Tuesday, July 31, 2007

Evidence-based Medicine Questions

Can nutrition research effectively be assessed in an evidence-based medicine paradigm?

Are randomized clinical trials actually the "gold-standard" for nutrition research?

Although healthcare professionals and regulatory agencies have eagerly embraced evidence-based medicine to evaluate health claims, they never seem to get around to checking out whether this model actually fits the nutrition context.

Randomized clinical trials are usually very limited in their relevance to the general population and they impose many constraints that are not always suited to testing nutrients and dietary supplements.

The full spectrum of research available, including observational studies, provides better and more complete evidence of the benefits of dietary supplements.

Feedback on this issue will be interesting!


carmindy said...

You know; I have always wondered about clinical trials. We all (at some point during our high school education)learned how a hypothesis becomes a theory; but how do you control so many variables in the real world? Can you really isolate that many test individuals for a long enough timer period to correctly identify all side effects? Makes you wonder ... What really happens 10 or 15 years down the road?

Ellen said...

Carmindy, I'm not entirely sure I understand your comment.

The subjects in medical clinical trials are not isolated, and side effects are monitored during the trial period, and if the study was large and long enough, the data collected are mined by many other scientists who are looking for a flaw in the original study design.

Randomized controlled trials, the holy grail of medical research, certainly take the top seat category in evidence-based medicine - justified or not in the area of nutritional medicine.

Systematic reviews of the literature takes the second seat category, and unfortunately there are comparatively few well-designed studies published on nutritional therapy vs. pharmaceutical therapy, although that area is certainly changing, as disease prevention becomes an absolute financial necessity for the majority of Americans.

The third evedence-based category is both medical and consumer driven evidence that centers around patient satisfaction and other obvious questions like:

1. Did the patient get better or worse with the therapy?
2. Does the therapy change clinical markers associated with a disease process?
3. Was the therapy cost effective?
4. Is the treatment useful in the medical practice?
5. Is the therapy appearing to prevent or slow down the disease progression?

Anonymous said...

My 40 years of experience counts for a lot, so screw evidence-based medicine!

Here's the real evidence: if your patient gets better, your treatment worked. If your patient gets worse, your treatment was probably wrong. Or, you've misdiagnosed and it's time to admit it and start all over.

James Waugh, MD said...

Hey Anonymous,

Really like your thoughts on evidence-based medicine. Who are you?