April 8, 2014
the altar upon which we worship
"What happened to evidence based medicine? I thought we were supposed to be a school that teaches that, not hocus pocus stuff like acupuncture," I overheard a student say at the end of a workshop dealing with integrative medicine. I will be the first to admit that there is much woo in alternative therapies. I approach ALL therapies with a skeptical eye. But how many doctors are willing to admit, hell are even aware that there is quite a bit of our guidelines that have just as much woo and hand waving? I told the student, "I've gone to acupuncture. It helped somewhat but just wasn't cost effective," as I gave him a brief rundown of what life is like with chronic pain.
"It sounds like you need a good orthopedist," he replied. Did he think me stupid? Of course, that's the first person I went to after my family doc. Surgery couldn't help me so he wished me luck and ominously told me to come back when I "get worse".
But what I really wanted to tell the student was to be careful at which altar you worship. Our precious medicine is not always as hard and fast as we've been taught. For instance, cardiovascular disease is the number one killer in the western world. You'd think we'd have a very firm grasp on that with it being the number one killer and all. And yet, when somebody decided to ask the question, how many of the things we preach to patients about avoiding heart disease are really based on solid evidence, the answer was less than awe inspiring. About 300 recommendations. Out of 2,700. About 1 in 10. What's worse is that more and more recommendations are being added and, "The proportion of recommendations for which there is no conclusive evidence is also growing." So when my dad got a lecture from the cardiologist about changing his diet, I told my dad that statistically speaking, 9/10 were based on weak data or worse, "expert opinion." (Actually, it was all nonsense.)