Blog | Wednesday, March 19, 2014

Do doctors practice evidence-based medicine?


I advocate evidence based medicine. We should restrict our medical recommendations to those that have a reasonable underlying scientific basis. On the opposite end of this spectrum is quackery, when snake oil and other potions are hawked that either have no scientific support or have been shown scientifically to be ineffective.

I do not offer snake oil here as a historical reference. We have more snake oil and its congeners today than ever before. People who are sick want to believe the man who promises them healing, particularly when conventional medicine has not succeeded. This belief goes to the core of human nature, at least as I have observed over the past 3 decades.

Of course, in the medical world, we don’t have enough science yet for all of the medical issues that we physicians confront. That means that we guess a lot. How often does this occur? Every single day. Patients would be quite surprised to learn that there is usually scant or conflicting medical evidence to guide the issue that has brought them to our offices. This does not mean that your physician is rolling the dice on you. He relies upon available medical knowledge, if there is any, and his judgment and experience, 2 invaluable assets that are not measured in the various pay-for-performance schemes. These invaluable assets are not measured and rewarded by the government and insurance companies because they cannot be easily measured. Does that mean that they don’t count? Absurd, of course.

If you doubt the presence of non-evidence based medicine, consider the promised health benefits of yoga, probiotics, medication, massotherapy and the latest gluten-free rage. I’m not stating categorically that these and related techniques do not work; I am pointing out that there is no persuasive medical evidence supporting their claims. Our airwaves are clogged up with snake oil disguised as medicines promising “good prostate health” or “healthy bones”. These sound like health claims to me, but their language is carefully selected and is followed by the disclaimer “not designed to diagnosis or treat any medical disease”. Would you rather believe the false promise or the true disclaimer?

Of course, these prostate potions do not want to be subjected to rigorous scientific scrutiny. Why would they? They do not need FDA approval like prescription medicines. They can freely and legally use the phrase “clinically tested” (whatever that means) and empty their warehouse shelves to clogged prostates across the country. These companies only have to spend funds on marketing, unlike true drugs that must spend millions demonstrating to the FDA that their products are safe and effective.

There are many products on the market today that don’t want to be tested to confirm or determine efficacy. Guess why.

This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.