Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Evidence and the Eastern paradigm of medical treatment

Marya Zilberberg, MD, MPH
Conditions
March 7, 2010
Share
Tweet
Share

Remember the trial a couple of years ago that showed that group support participation was associated with prolonged survival among women with metastatic breast cancer?

I’ve thought a lot about that over the years. Isn’t it interesting that something as simple as a supportive environment can make a difference in what researchers consider to be the hardest endpoint there is: survival? In our dualistic view of the human organism, we think of support as acting in the realm of the psyche, and not the physical. And yet, here is the evidence of a psychological exposure somehow making a tangible physiologic difference.

Now, how do we do evidence-based medicine? Well, we look for clinical studies that tell us whether and how well a treatment works for a particular condition. For the rabid evidenistas among us the most valid design to provide such evidence is a randomized controlled trial, since it has the most internal validity (i.e., we are in fact likely to be studying what we think we are studying). When we pat ourselves on the back on a randomization well done, we cite the balance in the fairly obvious demographic and clinical characteristics in the two (or more) comparator groups, namely, age, gender, comorbidities, the burden of acute illness, and the like.

We rarely bother with their social or psychological milieu; in fact edging up to evaluating that may be viewed by some as engaging in quackery. Well, true, these exposures are ephemeral and somewhat abstract, but look at the breast cancer study… Just because it is difficult to study and we do not have validated tools for them currently, does not mean that we can ignore, or worse yet, disparage, their potential influence. Isn’t there a saying to the effect that we cannot discover that which we do not currently have the tools to understand?

And speaking of inadequate tools, a related sticky wicket comes to mind: heterogeneity. I say it is related because we do not even dare look at the underlying non-physiologic heterogeneity as I mentioned above. What may surprise the uninitiated more, however, is the fact that we do not have good tools to identify physiologic heterogeneity. And as most appreciate, heterogeneity demands large numbers of subjects to study to get a detectable effect. In fact, our research enterprise is set up to do mammoth studies for often a miniscule difference (think cardiology trials requiring 20,000 patients to demonstrate a fall in mortality from 0.5% to 0.25%). It is very likely that by using this sledge hammer method to craft the fine jewel of evidence we are missing huge chunks of useful information.

And if this is the case for our Western paradigm of medical treatment, how does it play out in our study of Eastern and other non-traditional modalities? Don’t take me wrong; I am not suggesting having blind faith in homeopathy, for example. But I am curious about how cultural psychology may influence responses to such treatments as Ayurvedic medicine, say. Perhaps it only “works” in conjunction with meditation and yoga? An “Eastern bundle” anyone?

The point is I do not know the answers to these questions. What I do know is that with our approach to evidence building we are looking at a vast castle through a key hole: we are only seeing small swaths of reality. My final point is this: because so much remains in the dark, we need to be humble when exploring evidentiary basis for any intervention. A parochial attitude equating gaps in our understanding to lack of effectiveness makes us seem like the Inquisition persecuting Galileo for defining an alternate reality which turned out in the long run to be the truth we live by.

Marya Zilberberg is founder and CEO of EviMed Research Group and blogs at Healthcare, etc.

Submit a guest post and be heard.

Prev

Health blog posts of the week, February 28-March 1, 2010

March 7, 2010 Kevin 0
…
Next

A hospital benefits when joining a large medical center

March 8, 2010 Kevin 3
…

Tagged as: Patients

Post navigation

< Previous Post
Health blog posts of the week, February 28-March 1, 2010
Next Post >
A hospital benefits when joining a large medical center

ADVERTISEMENT

More by Marya Zilberberg, MD, MPH

  • a desk with keyboard and ipad with the kevinmd logo

    Doctors are shackled by the stigma of ignorance

    Marya Zilberberg, MD, MPH
  • a desk with keyboard and ipad with the kevinmd logo

    A radical transformation in healthcare decision making is needed

    Marya Zilberberg, MD, MPH
  • a desk with keyboard and ipad with the kevinmd logo

    Turn away from interventions that merely prolong dying

    Marya Zilberberg, MD, MPH

More in Conditions

  • Affordable postpartum hemorrhage solutions every OB/GYN should know

    Frank I. Jackson, DO
  • How are prostate exams done and why you shouldn’t avoid them

    Martina Ambardjieva, MD, PhD
  • Airlines’ policy ignores your do not resuscitate (DNR): Discover why and some ways to protect yourself

    Althea Halchuck, EJD
  • How coaching transforms care for people with multiple sclerosis

    Jessica Singh, MD and Liz Kiniry
  • Integrating vitamin education in mental health care

    Scarlett Saitta
  • Mumps orchitis still causes infertility years after childhood

    Oluyemisi Famuyiwa, MD
  • Most Popular

  • Past Week

    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
    • How AI, animals, and ecosystems reveal a new kind of intelligence

      Fateh Entabi, MD | Tech
    • Why kratom addiction is the next public health crisis

      Muhamad Aly Rifai, MD | Meds
    • A physician employment agreement term that often tricks physicians

      Dennis Hursh, Esq | Finance
    • The hidden moral injury behind value-based health care

      Jonathan Bushman, DO | Physician
    • Nurse-initiated protocols for sepsis: a strategic imperative for patient care and hospital operations

      Rhonda Collins, DNP, RN | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Affordable postpartum hemorrhage solutions every OB/GYN should know

      Frank I. Jackson, DO | Conditions
    • Why kratom addiction is the next public health crisis

      Muhamad Aly Rifai, MD | Meds
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
    • How are prostate exams done and why you shouldn’t avoid them

      Martina Ambardjieva, MD, PhD | Conditions
    • Airlines’ policy ignores your do not resuscitate (DNR): Discover why and some ways to protect yourself

      Althea Halchuck, EJD | Conditions
    • A dual citizen’s choice between two imperfect systems [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 5 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
    • How AI, animals, and ecosystems reveal a new kind of intelligence

      Fateh Entabi, MD | Tech
    • Why kratom addiction is the next public health crisis

      Muhamad Aly Rifai, MD | Meds
    • A physician employment agreement term that often tricks physicians

      Dennis Hursh, Esq | Finance
    • The hidden moral injury behind value-based health care

      Jonathan Bushman, DO | Physician
    • Nurse-initiated protocols for sepsis: a strategic imperative for patient care and hospital operations

      Rhonda Collins, DNP, RN | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Affordable postpartum hemorrhage solutions every OB/GYN should know

      Frank I. Jackson, DO | Conditions
    • Why kratom addiction is the next public health crisis

      Muhamad Aly Rifai, MD | Meds
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
    • How are prostate exams done and why you shouldn’t avoid them

      Martina Ambardjieva, MD, PhD | Conditions
    • Airlines’ policy ignores your do not resuscitate (DNR): Discover why and some ways to protect yourself

      Althea Halchuck, EJD | Conditions
    • A dual citizen’s choice between two imperfect systems [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Evidence and the Eastern paradigm of medical treatment
5 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...