of those dirty little secrets that’s so dirty you won’t believe what I’ telling you is true is that side effects of DRUGS and VACCINES are under-reported by on average of around 99% (HERE), and never less frequently than 90% (HERE and HERE). Although patients might be telling their doctors about said side effects; unless their doctors actually report these reactions to the proper governmental reporting agencies (VAERS for instance), nothing is ever done, and the side effect is never officially tallied as a side effect or AE (Adverse Event). Does not reporting to said agencies skew results in similar fashion to the Invisible & Abandoned Studies?  You bet your sweet bippy it does (HERE)!

• ANTI-INFLAMMATION MEDICATIONS:   NSAIDS and CORTICOSTEROIDS are typically prescribed in a manner that in no ways takes into account their crazy side effects or fact that they are massively degenerative.  Truth be known, doctors rarely follow their own profession’s Standards of Care with their prescriptions in this arena — particularly with Steroids.  What this means is that when using this class of drug for chronic problems, you are exchanging any short-term relief gained for long-term degeneration and dysfunction.

• VILIFICATION:  Big Pharma (via their medical mouthpieces) will ignore any and all ‘evidence’ and vilify anything they don’t like (i.e. ‘alternatives’ such as Chiropractic) — HERE is a recent example from Forbes of all places.  Who benefits from BASHING ALTERNATIVES to EBM? Certainly not the patient. 

• LEAKY GUT SYNDROME:  Although there are well over 10,000 peer-reviewed studies that deal directly with the phenomenon known as LEAKY GUT SYNDROME (the medical research community refers to this as Increased Intestinal Permeability, Gut Barrier Dysfunction, or any number of similar), by-and-large, practicing physicians refuse to acknowledge or even discuss it. Why?  Not sure, as there are actually several good inexpensive tests for it that you can order yourself.  Just remember that it’s always more profitable to treat symptoms than to address underlying causes.

• AUTISM:  Although most of the medical community vehemently denies a link between VACCINES AND AUTISM, this one is getting tougher and tougher to hide from the public — especially with the landslide of insane information coming out on the most commonly used vaccine adjuvant on the planet, ALUMINUM.

• CHRONIC PAIN:  Prescription drug addiction is literally exploding in America (HERE).  Instead of helping patients attack pain at it’s source, doctors tend to do one of two things — neither of which are beneficial.  Treat everyone as a drug-seeker and send them packing.  Or simply give their patients pain meds without at least attempting to address the underlying causes of said pain.

• PROTON-PUMP INHIBITORS:  This class of drug (given for heartburn, GERD, acid reflux, etc) not only has some freaky side effects (HERE and HERE), it’s almost never the best way to treat patients struggling with these common symptoms.  This is because it’s virtually impossible to have too much or too strong Stomach Acid (HERE).  Furthermore, if you will read the “trust us” warning labels, most of these drugs recommend not taking their product for more than two consecutive weeks — tops, three times a year (in other words, six weeks total per annum).  The FAQ page for one of the most common meds from this class says, “Do not take Nexium 24HR for longer than 14 days unless your healthcare professional directs you to do so.  You can repeat a 14-day regimen once every four months.”  Many individuals taking these drugs haven’t been off of them for decades.

• CORRUPT POLITICIANS & GOVERNMENT:   It doesn’t matter whether you are a democrat or republican, the fact that you can’t trust politicians is a no-brainer.  Unlike our founding fathers — many of whom gave everything for this great nation of ours (lives, families, personal fortunes) — today’s politicians can’t be trusted to do much of anything beyond padding their pockets and doing or saying whatever it takes to get elected or re-elected (HERE). As long as the money continues to flow from Big Pharma to both Washington and academia (HERE), you can kiss any sort of real reform goodbye.  This has led to UTTERLY RIDICULOUS IDEAS being put forth to reform the healthcare system.

Folks; in case you haven’t figured it out yet, you have to be your own health advocate.  Despite their assertions to the contrary, our government is not going to save you (see previous link).  Furthermore, it’s both scary and empowering to realize that your doctor isn’t going do do it for you either.  They can’t.  Drugs rarely solve anything. 

The reality is that your health is up to you (HERE is the story of someone who came to that realization last spring and turned their life around, and HERE are dozens of others like her).  If you are struggling with Chronic Health Conditions of nearly any sort, at least browse some of THESE suggestions. And like, share or follow on FACEBOOK while you are at it.