SBM, EBP and Traditional Medicine

The combination of the best SBM, the best EBP and the best Traditional Medicine, provides the best answers for the most people when it comes to medicine and healthcare.  That is my opinion from my clinical experience.

Recently, I discovered a website called Science Based Medicine (SBM) and I now read it on an occasional basis with interest.  It is a website whose articles are written by MDs (many who are specialists in various fields) who unequivocally believe that alternative medicine (naturopathy, homeopathy, acupuncture, healing touch, Reiki, many vitamin/mineral therapies, chiropractic medicine, etc., etc., etc.) are useless at best, and harmful at worst.  The message on their website is very clear:  scientific based medicine that involves well conducted double-blind (or triple-blind) randomized control trials (RCT) and clinical trials based on known scientific plausible information is the only type of medicine that is useful and effective.  

I have increased my learning from reading this site.  Some of the information has been quite eye opening and informative, and other information has been false.

There is no doubt in my mind that SBM is responsible for the great improvements in modern medicine that we see today, such as found in childhood leukemia treatments, stent insertion for coronary artery disease, and many other wonderful inventions too numerous to mention.  There is no doubt in my mind that as a species we are living longer because of the advent of pharmaceutical drugs and more effective surgical techniques.

Yay SBM!

Unfortunately, SBM does not contain the answers for all people, and depending on the condition we're talking about, SBM lacks answers for many, many people.

Evidence Based Practice (EBP) as taught to us by our pharmacology profs, includes the integration of 3 aspects of care:  the best researched evidence, combined with the best clinical expertise, combined with what the patient values.  In this model, the best researched evidence has a hierarchy of efficacy.  That is, different types of studies hold more importance and are more accurate than other types of studies.  From most important to least important, here is the list:  meta-analysis of RCTs, single RCTs, cohort studies, case-control studies, case series, case reports (anectodal evidence) and expert opinion.

The beauty of EBP lies in the notion, that along with science based medicine, acceptance of what a patient believes, thinks and wants, as well as the clinical experience of the healthcare practitioner, is the best way to determine course of therapy and treatment for a patient.  I wrote:  along with, not instead of, and not subservient to, but along with. SBM, as narrowly defined by RCTs and clinic trials, while solid and useful, is not the panacea of great health and longevity for all people.  Wouldn't life be grand if that were so!

Different than SBM and EBP, is medicine based on historical relevance that I will call Traditional Medicine.  Many therapies that are used by naturopathic physicians date back centuries (like homeopathy), or a few millennia (like acupuncture and TCM), or tens of thousands of millennia (like botanical medicine).  While longevity doesn't necessarily equate with efficacy, a person with critical reasoning must ask, if these types of treatments are not efficacious, then why have they been around for centuries and millennia?  An herb like Milk Thistle (Silymarin) for example, by trial and error, was found to aid liver problems thousands of years ago.  No RCTs or well conducted clinical trials affirmed for our ancestors, that certain botanical remedies alleviated certain medical conditions with great efficacy.  Now, because of the push for scientific medicine to prove or disprove the effect of botanical medicines, herbs like Milk Thistle are brought to task as in this one of many studies analyzing this herb.

I will reiterate my opening paragraph.  When the combination of the best SBM, EBP and Traditional Medicine work in concert with each other, the patient stands to benefit maximally in the majority of situations and conditions.  This is what I have repeatedly observed in practice.

In certain medical conditions, one size fits many people really well, but not everyone, like the man who dies on the operating table from coronary by-pass surgery (2% of people die from this surgery).  In other conditions, where modern medicine provides little to no answers for relief, (for example chronic fatigue syndrome), one size does not fit all, and alternative medicine shines in this area.  And very sadly, for other diseases like amyotrophic lateral sclerosis (ALS), never mind that one size fits most, or one size does not fit all, in this disease the size has not yet been found in either conventional medicine or alternative medicine.

The bottom line for any patient embarking on any type of medical treatment is twofold:  Will this hurt me?  Will this help me?  Everything else is details:  SBM, EBP, Traditional Medicine, a combination thereof, or no medicine at all.