One of the most common questions physicians ask when evaluating a new idea is simple: “Where is the evidence?” It is an appropriate question.
Scientific evidence has transformed modern medicine. It has helped identify beneficial therapies, eliminate ineffective treatments, improve patient safety, and extend human life. Few would argue against the enormous contributions of evidence-based medicine. As a physician, neither would I.
Yet over time, I have become concerned that we sometimes confuse one scientific tool with science itself.
The randomized, double-blind, placebo-controlled clinical trial has become the undisputed gold standard of medical research. These studies deserve tremendous respect. They help reduce bias, establish causation, and provide valuable guidance for clinical decision-making.
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But science is not a study design. Science is a method of inquiry. Throughout history, medicine has advanced through observation, physiology, engineering, clinical experience, public health research, and innovations whose benefits were too significant to ignore.
Consider organ transplantation. The first successful kidney, liver, heart, and lung transplants did not emerge from large multicenter randomized placebo-controlled trials. They emerged from scientific curiosity, physiological understanding, surgical innovation, careful observation, and relentless refinement. Over time, evidence accumulated through registries, cohort studies, long-term follow-up, and continuously improving outcomes.
The same can be said for many orthopedic procedures. Millions of individuals have regained mobility and independence through hip and knee replacement surgery. Yet the development of these procedures relied heavily on engineering advances, anatomical knowledge, clinical outcomes, and long-term patient follow-up rather than traditional blinded placebo-controlled trials.
Even one of medicine’s most important patient-safety interventions, hand hygiene, became widely accepted because physicians observed dramatic reductions in infection and mortality. The evidence accumulated through observation, biological plausibility, replication, and measurable outcomes. Today, no hospital would abandon handwashing because it was not originally validated through a modern multicenter randomized trial.
The lesson is not that rigorous science is unnecessary. The lesson is that science possesses many pathways for discovering truth.
There is another reality that physicians encounter every day but that statistical analyses sometimes obscure. Clinical trials generate averages. Patients arrive one at a time.
After nearly four decades in clinical medicine, I have rarely encountered a patient who perfectly matched the profile of participants enrolled in major clinical trials. Real-world patients are often older, carry multiple chronic conditions, take numerous medications, and live within complex social circumstances.
No two human beings are genetically identical, biologically identical, environmentally identical, or behaviorally identical. Every patient carries a unique combination of genetics, life experiences, environmental exposures, nutrition, physical activity, sleep habits, stress levels, medical conditions, and social circumstances.
Within the same clinical trial, some patients improve dramatically. Some improve modestly. Some experience little benefit. Some experience adverse effects.
Population science provides invaluable guidance. But every physician eventually learns that the average patient does not exist. Only individual human beings exist.
Perhaps this is why medicine has increasingly embraced personalized medicine, precision medicine, genomic medicine, and individualized treatment strategies. Modern science itself is recognizing that biological diversity matters.
This issue becomes particularly important when evaluating interventions aimed at creating health rather than simply treating disease. How do we create a double-blind study of walking? How do we blind participants to strength training? How do we create a placebo version of improved sleep habits? How do we blind people to balance training, Tai Chi, yoga breathing, posture correction, nutritional improvement, or patient education?
These interventions may not fit neatly into the traditional pharmaceutical research model. Yet they can still be studied scientifically through pragmatic trials, observational studies, prospective cohorts, pilot programs, implementation science, functional outcome measurements, health care utilization data, and population health analyses.
Many of health care’s greatest challenges today involve precisely these types of questions. How do we help older adults preserve mobility and independence? How do we reduce falls and fractures? How do we maintain muscle mass and functional capacity with aging? How do we improve sleep quality? How do we encourage healthier movement patterns, better nutrition, and greater patient engagement?
These questions profoundly influence quality of life, disability, health care expenditures, and chronic disease burden. Yet they often receive less scientific attention because they do not fit easily into conventional research frameworks.
The future of health care should not involve lowering scientific standards. It should involve applying the right scientific tools to the questions we are trying to answer.
Evidence-based medicine remains one of the greatest achievements of modern health care. But evidence-based medicine should never become methodology-based medicine.
The ultimate goal of science is not protecting a particular research design. The goal is discovering truth, improving health, reducing suffering, and helping human beings live better lives.
To achieve that goal, health care will need both scientific rigor and scientific humility, and perhaps most importantly, a broader view of what constitutes meaningful evidence.
Narinder Singh Parhar is a physician with more than three decades of experience in internal medicine, hospital medicine, and intensive care medicine. Over the course of his career, he cared for a broad spectrum of medically complex and critically ill patients while developing a growing interest in health care systems improvement, prevention, biomechanics, and population health.
Dr. Parhar previously served as an associate clinical professor affiliated with the University of California, Davis, and on the executive board of Sutter Independent Physicians IPA in California. His professional experience spans outpatient medicine, inpatient care, intensive care medicine, and health care leadership, including past affiliations with Sutter Health and Sutter Roseville in California.
Throughout his career, he became increasingly concerned about several structural challenges within the current health care model, including affordability, accessibility, polypharmacy, health care fragmentation, microbial resistance, physician burnout, and the progressive underemphasis of prevention and functional preservation. These observations led him to develop the Health Enhancement Organization (HEO) Framework, a prevention-oriented and biomechanics-aware health care enhancement model designed to complement scientific medicine through earlier biological support, movement preservation, patient empowerment, and health care team well-being.
Dr. Parhar’s current work focuses on health care course correction, scalable prevention strategies, biomechanics education, healthier aging, and improving long-term population health resilience in practical, affordable, and biologically grounded ways. He is the founder of Jeeva Health Systems, and his research includes “Impact of a Novel Plant-Based Treatment Option in Improving Pulmonary Function Markers,” published in Alternative and Integrative Medicine.
