David Healy - Time to abandon evidence based medicine?
- You can't trust trial data
- You can't trust reviews (not even Cochrane Reviews)
- Real significant problems (e.g. increased suicides on Prozac) can be "statistically not significant"
- Data is hidden
- Evidence vs. Evident: Large controlled trials are needed to weed out the drugs that don't work – drugs that "really" work show their effects in small trials. If you need 10,000 people to show an effect, something is fishy.
- If alcohol were a novel substance, a (hypothetical) trial could be made that would show that alcohol works as an anti-depressant drug
- In this (hypothetical) "alcohol as anti-depressant drug" example, one could even get alcohol as drug to be included in the NICE-guidelines
- One (hypothetical) 6 week (!) trial alone (!) could "prove" that the economy would save lots of money by putting people on alcohol for depression
- And this (hypothetical) one 6 week trial would be enough "prove" that doctors would insist that patients should take this drug for life(!), because the condition is life-long
- If a drug causes symptoms (e.g. more suicides), which the disease can also produce, then a control trial can not answer that question for you
- Clinical trials are not the answer:
1. If both the illness & the drug cause a problem
2. If the clinical population is heterogenous (if the underlying condition is unknown)
3. If the researchers don't know what they are doing
4. Clinical trials cannot provide patient level answers
5. Clinical trials do not reveal cause and effect
- Doctors will defend prescription drugs – and hereby delay investigation into adverse effects by 15 or more years
We have all these amazing medical, technological and scientific advances, which should put us in a position to fight diseases in a way that would make all the Pasteurs and all the Enders' and all the Salks and all the Sabins of past times green with envy. Where is the evolution in medicine? Why does it seem to me that we are stuck in a dead end?
The medical profession does well with clearly defined illness – say HIV/AIDS – that, if left untreated, lead to clearly measurable, visible adverse outcomes. But things like depression? MS? T2DM? In all likelihood, the treatment may lead to worse outcomes than if the illness is left untreated.
And this hits me at the moment. My doctor is willing to try out medication for my ME/CFS and therefore I'm currently looking into what agonist drugs are available to stimulate the alfa 2A receptor which is shown to be involved in at least subgroup of patients. Besides
- the almost total lack of scientific interest in ME/CFS by the medical commuity that leads to a situation where every person with ME/CFS is going from one "personal drug trial" to the next because guiding trial data is non-existent,
- besides not having any certainty whatsoever what actually the pathology is in my case (besides some personal indication that the alfa 2A receptor might be involved for me as well),
- besides not knowing if a stimulation with an Ad2A agonist is actually the right thing to do, if it is the Ad2A in my case,
- and besides not knowing what the actual (vs. claimed) spectrum of adverse reactions of these drugs is,
Should I give Guanfacine a try? Or rather Tizanidine? Maybe Xylazine? What about Lofexidine? Is Brimonidine only for occular hypertension?
I know, let's play guinea pig! And if one doesn't work, or makes me awful, then we try the next! Oh boy, what fun.
I feel like I might go to a pharmacists, and at gun point take any random medication and try that – and not be worse off…
But it sure is nice to see a psychologist like David Healy sharing his good insight into the problems of his profession and giving his best to address them properly.