Evidence Based Medicine – is it actually science?
Evidence Based Medicine – is it actually science?
So what is the point of following the evidence if even studies in major well known journals cannot be reproduced?
In the healthcare professions we hear a lot about the need for ‘evidence’ in order to back up or justify, guide or direct our understandings or treatment directions. But the only problem here, is that after 10 years, the results of 40.2% of clinical treatments cannot be reproduced and they are reversed. [i]
Surely if there was a reliable science here at play, then the results ought to be reliable.
But this is not what we are seeing in the case of published studies, yet they are being held up as being absolutely reliable.
Why are the studies that are published not reliable?
There are many reasons, but the fact is that people in highly regarded positions who have been diligently reviewing the data, the evidence and the studies for 20 years have themselves come to the conclusion that the data cannot be relied on.
Maya Angells, editor of the New England Journal of Medicine, says:
“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as editor of The New England Journal of Medicine” [ii] .
Richard Horton, at the time the editor of the BMJ, says:
“The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness.” [iii]
The fact that this result is seen consistently across the board tells us that there is a problem with science.
Where does it begin?
We know that with the evidence there is always corruption involving the human element.
Fiona Godlee, editor of the BMJ, states that: _ "Medicine and science are run by human beings, so there will always be crooks," _
"There does remain a really entrenched problem with institutions, when asked to investigate allegations of misconduct. They will tend to close down, will tend to prefer not to investigate, will tend to hide any evidence and see it as a damage to their own reputation if they were to take action."
Clearly when there are human elements involved it can be seen that things such as:
Rigging of studies
Hiding of negative results
- Not publishing negative results
- Being jealous
- Stealing results
- Stealing ideas
- Blocking publications
- To designing studies deliberately to get achieved results in order to be paid or get enormous profit
...will all lead to errors, and – to be blunt – blatant lies being published.
However, is it only the human factor that leads to results which cannot be trusted?
What about the very methodologies themselves? Are they flawless and are they designed to lead us to truth?
A simple examination of the methods reveals that this is not so, as much as we would like it to be the case.
All studies are based on statistical modelling; they are designed and the numbers needed to recruit to get significant results are based on something called ‘The Null Hypothesis’. This is a concept that proposes that there is no relationship between two things. But scientifically this is not even the case. Quantum physics is a well recognized branch of actual science that appreciates and demonstrates that there is a relationship between everything in the universe. It is simply a matter of quantifying that relationship, yet in the process of medical science we do not do that. We base our entire statistical modelling on what is in fact a scientific lie. And then we wonder why ‘statistics’ is lumped with 3 types of lies as Mark Twain says:
"Lies, damned lies and statistics"
Furthermore, if the statistical foundation were not ill enough to reveal the remove of medical science from real life, studies that are designed are then designed in order to be able to achieve certain results. Yes, studies are not designed to help us understand things more deeply, they are designed with a particular result in mind. After all, if you don’t have a particular result in mind, you can never design the study to get the result! How might you design a study if you didn’t know what result you were likely to get?!
Is this not craziness?!
True science knows that to understand an organism or an animal in fullness, you need to examine and observe it in full in its natural environment.
Instead of observing people in their fullness, as we might do animals, research science has us reduce people, limit them to a few characteristics, measure only what limited available tools can measure and then dismiss the rest and pretend that it is not there. Research tries to pretend that we are all the same and that we are all affected the same way by things, but does not acknowledge at all our multi-dimensionality.
Thus if there is a process trying to reduce us to numbers, but only a set of numbers which can be measured and quantified and reduced, then how can we possibly call that science?
In short, we cannot call it true science because it is not of the whole.
Worse, these studies when they are done – in all their reduced mannerisms, examining only a small part of each person, each study designed according to the biases and corruptions of all of the people engaging from sponsors to scientists – are then pooled together into what is called a meta-analysis, where bias is lumped with bias and the truth is said to come from that……….. as I say, yeeeeah, right……
Richard Horton puts it more eloquently when he says:
"Our love of ‘significance’ pollutes the literature with many a statistical fairy-tale" [iv]
Worse still, the process called ‘peer review’, which is supposed to give meaning, purpose and validity to things that are granted the holy grail status of ‘publication’, has not even been validated by the same scientific standards that scientists say all things need to be evaluated by!  It is well known to be completely corrupt and unreliable, yet it still stands, its presence a further damning statement of the state of current evidence based science, which can be actually seen when examined more closely to be a protection of positions and beliefs and faiths rather than a promotion of true scientific inquiry.
True science looks at things in their wholeness. One cannot understand the entire universe when viewed through a pinhole, yet this is our current approach to humanity with our ‘scientific’ methodologies of examination.
Sadly, despite our best investments and intentions, evidence based medicine at present is not true science, nor will it ever be until it incorporates the whole of the person and their personalised experiences.