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Evidence Based Medicine?

In questions of medicine and health, just like in theology, there are a variety of opinions. However, unlike in theology, there still exists a “state church” of medicine. Anyone not in agreement with the state church of medicine is automatically considered a schismatic cult of medicine.

Most people default to trusting state medicine and will look upon others with great suspicion (and often contempt). You will often hear “alternative” medicine denounced as not being “evidence based.” But is that true? What exactly does that mean?

Dr. David Perlmutter: Autism, Alzheimer’s & The Gut Microbiome – #250

David: Well, one of the criticisms that I have gotten in the past has been, “Well, Perlmutter, you’re not practicing evidence-based medicine. What that means is, what I’m doing hasn’t been validated in peer-reviewed studies in a double-blinded way, using thousands of individuals, so that somebody can develop a proprietary drug that I would then prescribe. That’s what evidence-based medicine is all about. In this lifetime, I choose to look at the evidence of what happens to my patients. When I see a child who couldn’t speak or socially interact, and sat in the corner spinning circles, and would scream, suddenly have a videotape sent to me from his mother of this child practicing a book report about Benjamin Franklin, and that’s a true story. Because he underwent a fecal transplantation, and he has autism, that’s … There is not a double-blinded trial.

Although, interestingly enough, that is actually going on right now, at University of Arizona, doing fecal transplant study on kids with autism. The reason that child underwent fecal transplantation to reestablish a healthy microbiome is because of the numerous scientific publications demonstrating that kids with autism have a disturbed microbiome, because of the fabulous research by Dr. Derrick MacFabe at the University of Western Ontario, showing that the bacterial changes in the gut that are correlated with autism induce changes in the levels of what are called the short chain fatty acids. Higher levels of one short chain fatty acid, called propionic acid, that directly damages brain function. He’s actually injected rodents with propionic acid, and what do they do?

They go into a corner, and they spin around in circles, and they don’t sniff each other, they don’t socialize. I have that on my website; it’s on YouTube, for crying out loud. He is going to present his data at our upcoming microbiome conference. When a parent brings me their autistic child, and their family has been devastated by it, they don’t know what the future holds. They know pretty well that that child is going to grow up into an adult who requires full-time assistance. They say, “Dr. Perlmutter, we know there is no pill, but what’s your best guess?” I don’t guess based upon hunches, I’m guessing based upon this information that we have at hand, that researchers are looking at around the world, that I try to write books about, and I try to lecture about.

I say, “Here’s what we ought to do. We ought to change the diet, X, Y, and Z. We ought to consider aggressive probiotics; we might even consider probiotics enemas.” What a crazy idea, putting probiotics in the colon of a kid with autism. Why in the world would you do that? When that question is asked, I give an hour lecture, I show slides, I give people the peer-reviewed literature that documents the research going on that is supportive of these wacky ideas. Again, when people say, “Gee, this is stepping out, why don’t you just toe the line?” I’m not going to do it. I’m not going to look parents in the eye, and say, “Look, at this point in time we really don’t have a medication for your child, and that’s about as much time as I have. See you later.”
That just isn’t going to work for me.

[…]

Dave:  One of the things that really made a difference to me, is I come from a family of engineers and scientists, evidence-based people. When you study actual evidence in the history of debate, and the Greeks, there’s actually 7 different kinds or 8 different kinds of ways of having evidence. To this day, there is actually no double-blind study, that jumping out of an airplane would kill you.

I would invite the evidence-based people to go ahead, and do that, to figure it out, because if you say evidence-based, and you only count one of the 7 kinds, what you’re doing is you’re suddenly insulting everyone else who said, “Well, here’s the evidence. When I smack myself in the face, it hurts; that’s evidence. It just is.” There is not a double-blinded study that says that that hurts, but it is evidence. We can just reject evidence-based people as close-minded, and unwilling to consider most forms of evidence, because it doesn’t fit with whatever dogma they believe. Those are religious people hiding as scientists.

In other words, you could compare these people to “proof-texters” who deny the use of inference in the study of theology and demand an explicit proof text for every doctrine.

Do theologians who draw inferences from the text in order to establish doctrine not explicit in the text reject “bible-based” doctrine? No.

Do practitioners who draw inferences from studies in order to establish treatments not explicit in the studies reject “evidence-based” medicine? No.

Consider the following as well:

As a practicing physician for more than 25 years, I can assure the reader that virtually all doctors fear being ridiculed by their colleagues more than anything else. This fear, more than any other factor that I can identify, appears to almost completely stifle independent medical thought. As Goethe once said: “We would rather admit our moral errors, mistakes and crimes than our scientific errors.” Certainly, a small handful of dishonorable physicians may realize that some unwelcome but legitimate medical breakthroughs could reduce their income, and they may oppose those breakthroughs for that reason. However, most physicians really care about and want to help their patients. The problem that remains is how to get physicians and the complete medical truth together. Forman (1981) analyzed this resistance to innovation by some scientists, especially those who are physicians and clinicians.

