Leisure, Lifestyle & Wellness
A Relook at Evidence-based Medicine

Is the relationship between scientific method and medicine fragile?


Many years ago, I wrote an article titled “Evidence based or evidence burdened science” that attracted much criticism from the ‘great medical scientists’. Luckily, today, I chanced upon an article in the International Journal of Evidence Based Health Care 2006 (Volume 4: pp 180-186) wherein the authors, Dave Holmes, Stuart J Murray, Amélie Perron RN and Genevieve Rail, claim that evidence-based movement is not just a fraud but a dangerous game that the powerful people play to keep their industry moving. The abstract of their paper is reproduced below:

“Drawing on the work of the late French philosophers Deleuze and Guattari, the objective of this paper is to demonstrate that the evidence-based movement in the health sciences is outrageously exclusionary and dangerously normative with regards to scientific knowledge. As such, we assert that the evidence-based movement in health sciences constitutes a good example of micro fascism at play in the contemporary scientific arena.

“The philosophical work of Deleuze and Guattari proves to be useful in showing how health sciences are colonised (territorialised) by an all-encompassing scientific research paradigm—that of post-positivism—but also and foremost in showing the process by which a dominant ideology comes to exclude alternative forms of knowledge, therefore, acting as a fascist structure.

“The Cochrane Group, among others, has created a hierarchy that has been endorsed by many academic institutions, and that serves to (re)produce the exclusion of certain forms of research. Because ‘regimes of truth’, such as the evidence-based movement currently enjoy a privileged status, scholars have not only a scientific duty, but also an ethical obligation to deconstruct these regimes of power.”

The above abstract leads to the conclusion that medicine is NOT a science. The much-touted randomised controlled trials (RCTs) that are sold as hard evidence in medicine are making a mockery of science. In fact, medicine is not a science; but is not unscientific either. It is better called non-science enquiry. The doctor’s job is to make a diagnosis which is exclusively done by trial & error and more by past experience of having seen hundreds of cases. That is where experience plays a vital role. The diagnosis can be supported by some investigations; but the final proof of the pudding is in the response to the treatment. The pain-in-the-neck is the side-effects of various drugs. If one uses very powerful drugs, one might feel that the disease comes under control sooner. This is, often, only an illusion.

That is why adverse drug reactions (ADRs) have become a common cause of hospital admissions and death. Even simple antibiotics, like clarithromycin, can give rise to heart attacks in the ensuing months and years! In fact, a senior functionary of a well-known drug company said: “It is an open secret within the drugs industry that most of its products are ineffective on most patients.” Now, we also have strong evidence that the faith of the patient in the doctor is a vital part of the patient's response to treatment, even surgery! Therefore, medicine is less scientific but more humanistic.

Case histories and individualised outcomes work better in medicine than large-scale trials which look at a large group. RCTs will not be admitted as evidence in a law court but case histories may be admitted as evidence. Medicine can learn more from law rather than from the so-called hard sciences like physics and chemistry.

“The practice of medicine is largely observational and functions without the level of certainty essential to science. As the reign of ‘evidence-based medicine’ with its crippling flaws is replaced by evidence-informed individualised care, healthcare providers, physicians and surgeons will once again better appreciate the importance of and application of non-scientifically obtained evidence. Case reports and case series are examples fundamental to medical practice and education,” wrote Clifford Miller and Donald W Miller Jr in their article in the European Journal of Person Centred Healthcare (Volume 2, Issue 2, 2014, pp144-153).


Professor Dr BM Hegde, a Padma Bhushan awardee in 2010, is an MD, PhD, FRCP (London, Edinburgh, Glasgow & Dublin), FACC and FAMS.



Ashwin Tombat

2 years ago

Medical science is imprecise and constantly evolving. And the evidence-based system is certainly not perfect or even desirable in its present form. But at least it is a thoroughgoing system.

To criticise it is fine, but to completely debunk it on the basis of 'evidence' that reads more like a political manifesto than a scientific piece of writing is quite over the top.

More important, the trenchant critics of modern-day scientific medicine have no real alternatives to offer, unless one considers so-called 'alternative therapies', many of which are completely unscientific, unverified and downright dangerous.

A lot of what Dr Hegde writes is good and incisive. But every now and then, he advocates some kinds of mumbo-jumbo that the world is better off without.


2 years ago

Ridiculous. All this jabbering on about how diagnosis is trial and error. Of course physicians must use judgment and experience to make a diagnosis. And do we also want them to use their best judgment (or the last industry fop who took them to dinner) to pick a treatment once a diagnosis is made? Or accumulated evidence on the benefits and harms of available treatments, evidence they often don't have time or resources to examine themselves?

US Diploma Mill Allegedly Swindled $11 million from Students

Consumers allegedly charged between $200 and $300 for high school diplomas that turned out to be bogus


A Florida court has temporarily halted an online high school diploma mill that allegedly swindled more than $11 million from consumers by charging them between $200 and $300 for high school diplomas that were advertised as “official” and accredited but were actually fake, the FTC announced last week.

The companies allegedly sold the phony diplomas using multiple names, including “Jefferson High School Online” and “Enterprise High School Online.” Consumers were given a multiple-choice test before paying for a diploma.

