In medicine and in many matters pertaining to our health these days, there are many references to Evidence-Based Medicine (EBM) – which generally refers to clinical trials which prove/disprove the safety/effectiveness of various treatments. While this is a standard which we try to live up to in our clinical practices here at The Core Family Health Centre, there are some limitations to it.
Every day we are bombarded with reports of evidence which “proves” that something is harming us or something else could save us — and over the course of a few years, the same item could be in both camps! We hope to provide clarity and save you from buying products or services that may not be proven to help.
While these issues can be complicated and confusing, it is extremely useful to be aware of a few things in order to make sense of it all. Two terms in particular, the placebo effect and pre-test probability can help with the (mis)information we are bombarded with on newsstands, websites, newsletters, emails, etc. Our goal is to be informative, holistic and patient-centred in order to help you make the best decisions for your health – but still meet the standards of science.
The placebo effect is a real response — psychological or physiological — to any inert, inactive, or irrelevant procedure or substance (a sugar pill for example). In other words, in any situation, people will respond to a treatment simply because they expect it to work and are receiving it from a trusted practitioner. Since we know of its presence and power, it needs to be controlled for. In EBM, good trials take this into account by testing 2 groups of people where one group is receiving the experimental/proposed treatment and the other group is not – but no one involved knows which is which. This will help determine if the treatment in question has any benefit more than the placebo effect.
Science based medicine (SBM) follows the same principles but takes somewhat of a bigger picture as well. Since science builds on itself, it is useful to look at the general body of knowledge that we have and see if there is a way to explain the mechanism of action of a proposed treatment. At its most basic level, SBM agrees with Carl Sagan’s quote – “Extraordinary claims require extraordinary evidence.”
If something totally contradicts the current understanding of science as we know it, then one clinical trial is not going to be enough to overturn it. For example, it took a lot of studies and evidence to prove that ulcers were caused by bacteria and change the clinical practice. Similarly, it would take an immense number of positive studies to convince the medical community that cancer can be cured with baking soda! This is the pre-test probability — what are the chances of something being positive/effective before the study is even done? In other words, even if the trial is positive, an error in the study may be more likely than that the treatment was truly effective; therefore, significantly more evidence would be required before supporting it.
Admittedly this is a challenging process to go through, but we continue to do our best to support our patients through the various small and large decisions to be made regarding their health, and hope to do so by providing the most accurate information we can. Hopefully this article can help make some sense of our outlook on health.