Posted by: ensomabodyworks | November 2, 2017

EVIDENCE – BASED MEDICINE’S (“EBM”) FOUR MAJOR FLAWS AND TRAPS AND SOLUTIONS TO THEM

If i hear one more colleague, patient or doctor say, “show me the data,” I am going to puke.

This short post will hopefully give you an ‘ah ha!’ moment concerning your doctors’ need for the ‘data’ before supporting a particular type of therapy of intervention to our ailments and how sticking to “the data” can be on ill-outcome for you.

The problem with EBM is four fold:

1. The body of collaborative knowledge that is used to make decisions is lacking certain data.

Google low back pain.  You will probably not find muscle dysfunction or muscle pain as a cause of back pain at web MD or similar sites.  Why?  Its not on their radar because its not taught in med school nor researched much nor included in the meta analysis’ being referenced by medical professionals.

The widely used reference site “uptodate” is the go to site for clinicians and doctors when wanting more info about a particular problem.   When its low bak pain or neck pain the uptodate researchers will not include soft tissue therapy or massage or manual therapy as its not included in their data scouring of the research on back pain and neck pain.

2. Confirmation bias.

Lets take the idea that  lowering cholesterol is always good for health. Cardiologists did a meta-study and found that men with higher cholesterol lives longer than those with lower cholesterol and concluded that they should consider recommending getting cholesterol even lower instead of asking the question, “Maybe we are barking up the wrong tree?” “Maybe cholesterol is not the killer we thought it was?” These cardiologists cannot take a step back as their confirmation bias towards cholesterol being the killer on heart disease is too powerful and blinding them.

I will even state that people with higher cholesterol live the longest!    Sounds nuts right according to what the media and American Medial Association tells us (and our docs)?  Read this here to prove my claim and that of the meta study mentioned in the previous paragraph:

 http://www.ravnskov.nu/2015/12/27/myth-9/

And I used to think most pain was muscular (as a soft tissue guy) but have since learned umm, that ain’t the case Marty.  Confirmation bias is very very strong.

4. Corporate influence on research has left the research world a big QUESTION MARK as to can you believe the results are accurate and truthful?

Research is more and more funded by the corporation wanting an outcome supporting their drug or intervention of technology.   Dr. Gerger, MD does a amazing job of explains this and the “data” to back it here:

https://www.youtube.com/watch?v=ludhja7sW0I.

He explains how independent research on cell phone radiation shows a correlation to illness while cell phone company and telecommunication industry funded research does not!

And corporate interests are messing with studies and their outcomes – https://www.drugwatch.com/manufacturer/clinical-trials-and-hidden-data/

And Companies mislead doctors – https://www.nature.com/nature/journal/v429/n6992/full/429589a.html

In summary:
Data is two fold: Informed base and data based.  What goes on in my private practice as well sa data should influence what does on in my office. Not just one or the other.

I suggest asking broader questions to you therapists and doctors and ask them to think outside the “data box” concerning treatment for pain or what ever ails you and not make a decision on the “data” pooled from data based that are lacking in scope and outcomes of trials and research is skewed by bias and corporate financial outcomes.

Don’t just get two opinions get different expert opinions.

The father of EBM, David Sackett said it best. EBM is “integrating individual clinical expertise with the best external evidence”.

And this perspective is lost in the rush for “show me the data.”

You can read more about Sackett here:  http://retractionwatch.com/2016/03/16/evidence-based-medicine-has-been-hijacked-a-confession-from-john-ioannidis/

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