RELATED: Feds Sue Corinthian Colleges over Deceptive Advertising

“A high school diploma is necessary for entry into college, the military, and many jobs,” Jessica Rich, director of the FTC’s Bureau of Consumer Protection, said in a statement. “These defendants took students’ money but only provided a worthless credential that won’t help their future plans.”

Online high schools may appear to be authentic but there are some red flags to watch for before you pay for a diploma. For example, if you only have to pay a flat fee for a diploma instead of fees per semester, it’s probably a scam like this one.

And if you are seeking the equivalent of a high school diploma, consider your state’s GED, a less expensive and safer option.

Courtesy: TruthInAdvertising.org


How Detectives Coaxed Suspect in Etan Patz Murder to Confess

Pedro Hernandez, a man with an IQ of 70 and history of mental illness, confessed to strangling a 6-year-old boy after investigators appealed to his religious faith


For more about the disappearance of 6-year-old Etan Patz, a case that frustrated and mystified police for decades, read the story ProPublica produced with WNYC in 2013.

Earlier this week, prosecutors played a confession given by the man they have charged with the 1979 murder of Etan Patz. In it, the accused, a former bodega worker from the Patz family's Manhattan neighborhood, is calm and composed in detailing how he strangled the 6-year-old boy and disposed of his body in a box. Pedro Hernandez cups his head in his hand at one point, crosses his legs casually in another. He chuckles at a prosecutor's joke. The prosecutor, seated across a table, carefully advises Hernandez of his rights and questions him methodically.

On Thursday, a very different version of the confession was played in Manhattan Supreme Court. This confession had been taken in a New Jersey police precinct after Hernandez had been questioned for more than seven hours by detectives excited about solving one of America's most famous missing child cases.

In this version, Hernandez sobs. Detectives, in a cramped corner of an interrogation room, rub Hernandez's head and gently touch his shoulders. The detectives invoke Hernandez's faith as an encouragement for him to come clean. The environment is highly charged.

"That's strength," one of the detectives says as Hernandez starts to detail his account. "That's the strength of the Lord."

At another point, detectives place a missing person poster with Etan's face on it before Hernandez.

"What did you do to him," a detective asks.

"I choked him," Hernandez says.

The detectives then ask Hernandez to write down in a notebook what he had just said.
"How do you spell choke," he asks.

"C-H-O-K," the detective instructs. "Sign here."

The fate of Etan Patz has nagged achingly at New Yorkers for decades. The boy had been on his way to school alone when he vanished. A manhunt was undertaken. National headlines followed. The FBI joined New York police in the investigation.

But the case had never been solved. Suspects were identified, and one was even found culpable for Etan's death in a civil proceeding. But the boy's body was never found. No one was ever criminally prosecuted.

The prosecution of Hernandez, still in its infancy more than two years after his arrest in May of 2012, is the latest uncertain chapter in the Patz saga. The arrest came with declarations of triumph by police and prosecutors, but also with skepticism among many, including FBI agents who had long worked on the case.

The playing of the two confessions arose as part of a judicial hearing to determine whether either would be admissible at a trial.

Prosecutors have sought to depict the raw emotions of Hernandez seen in Thursday's version as evidence of his authentic guilt. The tears, for them, are genuine, a logical and natural consequence of a painful, shameful unburdening. The appeals to his faith were an effort to get at the truth of what happened.

For Hernandez's lawyer, the behavior of the detectives is manipulative, and the anguish of his client is the consequence of what can happen when a mentally ill man is interrogated out of public view for hours.

In court on Monday, the lawyer, Harvey Fishbein, said all versions of Hernandez's confession are provably wrong when compared against the known evidence about the crime. But Fishbein said he does not doubt that Hernandez, a man with an IQ of 70 and a long history of treatment with anti-psychotic medications, believed what he was telling detectives.

The idea that people could falsely confess to serious crimes and provide compelling details of the rapes or killings they did not commit has been a subject of growing concern in the judicial system. Some states and localities have taken steps to try and limit false confessions.

One of those steps has been to re-examine police interrogation techniques. Another has been to require the taping of initial interrogations. New Jersey, it turns out, is one of the state's that demands recordings. But that's not what happened when Hernandez was questioned in New Jersey in May of 2012.

Prosecutors have argued that taping the seven hours Hernandez spent being interrogated by detectives was not required because it was a New York case, not a New Jersey matter.


And they have said they were not obligated to advise Hernandez of his rights because he was not formally in custody. Fishbein has disputed that, saying that Hernandez more than once said he wanted to go home, but was instead kept in the interrogation room.


Fishbein argues that all of Hernandez's ensuing confessions should be thrown out because of the failure to read Hernandez his rights during the hours of untaped questioning.

The confession played Thursday, then, captures a kind of middle stage in Hernandez's 36 hours with the authorities -- after the untaped interrogation, but before the more decorous interview in the offices of Manhattan prosecutors.

The detectives often make physical contact with Hernandez. They touch him, nearly hug him. They applaud his eventual admissions.

"You did the right thing today," one detective says. "It takes a lot."

Another detective asks if Hernandez wants to say anything to the Paz family.

"That I'm really sorry, that I never meant to hurt their child," he says. "That I hope they can forgive me."

Near the end of the recording, Hernandez remarks to a detective that he knew that what he had said would get a lot of attention.

"Because this is a big case," Hernandez says.

Courtesy:  ProPublica.org


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