Shortly before his death, Dr. Albert Schweitzer was interviewed by a reporter. “Dr. Schweitzer,” asked the interviewer, “what do you believe to be the greatest problem in the world today?” The famous humanitarian contemplated the question for a moment and then replied, “The greatest problem in the world today is that men simply don’t think!”

 

“Men simply don’t think!” Since the interview took place during an age when the term “men” was still used generically, it was not a sexist remark. Today the respected physician would undoubtedly say that people simply don’t think.

 

Nowhere is the lack of deep thought and absence of logical reasoning more evident than in the medical profession, especially as it has evolved in the United States. The Nobel Prize winning chemist, Dr. Linus Pauling, noted this some years ago when he commented, “As a profession, physicians do less independent thinking than any other.” 

 

The level of thought has certainly not improved since Dr. Schweitzer named its lack the greatest problem in the world. If anything, people are doing less thinking than in years past. I know, for example, that the amount of thinking done by physicians has declined sharply since Dr. Pauling made his observation.

 

Several years ago a new phrase appeared in medical vernacular of the United States. Medical school professors, authors of journal articles, and speakers at medical seminars began referring to “Evidence-based Medicine”, a euphemism for the practice of relying primarily upon placebo-controlled studies to determine the efficacy of procedures or treatments.

 

Evidence-based medicine has become the Holy Grail of American medicine. Diagnostic and therapeutic options are now graded on the “quality of the evidence”, which is based almost solely upon the results of placebo-controlled studies that have been published in peer-reviewed medical journals. There lies the rub.

 

Peer-reviewed journals provide a means of controlling what data are considered in determining whether or not enough evidence exists to support a treatment or procedure. Articles that are not consistent with current mainstream thought are rarely, if ever, accepted for publication in a peer-reviewed journal. Since data that has not been published in a peer-reviewed journal is not considered relevant in the brave new world of evidence-based medicine, physician practice patterns can be skillfully dictated by those who control access to the journals.

 

The admonition “Don’t bite the hand that feeds you!” is a basic tenet of business. If you ever have an opportunity to look through a copy of the Journal of the American Medical Association (JAMA), the New England Journal of Medicine, or any other distinguished medical publication, take time to count the number of pages devoted to pharmaceutical advertisements. If you do, it will immediately become clear to you why articles favorable to non-drug treatments almost never appear in their pages and why articles purporting to demonstrate the hazards of nutritional supplementation are commonplace. You will no longer wonder why your physician is so quick to reach for his or her prescription pad and so reluctant to endorse a nutritional supplement. He or she is simply practicing evidence-based medicine.

 

Nearly everyone has jumped on the evidence-based bandwagon. One of the worst accusations that can be hurled at a physician today is that he or she is not practicing evidence-based medicine. “Lack of evidence” (defined as the absence of convincing placebo-controlled studies in peer-reviewed journals) has become the primary reason given by physicians for failing to incorporate nutritional supplementation or other supportive measures into their disease management protocols.

 

Dr. Ralph Snyderman, Chancellor Emeritus of Duke University took this position in a video commentary on Medscape, an Internet site that posts medical news and other items of interest to physicians. Expressing his thoughts on the wisdom of integrating non-surgical or non-pharmaceutical approaches into medical practice Dr. Snyderman stated:

Dr. Snyderman’s comments are representative of the evidence-based medicine movement. To a casual listener they sound reasoned, logical, educated and noble. After all, who could find fault with basing decisions upon evidence, science, research, and data? Unfortunately, evidence-based medicine is like the emperor who had no clothes. It is devoid of logic and reason, and is, therefore, diabolically dangerous.

 

Observe what Dr. Snyderman is really saying: “I am open to incorporate things I do not understand if placebo-controlled studies suggest that they work. I am not willing to consider things that aren’t supported by such studies. What is known about how a particular substance or intervention affects the human body is irrelevant.”

 

The great problem with abandoning thought, with its accompanying reason and logic, is that erroneous conclusions can be drawn so easily. Rosalie recently purchased a DVD that contains television episodes from the 1950s, some of which include the original commercials. One ad featured the results of a medical study on the effects of smoking Chesterfield cigarettes.

 

I was intrigued to learn that the results demonstrated conclusively that the health of Chesterfield smokers was equivalent to that of a control group of non-smokers. Based upon the results of the Chesterfield study and others of that era, an evidence-based medical panel would have concluded that there was no reason to advise individuals to stop smoking cigarettes. Such a recommendation could not be supported by the available data. (That was the stance of the AMA, which was reaping profits from cigarette advertising in its publications.)

 

Poorly designed studies that predictably fail to demonstrate significant benefit from nutritional supplementation appear in peer-reviewed medical journals with great regularity. From them evidence-based physicians have erroneously concluded, for example, that vitamin C is dangerous for diabetics, that B vitamins are hazardous for people with advanced atherosclerosis, and that glucosamine sulfate supplementation is ineffective in easing arthritis pain.

 

I am not an evidence-based physician. I would never consider recommending a diagnostic or therapeutic measure if I did not have a clear understanding of how its effects were produced. Conversely, I am unwilling to accept as “safe” substances or devices that I know produce effects that would be expected to damage the body in a particular way. I am acutely aware that benefits or damages often become apparent over decades, not within weeks, months, or even a few years.

