Is Evidence-Based Medicine (EBM) "Legitimate"?

On April 24th, Dr. Mark Mosley wrote an opinion piece in the Wichita Eagle newspaper declaring that “vitamins, minerals, herbs, massage, chiropractory, homeopathy and other alternative approaches” were not legitimate medicine. He admonished “real physicians” to “protect patients from harm.” How? “To have the moral courage…to say, prove it first.”

In the spirit of intelligent debate, let’s take these assertions one at a time, starting with “protect patients from harm.” How do alternative approaches stack up to pharmaceuticals?

Fact: adverse drug reactions from prescription drugs (supposedly “safe and effective” based upon RCT drug trials) contribute to about 106,000 deaths per year.¹

Dr. Barbara Starfield of the Johns Hopkins School of Hygiene and Public Health, who was responsible for deriving the data for the headline—Doctors are the Third Leading Cause of Death—ironically and tragically died from the wrong dose of Plavix. What about death from vitamins?

According to a 2009 Poison Control Center report, over the past 27 years—the complete timeframe that the data has been available—there have been ZERO deaths attributable to vitamins.²

The word “vitamin” had not even been invented at the time of the 1910 infamous Flexner Report. Nutritional medicine is a relatively young science, poorly represented in pharmaceutically-dominated medical education.

Using vitamin C as just one example, does it come as a surprise to a nonnutritionally trained physician that a PubMed search on “ascorbic acid” yields 32,232 full text journal articles? “Vitamin” yields 143,432 and “herbal” yields 19,060 journal articles. Does Dr. Mosley honestly believe these studies have “no value”? Or is he simply viewing with the ironic “bias” of an EBM and RCT “true-believer”?³

Perhaps he is unaware of the criticisms of “Evidence-Based Medicine” (EBM) coming from his own colleagues:

1. Based only on statistical empiricism, EBM misrepresents the basic philosophy of science;
2. The EBM definition of “evidence” is quite narrow: it excludes important clinical information, and is not itself “evidenced-based”;
3. EBM, while seeking to limit bias, has created a “paradigm of bias” replete with expensive data, often of limited use in clinical care;
4. Finally, the narrow-minded reliance on EBM threatens the autonomy of the doctor/patient relationship.³

Those readers concerned about government intrusion into medical care should take heed: EBM “proof” is a growing subterfuge for powerful lobbies of the food and drug industry to insert this Trojan Horse into your lives. If unbridled, it will result in the FDA “declaring unproven” the very treatments that Dr. Mosley has taken aim at in his “opinion” thus limiting access to the care of your choice.

If you think the EBM paradigm (first proposed in 1991 and growing) of medical care provides “legitimate proof” of effectiveness and adequately serves the wellness needs of humankind—stop by, day or night, and visit Dr. Mosley’s crowded ER waiting room.

Sources:

1. Starfield, B. Is US health really the best in the world? Journal of the American Medical Association, (2000, July 26). 284(4), 483-485.
2. Bronstein AC, et al. 2009 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 27th Annual Report. Clinical Toxicology (2010). 48, 979-1178.
3. Cohen AM, Stavri PZ, Hersh W. A categorization and analysis of the criticisms of Evidence-Based Medicine. Int J Med Inform. (2004, Feb). 73(1):35-43. “Studies have failed to show that RCTs and meta-analysis are consistently better than good quality research using other methods for determining clinical effectiveness.”