The myth of evidence-based medicine

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Over the next eight weeks I’m going to be studying like a madman for the California State Board Acupuncture licensing exam. I won’t have time to write any special reports or long, “researchy” articles. But I hope to be able to share some of my thoughts here and there. Like this.

I was talking with a colleague the other day (let’s call her M). M related a story one of her patients told her. This patient is a nurse at Kaiser. The nurse was telling M about a meeting she recently attended with the rest of the clinical staff at Kaiser. The purpose of the meeting was to inform all of the doctors and nurses about new clinical guidelines for preventing heart disease.

And what were these clinicians told? To encourage their patients to eat fewer refined carbs, less vegetable oil and less sugar? To engage in a stress management program? To get a moderate amount of physical activity?

Hardly. They were told, in a nutshell, to give everyone statins. The idea communicated to them was that statins are “like vitamins” (a direct quote), and should be distributed in a similar manner.

This got me thinking about the concept of “evidence-based medicine”. I’m all for it, by the way. Evidence-based medicine, that is. The problem is that it doesn’t really exist in the conventional medical model.

Actually, I take that back. It does exist. But to be more accurate we’d have to call it “20-or-30-year-old-evidence-based medicine”. That’s a more representative term for the kind of medicine being practiced today.

The story above is a perfect case in point. The evidence is clear that statins don’t work. (If you don’t believe that, watch this presentation.) Furthermore, the evidence is also clear that the low-fat, high carbohydrate, vegetable oil-fueled diet promoted for decades by the American Heart Association (AHA) has not only failed to prevent heart disease, it has promoted it.

Anyone who actually reads the scientific literature with an open mind and a critical eye could reach these conclusions. The studies aren’t top secret. They’re not kept in an underground fortress. They’re readily available online or at your local medical library.

Yet in spite of the overwhelming evidence against statins and the low-fat AHA diet, this is still the standard of care for heart disease in the medical profession.

I wish I could say this is an isolated case. But you see the same thing in just about every disease or health condition. The standard of care for hypothyroidism is a complete joke. (More on this after I pass my licensing exam, I promise!) Type II diabetes can, for the vast majority of people, be managed and prevented by a low-carb diet. GERD is treated with PPIs and acid stopping drugs, in spite of the evidence that it is actually caused by low stomach acid in most cases.

Maybe the best example, though, is the 2010 dietary guidelines recently published by the USDA. Tom Naughton over at Fat Head published a post on this recently, so I’ll just crib from that:

I started reading the USDA’s 2010 Dietary Guidelines this week. For those of you who hoped the federal government would finally wise up and dump the high-carb/low-fat nonsense … come on, you didn’t really expect that, did you?

Did you honestly believe the government would put together a panel of so-called experts who would announce that the government has been wrong for the past 40 years? That the food pyramid was a disaster? That billions of taxpayer dollars are subsidizing the same foods that are making us fat and diabetic?

Of course not. The new guidelines are, if anything, a perfect example of something I’ve said in previous posts (which I believe I may have borrowed from Milton Friedman): when a government program produces disastrous results, those results are offered as proof that we need to do the same thing again … only bigger!

That’s mostly what the new guidelines are: the same old $#@%, only bigger. Bigger reductions in saturated fat, bigger reductions in salt, bigger reductions in cholesterol, and of course (this is a government committee, after all) lots of “calls to action” … otherwise known as BIG federal programs to convince us poor fools in the public to finally start heeding their advice.

Everywhere you look, you see medicine that isn’t evidence-based – or medicine that’s based on evidence that’s ten, twenty and even fifty years old.

The truth is we don’t have evidence-based medicine. We have profit-based medicine. And as long as the insurance and pharmaceutical companies are running the show, that’s what we’ll continue to have.

Did you know Big Pharma is the second-most profitable industry in the world, behind only the oil industry? Did you know that these companies fund 2/3 of all medical research? Do you really think honest-to-goodness evidence-based medicine is even a possibility in this environment?

