Today, we have Evidence Based Medicine, Science Based Medicine, Data Based Medicine, Instinct Based Medicine, Patient Based Medicine, Experience Based Medicine, Functional Medicine, disease based medicine, hospital based medicine, pseudo-evidence based medicine, and a jokes: Seven Alternatives to Evidence Based Medicine, Crap Based Medicine? What’s going on?
What should medicine be based on? Health. We need:
Health Based Medicine.
The leading candidate today is EBM, so called Evidence Based Medicine. ” is defined as “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” (Wiki). Wiki goes on to say “Trisha Greenhalgh and Anna Donald define it more specifically as “the use of mathematical estimates of the risk of benefit and harm, derived from high-quality research on population samples, to inform clinical decision-making in the diagnosis”.
The rub, simply, is to be found in the reasons Evidence Based Medicine exist. Medicines are dangerous. Standard medical technique is to ‘fight’ the illness. To war against the disease. We need EBM to reduce risk and harm for the patient, because medicines create risk, and harm patients.
According to BMJ “Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” If it is, we are only half way to success.
Science Based Medicine is the ‘new kid on the block’. Science Based Medicine vs Evidence Based Medicine says “Science-based medicine (SBM) is not a replacement for the more familiar concept of evidence-based medicine (EBM). Instead, it emphasizes some neglected aspects of EBM. This article explains the differences and the need for the distinction.”
What are those ‘neglected aspects of EMB’ that are provided by SBM? Frankly, the above post does not give a single difference worth quoting. It simply rants with phrases like “That’s insane!”, “quasi-scientific obfuscation”, and “the quack leapfrogs”, but provides no actual answers. It is interesting that proponents of SBM claim EBM is a ‘subset’ of SBM, while also suggesting that SBM ignores evidence that is attended to by EBM. SBM sounds like PBM (Propaganda Based Medicine) to me.
Both EBM and SBM ignore anecdotal evidence. Anecdotal evidence is one of the monsters of modern medicine. Specific cases of illness that were cured. In many cases, specific instances of illnesses – that are judged to be incurable – were cured. Anecdotal examples abound. Even more confounding to EBM and SBM proponents, in many anecdotal cases no ‘medicines’ were used – no prescription medicine, no Evidence Based medicines, no Science Based Medicines. How can this happen? Do EBM and SBM study these cases? Nope.
Is it possible to ‘cure’ a disease, without a medicine? Of course it is. It happens every day. It’s just not acknowledged by EBM, SBM, or any other current “based medicine”. If you are suffering from dehydration, the cure is not ‘medicine’, it is water. If you are suffering from scurvy, the cure is not ‘medicine’, it is nutrition. If you are suffering from malnutrition, the cure is food, not medicine. There are many,many types of malnutrition, more than we know.
If you are suffering from unhealthiness, the cure is to improve your health. No medicine is needed. No medicine will help. The only solution will be found in Health Based Medicine, which often does not use ‘medicines’ – improving healthiness instead.
How many illnesses are better served by Health Based Medicine than EBM or SBM? We don’t know. Obviously, dehydration and scurvy are best treated with health – medicines don’t work.
How many other illnesses are best treated by health? Make a list. Make a list of illnesses that are ‘incurable’ today. It’s a long list. It’s also a ‘growing list’.
The list starts with some of the oldest illnesses, arthritis. Why is arthritis incurable? Because, in many cases – especially in cases of slowly progressing arthritis – arthritis is not an illness, it is an unhealthiness. The progression, the gradual worsening of arthritis, continues because the unhealthiness continues. Arthritis has actually been compared to ‘rust’.The Orthopedic Institute, for example, says “One such form of chronic injury is arthritis, which might be thought of as a “rusting” of the knee joint.” If your car is rusting, can you cure it with ‘medicine’? Of course not. That’s why modern medicine claims arthritis is ‘incurable’. EBM, SBM agree to search for the best painkillers.
What do you need to cure arthritis? Health. Health does not require medicines, medicines fight illness.
How many other illnesses are best served by health? Make a list of ‘chronic illnesses’. Why are chronic illnesses “chronic”? Why do chronic illnesses progress slowly, but inexorably? Because chronic illnesses are actually chronic unhealthinesses. If the illness is progressing, the progression has a cause. In many cases, the cause is not illness, it is unhealthiness. It is likely that ALL chronic illnesses are better served by health improvements, by Health Based Medicine, than by ‘medicines’.
What about non-chronic illnesses? Can we treat all illnesses with health, instead of medicines? Should we try to treat all illnesses with health, instead of medicine?
No. There is a fundamental difference between medicines and health. Health is slow, honest, and true. Improving health is NOT useful in emergencies. In emergency situations, medicines are required.
But in non-emergency situations, Health Based Medicine can provide more, better, “health”.
Evidence Based Medicine, Science Based Medicine, Hospital Based Medicine, Patient Based Medicine, Disease Based Medicine all ignore health. They are very successful tools in critical situations, where patients are very ill, and in need of medicine. But they fail when the patient needs health.
We need Health Based Medicine. We need a health based theory of healthicine, more than we need an evidence based theory of medicine.