This is the continuation, in a way, of a theme from my piece on scientific fraud. Let's face it – humans are fundamentally irrational. We believe what we want, what feels right, what grandpa taught. We try to keep the facts out of it whenever we can. Furthermore, most of us don't have a real good grasp of statistics. And a lot of healthcare practitioners and politicians and salesmen prey on this vulnerability. I'll try to stick the topic as it relates to health care – but may stray.

You go to the doc with a sore throat. You had strep throat once as a kid, you think. This feels “just like it”. You don't want to bother with a strep test – who wants to be gagged – so you beg the doc to give you an antibiotic. Doc is busy, does not have time to explain/argue, sends in a prescription. A week later you are fine. You had strep, right? The antibiotic did the trick, right?

Not even. You are mistaking subsequence and consequence. You believe – you are convinced - that you got better because of the treatment. You probably don't know (or care) that most sore throats are caused by viruses, and most are better in a week anyhow. You don't know that there are actually some pretty good clinical rules that can help us better estimate who needs antibiotics and who does not, often without tests. I'm not saying that this doc was taking advantage of you – but she or he was not practicing what we call “Evidenced Based Medicine”, which means using the best available information from the scientific literature to make treatment decisions. Furthermore, they were reinforcing your previous misinterpretation, and exposing you to needless antibiotics and contributing in a small way, to the development of resistance to antibiotics - a serious international public health problem.

Its true that a lot of the things we treat in conventional, modern so called “allopathic” or bio- medicine, do not have a strong literature basis, and we often have to go with experience and judgment. But most of the major diseases and treatments have been studied. Its also sadly true that too many doctors still don't follow evidenced based practice. This may be because old habits are tough to break, financial conflicts of interest that favor certain treatments over others, or because they too lack discernment or interest in the evidence.

Having bashed my profession, let me state that while allopaths have a ways to go, we still have a fundamental professional commitment to scientific practice, to following the evidence, to modifying treatments as the evidence changes.....and this is a foundational difference which distinguishes the mainstream medical provider from the growing array of “alternative” practitioners. More on that in upcoming posts.

Unlike these other fields, traditional medicine, whenever it can, bases its treatments on clinical trials. Meaning studies of, say a new drug, using sound research principles. These include the use of a sham or placebo treatment for comparison, the 'blinding' of the researchers and patient as to what patient got which treatment, so that natural biases could be eliminated, and so on. These kinds of studies, when done with the large numbers of patients needed to draw conclusions, are expensive and difficult to pull off. And as I posted recently, those reviewing the data need to be on the lookout for misinterpretation or fraud. But when done well, they are powerful, and they are the means by which your doctor can say (and show you if you like) that a given therapy really is superior to another.

I'm not suggesting that every patient become an expert statistician. But you do need to understand what your caregivers do and don't know, the profound differences between the scientific method which drives allopathic medicine, and the sham science and lousy, if present at all, research behind many of the alternative practices. It's important to know how therapies gain acceptance, what a “good” research study looks like, and the power of the “placebo” effect, which we'll take up next go-round.

Stan Seagraves M.D., an internist who has practiced in Missoula for over 20 years. He is currently practicing hospital medicine at St. Patrick Hospital, and is medical director of their hospitalist program.

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