Luckily we’ve got the Internet, and some conscientious and intelligent researchers and medical professionals that are willing to look beneath the veil and share what they find with the rest of us.

These days that’s really our only hope as people trying to live healthy lives: to be our own advocates, to seek out information that comes from people without a vested financial interest in selling you something, to maintain a “healthy skepticism” (if I may use the term) about any claims made, whether they come from the conventional or alternative world.

Because let’s face it, evidence-based medicine is a myth.

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Myths & Truths

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Comments Join the Conversation

  1. Lynne Parker says

    Just discovered your gem of a site and your podcast. Downloading now! Thank you for your time and effort to educate the public. Thank God for the internet!

  2. jme says

    Thank you so much for your wonderful, wonderful website. Please keep up the excellent articles and information.

  3. says

    Wow. Though I appreciate all your articles, this one hit close to home. Thirty years ago I became involved with modern medicine before eventually crossing over to the good guys. Having been on the inside of what goes on with hospitals and doctors, I’ve been privy to discussions among hospital staff members on how to increase the income of the system by performing more bypass surgeries, issuing more drugs and so forth. So sickening is the approach to disease and symptoms on the part of the modern medical industry that it makes me always want to express that there’s a difference between medical treatment and health care. Hardly anything about modern medicine is based on care or healing. Nothing natural. Money is god and there is barely a connection between what the body needs and what the body is given when in the hands of the modern medical machine.

  4. says

    So true! I don’t tend to blame any one group, though.
    Particularly doctors. Of all the groups in this industry, I feel like they’re the least culpable. It’s not their fault that they only get about 6 weeks of education in Nutrition during the course of their education. Nor is it their fault that the only information they get about treating disease comes from drug companies. Sadly, though, it *does* perpetuate an industry where you make money on illness — not health. In other words, it’s not a “healtchare industry” at all, but a “sickness industry.” Everything about it is perpetuated to make us sick and keep us that way. Again, I don’t think any particular group is to blame. I certainly don’t hold any conspiracy theory about it.
    All that to say: you hit the nail on the head by calling it “profit-based medicine.” The system itself only makes money when you and everyone you know is perpetually sick, so how else could it be? What else could it be?
    The only way to BE healthy is to OPT OUT of the system, teach yourself & those you love the TRUTH, and live by example. Why is it that I’m the ONLY person in my extended family (some 20+ members) without thyroid problems? Why is it that I’m one of two or three with excellent blood lipid levels, blood pressure, etc? No weight problems? I’m not lucky, and you can’t say it’s good genes when everyone else in the family is chronically ill. It’s all about diet & lifestyle, and what I adhere to completely bucks conventional wisdom on this point while EVERYONE ELSE in the family embraces it with gusto.

    • Chris Kresser says

      FoodRenegade,

      I agree with you in part, but I do think that doctors have a moral obligation to educate themselves about the treatments they provide and to stay abreast of the scientific literature. I know several excellent physicians who do exactly this. They are certainly out there. Unfortunately, many (if not most) do not. I understand very well that there are powerful forces (insurance and drug companies) invested in doctors not educating themselves, but that does not excuse them from doing so in my opinion. Perhaps the greatest challenge for most docs in doing this is simply time. They are extremely busy, especially if they’re working in the HMO model, and they have very little time during working hours to stay current with the medical literature. If they wish do to this, they’d have to do it on their own time – which can be difficult if they have a family or other personal obligations, or if they simply don’t want to be working away from work!

      I personally would never give something to a patient that I hadn’t investigated myself. I feel it is my responsibility to do this in order to protect the well-being of my patients.

  5. Lena says

    Part D Science Base, Section 3: Fatty Acids and Cholesterol, Page 1: http://bit.ly/dqiouY
    “Cholesterol, a sterol, is an important structural component of cell walls of tissues of the human body.”
    Looks like no one on the blue ribbon advisory committee remembered that humans do not have cell walls, and that cholesterol is a component of cell membranes.
    FAIL.
     
     
     
     
     

  6. Jesse says

    Yeah, there is way too much motive for profit in figuring out what works and what doesn’t.
     
