A discussion in the Australian Medical Observer this week has got me thinking about the huge push for evidence-based Medicine to form the foundation of our naturopathic practice. Now as you well know, I am a lover of science, and I enjoy immensely when scientific investigations are done well but is 100% of what I do scientifically supported? Heck, no.
I’m a naturopath and by virtue of this, at times I have to work on the edges, frequently push new frontiers and sail some completely unchartered waters – in my management of every unique ‘n=1’ client who comes through my door.
The over-emphasis or incorrect reflexive association between EBM and Random Controlled Trials and Meta-analyses, such as the Cochrane reviews can lead to a potentially dismissive attitude towards other forms of evidence – traditional, anecdotal and empirical and clinic-based results. Our best teachers taught and reminded us that EBM should include ALL forms of evidence, right?
Turns out this is not remotely unique to naturopathic or complementary medicine however. Increasingly, universally-accepted interventions from mainstream medicine is being found to be unfounded!
A recent Cochrane review has created a divide in the medical industry due to its evidence-based slant on a review of direct-acting antiviral drugs (DAAs) in the treatment of Chronic Hepatitis C. To give you some background on DAAs… these antiviral drugs have been seen as a kind of “wonder drug” by researchers and doctors trialling them, with clinical results showing a 90% cure rate in patients with Hep C!!! That’s not a bad success rate, right?! Well, the Cochrane review had a different opinion….It made these actual accepted clinical results appear questionable according to science, claiming that “the therapies were not proven to save lives or prevent harm [and that] the trials were generally weak.”
The clinical trials that the Cochrane review was based on, were focused on the effects of the DAAs on sustained virological response i.e. the long-term absence of the Hep C virus RNA in patients’ blood. However, the review declared that it was “questionable if sustained virological response has any clinical relevance to the person with chronic hepatitis C.”
Hmmmmm…?!? Surely the absence of the virus in the blood of a person diagnosed with hepatitis C has great relevance to that person??!!
This opens up a lot of questions regarding the relevance or the appropriateness of over-reliance on evidence from meta-analyses and computer-generated statistics, in the absence of tradition, real -world and clinical findings. With more and more pressure to base our practice on EBM, are we forgetting that the foundations of our art and our science, lie in the traditional knowledge passed down through generations of healers? The knowledge of using Nature as medicine? Are traditional, anecdotal and empirical forms of evidence being pushed aside too readily, in the name of science? Of course, I could be seen to be as guilty as anybody for perpetuating this…so I’m just setting the record straight…it’s the marriage of the best of all the evidence sources that is the true potency and success of naturopathic approaches, I believe.