 

In the case of cigarette smoking, for example, I reason that inhaling hot, noxious gases is a practice that is certain to cause inflammation in the lining of the throat, larynx, and bronchial tubes. Knowing that inflammation is the first phase of cancer development, I can predict that cigarette smoking will increase the incidence of cancers of the mouth, larynx, and lungs. I do not need to await the results of a thirty year placebo-controlled study to begin advising people that smoking is hazardous to their health.

 

Today, evidence-based medicine recognizes that cigarette smoking is hazardous to health. The point, however, is that had physicians been thinking, they would have recognized at least some of the hazards decades before conclusive data was available. Other hazards, many of which are avoidable, exist today, but evidence-based medicine is silent. It doesn’t’ see any data for them yet.

 

Numerous examples exist. Asthma is affecting an unprecedented number of people in our society, many of them children. Platinum-based compounds are known irritants of the bronchial tree. Logically, if the number of platinum-based compounds in the atmosphere were to rise the incidence of asthma should also increase.

 

Catalytic converters, which were introduced in the early 1970s – the exact time at which the incidence of asthma began to rise – introduce platinum-based compounds into the atmosphere. The rise in the incidence of asthma and other respiratory diseases exactly parallels the rise in the number of catalytic converter equipped vehicles on our streets and highways. The possible connection should be explored, but evidence-based medicine is silent. It doesn’t see any data for it yet.

 

Low levels of stomach acid give rise to an inflammatory condition called atrophic gastritis. Over time, the inflammation progresses to stomach cancer. Three of the top ten grossing drugs in the United States shut off the production of stomach acid. It is therefore possible to predict a rise in the incidence of stomach cancer in future decades. Absence of stomach acid also dramatically reduces the body’s ability to absorb minerals, including calcium. It is possible to predict that the number of people with osteoporosis will also increase as a direct result of the widespread use of acid-blocking drugs. Evidence-based medicine, however, is silent. It doesn’t see any data for these challenges yet.

 

Taking an aspirin-a-day will prevent platelets from clumping together and triggering a heart attack. Unfortunately, taking an aspirin-a-day – even a baby aspirin – increases the risk of a vessel in the brain leaking and causing a stroke. Omega-3 fatty acids provide building blocks the body needs to manufacture platelets that will not clump together abnormally but which will work perfectly when needed. Therefore, omega-3 supplementation will prevent heart attacks without increasing the number of strokes. Evidence-based medicine is silent in this regard. It doesn’t see any data to support such a recommendation yet.

 

Popular cholesterol-lowering drugs called statins block the body’s ability to manufacture a substance called coenzyme Q10. Coenzyme Q10 is needed for efficient energy production in muscle tissue. Low levels are associated with the development of a condition called congestive heart failure, which happens to be the most rapidly growing type of heart disease in the United States. Logic would dictate that coenzyme Q10 supplementation be routinely recommended when a statin is prescribed, but evidence-based medicine is silent. It doesn’t see data to justify routine coenzyme Q10 supplementation in statin users yet.

 

Homocysteine is a direct toxin to the lining of arteries. In addition, as an index of the body’s ability to use a process called methylation for maintenance and repair, elevations of homocysteine are associated with nearly every known chronic disease. With reference to homocysteine, however, evidence-based medicine is silent. It doesn’t see any data to justify routinely checking homocysteine levels yet.

 

Microwaves, including those that locate cellular telephones, adversely affect the body’s energy by changing the direction of electron spin. Electrical fields generated by computer monitors and other devices also disrupt the body’s natural energy flow. Devices that filter electromagnetic frequencies, blocking those that are disruptive and amplifying those that are supportive of the body’s energy systems are readily available, but evidence-based medicine is silent. It doesn’t see data to support electromagnetic protection yet.

 

One of the most common causes of upper abdominal pain is a slightly displaced rib, a condition that can be corrected by a chiropractor in one or two visits. Logic would dictate that removing a normal but “non-functioning” gallbladder is not going to make it functional again. Logic suggests that if the gallbladder is normal – that it contains no stones and that its wall is not thickened or inflamed – any pain that is present must be due to an, as yet, undiscovered abnormality. Nevertheless, evidence-based physicians continue to remove normal gallbladders in an attempt to eliminate right-sided upper abdominal pain. They don’t believe in working with chiropractic practitioners; they just don’t see any data for their methods yet.

 

You may be thinking at this point, “So what? Why are you devoting an issue of your wellness letter to the phenomenon of evidence-based medicine? What does it have to do with me and my health?”

 

What it has to do with you is this. If you are seeing a physician, it is almost certain that he or she is practicing evidence-based medicine. The decisions he or she is making regarding your diagnosis and treatment are not based upon logic and common sense, but upon the results of relatively short-term studies that have been carefully selected for publication by editors of journals awash in pharmaceutical industry dollars. It is time for you, like Dr. Snyderman, to develop a compassionate skepticism.

 

Compassion in recognizing that your physician is seriously devoted to improving your condition, but skepticism in your realization that the evidence upon which he or she is basing recommendations is markedly biased in favor of a pharmacologic or surgical approach to your health challenge. Compassion in heeding your physician’s advice when it is logical, but skepticism in being willing to say no to drugs or surgery when a safer, and quite possibly more effective, approach to the problem is available. Compassion in understanding that your physician has not been trained in the use of measures to support your body’s ability to heal itself, but skepticism in accepting his or her recommendation that you avoid giving your body those supports.

 

If you are seeing a physician your life is being impacted by evidence-based medicine. Being aware of this, you can feel more confident in questioning whether or not the plan outlined for you is logical and reasonable. Perhaps you will think before blindly following that plan. Perhaps you will become part of the solution to the greatest problem in the world today.