Abstract
Evidence-based medicine (EBM) is generally considered as the most complete paradigm in the practice of clinical medicine. Its application should preclude all kinds of quackery. Therapeutic reformers of the second half of the twentieth century have convinced the medical community that the double-blind randomized controlled trial (RCT) versus placebo is the gold standard in clinical research to establish evidence of treatment usefulness. Nevertheless, this paradigm ignores the importance of non-specific effects in the healing process and can generate misrepresentations. Additionally, because of methodological limitations, RCTs as they are used in practice can give rise to new forms of quackery by promoting drugs that are not useful for the patients who actually receive them, or are so expensive that their value is open to criticism. This is precisely the case when surrogate outcomes, with questionable clinical significance, are used. These can divert attention from clinically relevant outcomes, such as safety issues that are probably the core of treatment evaluation. The boundaries between quackery and EBM that clinicians are faced with are not so clear-cut. There is a need for doctors to acknowledge their share in quackery and to be continually conscious of the possible pitfalls of their therapeutic practice.
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Bewley S, Ross N, Braillon A, Ernst E, Garrow J, Rose L, Brahams D, Baum M, Marks V, Isaacs K, May J (2011) Clothing naked quackery and legitimising pseudoscience. BMJ 343:d5960
Ernst E (2011) College of medicine or college of quackery? BMJ 343:d4370
Kaptchuk TJ, Kerr CE, Zanger A (2009) Placebo controls, exorcisms and the devil. Lancet 374(9697):1234
Guyatt G, Cairns J, Churchill D, Cook D, Haynes B, Hirsh J, Irvine J, Levine M, Levine M, Nishikawa J, Sackett D, Brill-Edwards P, Gerstein H, Gibson J, Jaeschke R, Kerigan A, Neville A, Panju A, Detsky A, Enkin M, Frid P, Gerrity M, Laupacis A, Lawrence V, Menard J, Moyer V, Mulrow C, Links P, Oxman A, Sinclair J, Tugwell P (1992) Evidence-based medicine. A new approach to teaching the practice of medicine. JAMA 268(17):2420–2425
Benedetti F (2012) The placebo response: science versus ethics and the vulnerability of the patient. World Psychiatry 11(2):70–72
Wechsler ME, Kelley JM, Boyd IO, Dutile S, Marigowda G, Kirsch I, Israel E, Kaptchuk TJ (2011) Active albuterol or placebo, sham acupuncture, or no intervention in asthma. N Engl J Med 365(2):119–126. doi:10.1056/NEJMoa1103319
Finniss DG, Kaptchuk TJ, Miller F, Benedetti F (2010) Biological, clinical, and ethical advances of placebo effects. Lancet 375(9715):686–695. doi:10.1016/S0140-6736(09)61706-2
Arroll B, Elley CR, Fishman T, Goodyear-Smith FA, Kenealy T, Blashki G, Kerse N, Macgillivray S (2009) Antidepressants versus placebo for depression in primary care. Cochrane Database Syst Rev 8(3):CD007954. doi:10.1002/14651858.CD007954
Boussageon R, Gueyffier F, Cornu C (2014) Effects of pharmacological treatments on micro- and macrovascular complications of type 2 diabetes: what is the level of evidence? Diabetes Metab 40(3):169–175. doi:10.1016/j.diabet.2013.12.010
Boussageon R, Bejan-Angoulvant T, Saadatian-Elahi M, Lafont S, Bergeonneau C, Kassai B, Erpeldinger S, Wright JM, Gueyffier F, Cornu C (2011) Effect of intensive glucose lowering treatment on all cause mortality, cardiovascular death, and microvascular events in type 2 diabetes: meta-analysis of randomised controlled trials. BMJ 343:d4169
Gerstein HC, Miller ME, Byington RP, Goff DC Jr, Bigger JT, Buse JB, Cushman WC, Genuth S, Ismail-Beigi F, Grimm RH Jr, Probstfield JL, Simons-Morton DG, Friedewald WT (2008) Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 358(24):2545–2559. doi:10.1056/NEJMoa0802743
Duckworth W, Abraira C, Moritz T, Reda D, Emanuele N, Reaven PD, Zieve FJ, Marks J, Davis SN, Hayward R, Warren SR, Goldman S, McCarren M, Vitek ME, Henderson WG, Huang GD (2009) Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 360(2):129–139. doi:10.1056/NEJMoa0808431
Jonas DE, Amick HR, Feltner C, Bobashev G, Thomas K, Wines R, Kim MM, Shanahan E, Gass CE, Rowe CJ, Garbutt JC (2014) Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis. JAMA 311(18):1889–1900. doi:10.1001/jama.2014.3628
Middleton H, Moncrieff J (2011) ‘They won’t do any harm and might do some good’: time to think again on the use of antidepressants? Br J Gen Pract 61(582):47–49. doi:10.3399/bjgp11X548983
Avorn J (2012) Two centuries of assessing drug risks. N Engl J Med 367(3):193–197. doi:10.1056/NEJMp1206652
Furberg CD, Levin AA, Gross PA, Shapiro RS, Strom BL (2006) The FDA and drug safety: a proposal for sweeping changes. Arch Intern Med 166(18):1938–1942 166/18/1938 [pii]
Ioannidis JP (2009) Adverse events in randomized trials: neglected, restricted, distorted, and silenced. Arch Intern Med 169(19):1737–1739. doi:10.1001/archinternmed.2009.313
Pitrou I, Boutron I, Ahmad N, Ravaud P (2009) Reporting of safety results in published reports of randomized controlled trials. Arch Intern Med 169(19):1756–1761. doi:10.1001/archinternmed.2009.306
Groves T, Godlee F (2013) The European Medicines Agency’s plans for sharing data from clinical trials. BMJ 346:f2961
Greenhalgh T, Howick J, Maskrey N (2014) Evidence based medicine: a movement in crisis? BMJ 348:g3725
Lundh A, Barbateskovic M, Hrobjartsson A, Gotzsche PC (2010) Conflicts of interest at medical journals: the influence of industry-supported randomised trials on journal impact factors and revenue—cohort study. PLoS Med 7(10):e1000354. doi:10.1371/journal.pmed.1000354
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We thank Angela Swaine Verdier for revising the English of a first version of the draft.
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There are no conflicts of interest regarding this paper. All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that (1) No authors have support from any company for the submitted work; (2) N.F. has relationships (board membership or Travel/accommodations expenses covered/reimbursed) with Servier, BMS, Lundbeck and Janssen who might have an interest in the work submitted in the previous 3 years; B.R. has no relationships with any company that might have an interest in the submitted work in the previous 3 years; F.B. has relationships (board membership or consultancy or payment for manuscript preparation or Travel/accommodations expenses covered/reimbursed) with Sanofi-Aventis, Servier, Pierre-Fabre, MSD, Lilly, Janssen-Cilag, Otsuka, Lundbeck, Genzime, Roche, BMS who might have an interest in the work submitted in the previous 3 years; HD was expert witness for plaintiffs in 4 medico-legal cases against pharmaceutical companies for birth defects or suicide linked to antidepressants in the USA in the past 5 years; (3) none of the authors’ spouses, partners, or children have any financial relationships that may be relevant to the submitted work; and (4) none of the authors has any non-financial interests that may be relevant to the submitted work.
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Naudet, F., Falissard, B., Boussageon, R. et al. Has evidence-based medicine left quackery behind?. Intern Emerg Med 10, 631–634 (2015). https://doi.org/10.1007/s11739-015-1227-3
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DOI: https://doi.org/10.1007/s11739-015-1227-3