Has evidence-based medicine left quackery behind?

Area of Science:

• Clinical Medicine
• Medical Research Methodology

Background:

• Evidence-based medicine (EBM) is the dominant paradigm in clinical practice.
• The double-blind randomized controlled trial (RCT) versus placebo is considered the gold standard for research.
• Concerns exist regarding EBM's potential to overlook non-specific healing effects and introduce misrepresentations.

Purpose of the Study:

• To critically evaluate the limitations of the current gold standard in clinical research.
• To explore how methodological constraints in RCTs can lead to practices resembling quackery.
• To highlight the importance of clinically relevant outcomes over surrogate markers in treatment evaluation.

Main Methods:

• Critical analysis of the theoretical underpinnings and practical application of EBM.
• Examination of the role of non-specific effects in therapeutic outcomes.
• Evaluation of the impact of surrogate outcomes versus clinically relevant outcomes in RCTs.

Main Results:

• The RCT paradigm may ignore crucial non-specific healing effects, leading to misinterpretations.
• Methodological limitations in RCTs can promote ineffective or overly expensive treatments.
• The use of surrogate outcomes can divert attention from critical safety issues and genuine clinical benefit.

Conclusions:

• The line between EBM and quackery is not always clear-cut.
• Clinicians must acknowledge their potential role in perpetuating quackery within EBM.
• Continuous awareness of therapeutic practice pitfalls is essential for medical professionals.