Is there enough evidence for evidence-based medicine?

This week saw the publication of a ground-breaking editorial piece in the BMJ by the one and only Ben Goldacre of Bad Science fame. In it, he presents alarming evidence that health research is commonly exaggerated and badly reported.

For me this article underlines my frequent observation that evidence is no longer evidence. Even the most meticulously designed studies are subject to human spin, and who more likely than the author to fail to present his or her thesis objectively? Meanwhile our insistence on evidence before action in any medical situation fails to acknowledge its limitations and leaves us stymied.

To my mind, ‘evidence’ is the single most important way in which those currently in power keep other powerful contributors away from the debate. These days, if you haven’t got enough money to set up a double blind, placebo controlled trial with thousands of well screened subjects (and who has?) you are excluded from contributing.

Anything that isn’t presented within the strict definition of ‘evidence’ is discarded as opinion whereas, in reality it may be wisdom, intuition, small study observation, inspirational n=1 data, experience… any number of other ways of gaining knowledge that used to be perfectly acceptable, and which served us well through all the most important eras of breakthrough and discovery in human history.

The double blind, placebo controlled trial is a relative newcomer in terms of knowledge gathering, having emerged in the 1960s, and all kinds of breakthroughs have slowed significantly since it became the only way to get a green light.

Increasingly, it’s clear that large scale trials are nothing more than a very expensive and exclusive way of coming to an average conclusion about complex human organisms who are individually not responsive to average solutions.

When those conclusions are exaggerated and misreported then we are truly lost.

It’s nonsense.

We need to think again.

Please share if you agree.

Please read his article to understand how important this is:

http://www.bmj.com/content/349/bmj.g7465.full?ijkey=pdGfXk42ClHVR4e&keytype=ref

Image shared from http://www.whale.to/a/clinical_trials.html by Emma Hollister, 2005.