What’s the evidence?

In the August issue of Hadley Wood News my 200 words of “wisdom” focused on the rather contentious issue of Evidence Based Medicine. What’s it all about and can it be applied to the alternative arena. I seriously doubt we will ever come to a firm agreement on this subject but its worth a bit of dialog any way!
In my professional world, alternative medicine that is, results often speak louder than the supporting evidence for the my treatments. It may sound rather crude but if my patients don’t get or at least feel better my clinic would simply not survive. Hadley Wood Healthcare has been in operation for over 20 years now so something must be working. In this situation the evidence could be viewed as what ever we are doing does get results, but how those results are achieved is probably not fully understood from the purely scientific standpoint. I/we, the practitioners of the holistic approach, could be seen as practicing results-based rather than evidence-based medicine.

However, is this actually a bad thing? Should we have to wait for the evidence to catch up with the results? Take, for example, the much published case for using the herbal remedy St John’s wort in depression. The results documented by herbalists can be traced back for hundreds of years but only recently have scientific studies confirmed its ability to be as good if not better than regular antidepressants for treating mild to moderate depression. A look at the BMJ’s Best Treatment web site and pop St Johns wort in the search box you can do your own research and come to your own conclusions. Interestingly one of the most recent bits of research comments that; “Does it work? Probably“. and goes on to say that “St. John’s wort is likely to help you if you have mild or moderate depression. However, the research on St. John’s wort isn’t as good as the research on antidepressants”. Well… would you expect multiple millions to be turned over to research into a herbal remedy when we have plenty of drugs to sell? Oh, call me an old cynic if you wish but I am a realist. What this says to me is that, yes, we see that St Johns wort works in depression but we can’t endorse it because the studies are not as good as the multi-million pound funded drug trials. However, if the herb showed one wisp of a side effect it would be whisked off the shelf quicker than a Daily Mail headline could go to press.
The problem here is simple. If one of my herbal or natural remedies went to trial and was shown to be as good as the conventional drug it would be re-classified as a drug and taken off the market or produced by one or two big manufacturers and sold at a premium. Not only would this limit choice it would stifle any innovation in the natural health industry.
As much as I like the sound of the evidence based approach I prefer the reassurance of the traditional results driven approach. Why re-invent the wheel when it works just fine? If we had to wait for the evidence base to catch up with the results many people would have miss out on an effective natural therapy and, on the other hand, robbed of the freedom of choice. What a dull world it would be if there were no alternatives around. The evidence based articles go to great lengths informing us of what does not work but offers very little in the way of what one could try.

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