    But still, isn’t what you mentioned just a small set of things doctors treat? They may all be good examples, but they’re still a very small sample for judging whether most of medicine is evidence-based or not.

    • Chris Kresser says

      Jesse,

      There are many more examples. It’s much more difficult to find an example of medicine that is based on recent, solid evidence than medicine that is not.

  7. JimS says

    Another outstanding post, Chris.
     
    Hey Lena, good comment.  I followed your link and saw this next line:
    “Bile acids, required for solubilization and absorption of dietary fats, are synthesized from cholesterol in the liver, stored in the gallbladder and secreted into the small intestine after a fat-containing meal.”
    Because I bought into the official no-fat !$@# as a young man, my gallbladder rarely had to release bile, the bile precipitated into gallstones, gallbladder ‘attacks’ followed, resulting finally in gallbladder removal. I may very well have impaired fat digestion and absorption of fat-soluble vitamins, as a result.  And those dopes are still regurgitating the same old BS that they have since the ’70s.

  8. MSully says

    Chris- I’ve just recently learned of your site. THANK YOU for the wealth of information you provide in your posts … keep them coming.  Knowledge is power.. and better health!
    thank you!

  9. Marc Drillings says

    Ireally enjoyed reading this.  Just as a follow up, it really is all about the money.  Just as sure as osteopaths with less training get paid more for manipulation than chiropractors do.  The new trend is to deny the existance of meridians, learn watered down needling technique.  Call it dry needling, because after all you aren’t actually injecting anything into the patient and bill it with injection codes.  In that way you get to do acupuncture, be friends with the medical establishment, be done with your educationin100 hours for a PT,and make more money than a well trained acupuncturist.  It has nothing to do with evidence. 

  10. says

    Some of these comments moved me to write further…
    First, it’s been said that nobody is to blame. I’m not so sure about this, because if each part of the medical problem became responsible for their actions and their patient’s health, then things would change, including the emphasis on money and power. A doctor should not be a millionaire who doesn’t want to look his patient in the eyes, come to his house or care about the whole self. This is a cold, impersonal and rude way to interact with other human beings. Secondly, it is true that many, many medical doctors are good people. Still, more and more of them, perhaps through training, are becoming worse and worse when it comes to human relations and providing service. I hear a lot of this talk from patients wherein their doctors do not spend time with them, do not listen to them, do not believe their complaints or medical history, ignore their allergies and reactions and are not available when they are suffering and need a response. Is this right? If a doctor is not willing to provide ultimate service and caring, they should get into another line of work. Lastly, what is most interesting about traditional medicine is the attitude of the doctor and his relationship with his patients. The traditional doctor has been invested in the health of his/her charges. No more. We have a sad, broken, untrustworthy medical system offering medical treatment and not health care. The best thing people can do en masse is complain and walk out without paying when their doctors are not responsive. This may begin to knock them off their high horses. Can you imagine going to a restaurant and placing an order, getting the wrong advice from the waiter and the wrong food that makes you sick and still thinking it’s okay to pay for this? No. Doctors should not be above the law or beyond reproach. By and large they are under the misconception that they are superior beings.

  11. L says

    I’m really glad to know you’ll be offering acupuncture free of charge to well people, Certainly, you won’t be participating in “illness and profit based” medicine.
     
    I do wonder, though, why you wouldn’t pass on the info to folks that a vegan diet is the only thing that has every reversed both heart disease and type 2 diabetes (which are really the same disease). It’s scary to think that you may be giving health advice and are just as misinformed as those thinking statins are like vitamins. Bad info is always bad …

    • Chris Kresser says

      The distinction is between medicine that is based on evidence, and medicine that is based solely on profit. Nowhere did I say that physicians shouldn’t be compensated for their services.

      Speaking of evidence, I’d love to see some to support your claim that a vegan diet reverses heart disease and type 2 diabetes. I’ve provided countless studies demonstrating that a low-carb, high saturated fat diet prevents both on my blog. Where is your evidence?

