Naturally Healthy...Birth and Beyond

Evidence-Based Medicine – What Are We Really Relying On?

Most of us are familiar with the either/or approach to healthcare: either we go to the doctor or we go to the health food store. Personally, I’m not an either/or kind of person in this arena. I believe we should be able to take advantage of the benefits, while working to decrease our risks, for both. In my opinion, the best way to ensure that I receive the best healthcare possible from my physician and my nutritionist, midwife, or herbalist is to request evidence-based medicine as often as research and clinical research knowledge allows.

Evidence-based medicine is an emerging system of medicine that relies upon the back-up of scientific basis for medical therapies, to include both complementary and alternative medicine as well as conventional medicine. Evidence-based medicine pays attention to randomized, double-blind, controlled studies (RCTs) but does not rely solely upon RCTs. In addition to RCTs, this approach integrates clinical expertise, epidemiological studies and occasionally even anecdotal evidence, with the best clinical research. While it is quite easy for us to demand some evidence that our herb combination is going to be an effective means of treating our illness, most of us would not think of questioning the validity of the advice given in most physicians’ offices. A consistent approach might be to ask for evidence across the board for all types of healing methods.

What Does the Research Show?
A 1990 report from the United States Office of Technology Assessment of the United States Congress concluded that up to 80 percent of conventional medicine lacked an adequate basis in research. In 1991, British Medical Journal editor, Dr. Richard Smith, evaluated twenty-one standard medical practices and concluded that seventeen out of twenty-one had “poor to none” evidence for their effectiveness in an editorial commentary on the necessity of research-based medicine. Dr. Smith says, “Only about 15% of medical interventions are supported by solid scientific evidence. . . . This is partly because only 1% of the articles in medical journals are scientifically sound, and partly because many treatments have never been assessed at all.” Amazingly, 20 to 50 percent of conventional care and virtually all surgery, has not been evaluated by randomized, double-blind, placebo-controlled studies. Perhaps the most disturbing finding came more recently in a review by Jeanette Ezzo and Dr. Brian M. Berman of the University of Maryland, undertaken under the auspices of the International Cochrane Collaboration: Based on 159 reviews of conventional medical practices, the reviewers found that only 20.8 percent evidenced a positive effect on the treated group over the control group, and for the vast majority of conventional medicine practices, the evidence ranged from 6.9 percent demonstrating harm to 24.5 percent resulting in no effect at all.

Does this mean we are to avoid conventional medical practice? No, indeed. In fact, Dr. John A. Astin, of the Stanford University School of Medicine, found in a 1998 national survey that only 5 percent of persons seeking complementary and alternative medicine (CAM) expressed greater dissatisfaction with conventional medical care. And the number of visits to CAM providers in 1997 was 629 million visits as compared to 386 million visits to conventional providers, according to Dr. David M. Eisenberg and colleagues’ classic 1990 and 1997 surveys at the Harvard Medical School.

For both CAM and conventional medicine, we need to return to some of the very basics of healthy living. A “breakthrough” intervention now supported by decades of research from the National Institutes of Health that has been acknowledged by the American Medical Association and the United States Surgeon General has the documented effect of reducing virtually all forms of illness. It helps patients prevent or recover from high blood pressure, diabetes, osteoporosis, breast cancer, arthritis and chronic pain; improves mental function, sleep, weight loss and muscle mass, and extends life expectancy. The latest in nutritional supplements? Fountain of youth? Miracle drug? Actually, it’s exercise.

We’ve forgotten the basics in our health quest. We race for the check-out line with our buggy full of grasses and roots, then rush on over to our doctor’s office to grab our latest pill order without being willing to honestly examine our lives for areas of excess or neglect. We are perishing for lack of daily stewardship, or care, of our bodies.

A return to the basics requires a careful evaluation of our lifestyle habits, including what we regularly put in our mouths. A choice for Real, whole foods supplies some of the following Very Important Preventive Factors for Health:

Fiber – A real food diet guarantees a high fiber diet, which protects against certain diseases. Water-soluble fibers, such as gums and pectins, protect against heart disease and diabetes by binding in the intestines to bile acids, which contain cholesterol, thus preventing re-absorption of the bile acids. Water-soluble fibers delay glucose absorption and gastric emptying, which helps to stabilize blood sugar levels. Water-insoluble fibers, celluloses and hemicelluloses, protect against colon cancer by absorbing water, increasing stool volume and speeding up the time it takes for the stool to pass through the bowel. The water-insoluble fibers can also dilute the concentration of toxic bile acids, which may contribute to cancer. We should be consuming 25 to 35 grams of fiber daily.

Antioxidants – Every day, we are exposed to “free radicals,” highly reactive molecules that can damage the body and are associated with degenerative diseases. Fruits and vegetables contain high amounts of substances known as phytochemicals. Some of these phytochemicals act as antioxidants that protect us against free radicals. Since we’ve not been able to identity all the phytochemicals in our food but are discovering more each day, our best defense is to consume our antioxidants in real food, rather than in a supplement pill. A minimum of 5 and an ideal of 9 fruits and vegetables daily should be our real food goal.

Fats – Our total fat intake is too high, yet we tend to consume more “bad” fat than fats that actually may protect us from disease. We should aim for 15 to 20% of total calories as fat each day, and it is best to make certain these fats are from real sources:olive oil, nuts, seeds, avocados, deep-sea fish, beans, legumes, and even butter in small amounts. Fat from real food is necessary for healthy brain function. Fat sources providing Omega-3 Essential Fatty Acids are our best fat choice of all.

Next month, we will examine The Art of Medicine.

ⁱPelletier, Dr. Kenneth R. The Best Alternative Medicine, What Works, What Does Not? New York, NY: Simon & Schuster, 2000. P. 33.

The educational material on this website is for informational purposes only and is not intended to serve as a substitute for professional medical care. Please consult your health care practitioner for any health concern.