The Corruption of Evidence Based Medicine
When I was diagnosed with psoriasis, the dermatologist did exactly what she was trained to do.
She advised I try to suppress the symptoms with drugs, slowly scaling up the potency and danger as the meds got stronger.
When I left her office, I was furious.
She wasn’t malicious, she was following what she thought was correct, but she had inadvertently taken away my hope.
If I had not owned a book called Integrative Rheumatology which contained a great deal of information on bacterial and fungal infections that can cause psoriasis in people with the genetic predisposition, I would have been left in a state of helplessness.
In a state of complete dependency upon the NHS and all its pharmaceutical might, with no option or understanding on how I could create remission in my own body.
That IMO is just not acceptable.
The term “evidence based medicine” is thrown around like a slogan to defeat all opposition, “do you have any evidence for that” is easily spouted against something the accuser doesn’t agree with personally.
What it really boils down too, is when it is in their area of interest they use EBM as it was meant to be used: the best research with clinical judgment and patient centred.
When it is something else, something maybe they do not like, they start to gently change the definition without saying it out loud.
If you don’t have multiple double blind, placebo controlled RCT’s, and a meta analysis of those, then you are not deemed “evidenced based”.
Anything less than the gold standard of RCT’s and you can pretty much forget being taken seriously, you just do not get an invite to the evidence based party. It is considered opinion and hearsay, next to worthless.
A claim supported by a large RCT or epidemiological study is accepted without question; one based on thirty to forty years of clinical experience is derided as being anecdotal (especially by researchers that have never actually treated a patient).
This is a blatant misrepresentation of what EBM is meant to be.
This is statistics only based medicine, something no one should practice.
Statistics are used to justify all manner of highly expensive and highly questionable drugs & interventions.
As Dr James Penston says in his book
“…it’s a triumph of appearance over substance. We’ve been cajoled into believing that great advances in medicine have occurred when, in fact, this isn’t the case. Large RCTs are placed at the summit of the hierarchy of evidence and are claimed to be the most reliable means of establishing causal relationships in medical research. They are highly complex structures designed to identify small differences in outcome between the active treatment group and controls.”
The small differences are reflected in the ever popular P value and the use of relative risk reductions.
Relative risk reductions are a statical sleight of hand, a statistical turd rolled in glitter, gleefully accepted as a sacred gift by the medical profession.
How else could the best selling drug in the world be less than 1% effective yet prompted by the drug companies as 36% effective?
Well, it is all about the relativity of the risk drop.
See, most people think a 36% drop would mean if they had a 50% risk heart attack in the next 5 years, then the drug would drop that to 14% (50 – 36 = 14).
But they would be wrong.
If you believe the research is backed by genuine un-altered real data (and I don’t, because they refuse to hand over the raw data for independent analysis, but let’s pretend), then you get about a 1% reaction in the occurrence of one heart attack.
This appears to be limited to men under 69 ish, and only if our outcome is one less heart attack.
If we widen the outcome to death of all causes excluding trauma, then it drops to 0% (likely due to side effects that affect mortality).
But let’s go with 1% for now.
This is an ABSOLUTE RISK REDUCTION, it is a real-term reduction.
The challenge is that statins are mostly used for primary prevention, ie to stop the first heart attack.
But it is hard to know who is going to have a heart attack and who isn’t.
Over 5 years, if you have high cholesterol and do nothing/take a placebo, you have a 3% risk of a heart attack.
Or put another way, a 97% of being fine by doing nothing.
If you take the statins, the risk drops to 2%, a 1% ABSOLUTE RISK REDUCTION.
But that is not going to sell many statins now is it?
So, they prefer to argue that the 1% drop from 3 to 2, is a relative drop of 33-36%.
But for that to apply to you, you would need to know you were in the 3% who were going to have a heart attack, and you cannot know that.
Therefore, the 33-36% reduction is meaningless because you might be in the 97% who were fine.
If we get independent researchers to look at the data and work out the NUMBER NEEDED TO TREAT (or NNT – how many people need to be treated to stop one event), then it looks even worse.
https://www.thennt.com/nnt/
Note the benefit in overall mortality is zero.
One consistent finding is that when independent researchers do studies they often get poor results compared to industry sponsored ones.
The BMJ has called for access to the raw/personal level data in those industry studies, but so far this has not been available.
Why would those researchers not simply open the data files and prove they are right?
https://www.bmj.com/campaign/
Beyond this, did you know that post 2004, it is illegal to tamper with research data?
You could go to jail for that these days.
This is due to the Vioxx scandal, when Merck fiddled with data and got Vioxx on the market, which killed 50k people from over 100k stroke and heart attacks worldwide.
Note it wasn’t the regulatory bodies that flagged up a surge in CVA/MI’s, it was a Merck employee that grassed them up, then the data was looked at and yes indeed, plenty dead.
Think about that for a moment, 50K extra dead and the regulatory bodies looking for drug reactions did not spot it.
How about if the medical world wants to reduce heart attacks, they encourage exercise and a form of the Mediterranean diet?
Minimal cost to them, massive upsides and no downsides.
If your idea of prevention is whacking people turning 50 on statins and blood pressure pills, you are playing a game that has lost touch with reality.
As Penston says in a chapter entitled re-writing history:
“they (advocates of statical approaches) mock their forebears as inept quacks whose practice harmed more patients than cured. But they should be wary. At least physicians of the past didn’t spend their time rounding up millions of healthy individuals and applying dubious illness labels to them before commencing long term drug treatment based on the most flimsy of data. Future generations may reasonably judge that the EBM zealots with their obsession with statistics have caused more harm than their predecessors who at least targeted their treatments to patients with disease”
Does all this mean I do not like research and reading stats?
Trust me, I love it.
But it needs to be a real meaningful change, and it needs to be applied to the individual and they need to feel a difference, it needs to move the needle.
That is why I use the formula on the IN Health supplement range the way I did.
I have read literature and taken what really changed patient issues in a meaningful way, not a statistical way.
Come January we will launch our sublingual methyl B12, 1250 mcg per tablet.
Why? Because of studies like this:
32% actual reduction, not relative.
It is why we have 35 mg of B6 in our One a Day Essential Multi and 15 mg of B6 in our Magnesium Plus product, to give a daily total possible of 80mg B6.
This is what is used in the research.
It is why we use menthol and ginger in our Chiro Ice gel, and people are loving it.
https://www.
All natural pain relief, no weird chemicals. The info-graphic should be available next week and the branded stand in 2-3 weeks to sit gently on the reception desk.