  12. says

    Referring to L above… I’m not sure how it can be said that heart disease and type 2 diabetes are the same disease.
    I’d also argue that the problem with modern medicine is that it evolved into a close-minded system that has been hijacked by big industries. Judging by the protocols, absolute dependence upon (and overuse of) drugs, impersonal “service,” lack of anything natural and defamation of all forms of treatment outside its on canons, modern medicine’s fault is much greater than merely being about profits.

  13. says

    Hey Chris – great article, as always. And the statin resources are gold – thanks for those.
    Good luck with your boards! :)

  14. says

    Hi Chris, Awesome article! It is amazing that the government continues to get away with feeding the public absolute rubbish information. I guess at the end of the day, money talks!

    After completing a science degree in exercise physiology I took up studying nutrition and ended up giving it up after a year because of the out-dated and completely biased information they were teaching.

    Of course, those people who complete a degree in nutrition are totally brain-washed by the time they finish and end up regurgitating the same crap they were taught! Of course, the general public is led to believe that they are right because they’ve gone to university and have a few letters after their name- what a joke!

    As for doctors, well, the situation is even worse!

    The only glimmer of hope is that well-informed people can provide a more objective view on these topics and slowly influence enough people so that eventually the governments have no choice but to sit up and take notice!

  15. says

    Chris, your site is great and I’m so glad I found it. But railing against the profits of Big Pharma is off-putting. Sure – they push profitable drugs – but the system is gamed against them. The FDA is inefficient and a deeply flawed system that slows drug development. And the way that Washington is set up nowadays so that lobbyists have to go cap – and checkbook in hand to politicians makes me think I cannot blame any of these supposedly evil corporations for spending millions on lobbying. The system is gamed that way by the career politicians. If they don’t play that game then their competitors who do will gain advantage. If instead Washington worked properly: corruption and lobbying bribes weren’t the norm, and the pencil-necks at the FDA were even half as innovative as the drug companies then we might see quite quite different behavior from Big Pharma. I don’t begrudge them their profits either – the total amounts may indeed be vast, but in percentage terms since when has around 15 to 20 percent (profit as a percentage of revenue) been “massive”?

    • Chris Kresser says

      I completely disagree, Mart. Corporations should be held ethically responsible for their actions. Pharmaceutical companies have been caught red-handed several times over the past few years engaging in seriously unethical and arguably criminal behavior.

      The Merck-Vioxx and Vytorin scandals are just two well-known examples, where Merck sat on data showing these drugs increased the risk of heart attack and death while millions of people around the world continued to take them.

      Of course the FDA is to blame as well, but to claim that the companies themselves are not responsible is madness. I’m not against companies making a profit, but not when the pursuit of that profit kills people.

  16. says

    If we do a little research into the connection between Big Pharma, the AMA and other such power structures and law makers and government agencies, the picture becomes clear that natural health care is treated and regarded as a criminal, worthless enterprise. Drugs poison the body and their use is beyond helping people. The big money from Big Pharma represents latent and manifest corruption.

  17. says

    I totally agree Chris that corporations – big or small -  should be held responsible for their actions. I just think there are better ways to see that is done than to entrust the matter to government bureaucrats or corrupt career politician lawmakers. when Milton Friedman was paraphrased in your post I was encouraged. Here’s a couple of other quotes from him:
    “If you put the federal government in charge of the Sahara Desert, in 5 years there’d be a shortage of sand.”
    “Many people want the government to protect the consumer. A much more urgent problem is to protect the consumer from the government.”
    “The government solution to a problem is usually as bad as the problem.”
    With regard to the government’s disinformation or plain ignorance on the matter of the food pyramid – surely you can see that it’s also healthy to be skeptical of “the authorities”.

  18. paul says

    In a free market system, big pharma is in the business of selling drugs and the sugar/carb industry is selling unhealthy foods. I think the Docs are stuck in the middle because they don’t treat behaviour (except for some psych components) or they are not responsible or even knowledgeable about nutrition. We are on our own on this one. Anyway some people are capable of living off high carbs, but most get fat.

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