Although this book will address the incredible ability of vitamin C to effectively treat and cure many different viral diseases and effectively treat a wide array of other infectious diseases, the following true story about another long-standing effective therapy will probably best illustrate why additional attempts to get the truth out about vitamin C must be made. On Sunday, July 2, 2000, a made-for-TV movie aired during the primetime evening hours. Entitled . . . First Do No Harm, it starred Meryl Streep, one of the most acclaimed actresses of our day. It was a fictionalized story based on real events in the life of a mother (Streep) and her young child. The child developed epileptic seizures that proved to be progressively unresponsive to all of the prescription medicines that were used. Additionally, the child developed multiple side effects to the medications, with at least one being life-threatening. The child was finally offered brain surgery as a last resort, although not an option with much hope of long-term success. The child’s mother, not one to just accept fate but determined to mold it herself, threw herself into research at the medical library. She “discovered” a treatment called the “ketogenic diet,” which the literature said completely eliminated seizures in a significant percentage of patients unsuccessfully treated with multiple seizure drugs. Her neurologist had not even mentioned diet as a possible therapy, even though this treatment had been in the medical literature for about 75 years! When the mother mentioned trying the diet, the neurologist only ridiculed her, labeled the reports of success with the diet as “anecdotal,” and even threatened to use legal action to keep her from transferring her child to Johns Hopkins in Baltimore to try the diet and avoid surgery. As might now be expected, the diet worked dramatically, and the child rapidly became seizure-free and remained off of all medications.

The next day in the doctor’s lounge at one of the local hospitals in Colorado Springs, it was very apparent that the doctors as a group were indignant that their authority had been questioned by the movie, . . . First Do No Harm. When one of the younger doctors did assert that he should “look into” this ketogenic diet, the remainder of them rapidly built up a strong “group negativity” that welcomed only further negative comments about this treatment modality. Some of these real doctors’ comments actually closely paralleled the negative comments of the TV movie neurologist. The doctors also assaulted the reports of positive responses to the ketogenic diet as anecdotal, even though it was very obvious that most, if not all, of them had never even heard of the ketogenic diet before seeing or hearing of the movie. This was in spite of the fact that many of these positive responses to the diet had actually been published. One doctor even referred to the internet as just another “National Enquirer,” implying that lay people are too hopelessly ignorant to ever discover vital information on their own, and that they are easily deluded by anything they might read. Another older physician asserted that he would need a “full bibliography” of medical references before he would even give the ketogenic diet passing consideration. As a group, it was generally expressed and accepted that it was impossible that any significant therapy for unresponsive seizure disorders could possibly have eluded them in the course of their medical training. Rather than join in the conversation, i just listened, and then i left without commenting.

After I got home, it took all of about three minutes to get my computer online, access MEDLINE, and find 180 medical journal references on the “ketogenic diet.” MEDLINE is the database of the National Library of Medicine, containing over 11 million citations and author abstracts from more than 4,000 biomedical journals throughout the world, dating from 1966 to the present. (See the references cited at the end of this introduction for a small sampling of these ketogenic diet references.) in one of the more recent references in the April, 2000 issue of Pediatrics eleven studies on the ketogenic diet were reviewed. The authors concluded that the ketogenic diet completely stopped medically unresponsive seizures in a significant percentage of children. The diet also reduced seizure frequency by over 90% in an even greater percentage of children! Similar articles were found in the various neurology and epilepsy journals. Sadly, it would seem that many pediatricians and pediatric neurologists do not know what is in the most current issues of their primary and specialty journals. At the very least, it appears that what is read is rarely independently evaluated and weighed in the mind of the doctor reader. Invariably, new and “radical” information simply must already be accepted by the majority of a doctor’s medical peers to have any real chance of being utilized in patient care. Older, more “radical” information, ironically, seems to have even less chance of objective evaluation and practical application.

It is of further significance to note that there has always been a consistent push to use prescription drugs whenever possible for just about any medical condition. Modern epileptic drugs were not available when the ketogenic diet was first discovered. However, the proper application of the diet is demanding and requires much more of an investment in time and effort than needs to be taken in the writing of a prescription. When the anti-seizure drugs first came along a few years later, the ketogenic diet quickly fell into disfavor. This is especially unfortunate since epileptic drugs frequently have severe side effects compared to many other prescription drugs. Suffice it to say, however, that the ordinary physician rarely strays from what is contained in the primary textbooks, even if the current journals with which the physician should be familiar assert otherwise.

A word about one of the most common physician criticisms of a concept that does not mesh with traditional medical information needs to be mentioned here. When something is labeled as an “anecdote,” the person reporting the information is usually being told that he or she is incapable of accurately reporting the response of a patient to a treatment. In reality, the dictionary defines an anecdote as being a short narrative that is unpublished. The most esteemed journals of our day often contain what are called “case reports,” which are nothing more than brief summarizations of the response(s) of one or a handful of patients to a certain treatment. A case report is absolutely nothing more than an anecdotal report that managed to get published. However, the published case report is typically written by a health care professional, and the information is often given the validity of a much more “scientifically” prepared study or article. In the final analysis, however, a case report is an anecdote, and an anecdote is a case report. The only differences are the reporter and the reporter’s ability to be published. The lay person reporter or the non-mainstream medical doctor reporter will only endure ridicule and struggle to get published, while the mainstream doctor reporter will often get published and be awarded greater respect from the medical community for making a significant observation of a noteworthy clinical event. New, cutting-edge medical concepts from “non-sanctioned sources” frequently struggle just to see the light of day.

Levy MD JD, Thomas E. (2011-08-31). Vitamin C, Infectious Diseases, and Toxins:Curing the Incurable (Kindle Locations 202-263). Xlibris. Kindle Edition.

Finally, listen to this podcast Ep. 541 Just How Much Has Government Screwed Up Health Care? An ER Doctor Explains — and Tells Us How to Fix It

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