Monday, 9 April 2007

Evidence-based Medicine

Advocates of 'Evidence-based Medicine' have been able to point to many forms of medical treatment for which there is no evidence for their efficacy. Recently it has been suggested that in many medical units between 15% and 20% of treatments offered are completely unsupported.

When we consider its history, it is perhaps unsurprising that a practice such as medicine should have components which have not received the careful scrutiny of the modern clinical trial. In many cases we should welcome questioning of apparently well-established practices. For instance, some of the most important findings are against unnecessary surgical interventions, such as hysterectomies.

But should we accept unreservedly a drive whose aim is to analyse each treatment into its component parts and submit each to a test approximating the gold standard - the prospective randomized double-blind placebo-controlled clinical trial?

Well, not if it means that treatments which cannot be tested in such a way are automatically devalued. And isn't this precisely the case where there is a psychotherapeutic component to the treatment programme? While researching our book, we came across studies which attempted to apply 'placebo psychotherapies', but in doing so they reveal how little their authors understand psychotherapy to try to force it into a model of something active or inactive and applied in a fixed number of doses.

And what of the wart remedies I mentioned? Doesn't the ideal of a placebo-free effect act to discourage researchers from exploring the fascinating phenomenon itself?

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