COMMENTARY

Whatever Happened to Plausibility as the Basis for Clinical Research and Practice After EBM and CAM Rushed in?

Wallace Sampson, MD

Disclosures

January 26, 2007


Successful scientists have high intelligence and extensive knowledge, but also a sense for which trails contain things of importance. Relationships between things and events are innumerable. Which ones will yield greater understanding of nature? Which relationships matter?

Until recently, medical researchers used judgment and plausibility to decide. The result was an explosion in understanding of human physiology and disease, treatment advances, extension of human life, and relief from misery.

We now see accumulation of useless information in journals and information data bases -- hundreds of clinical trials (RCTs) on implausible methods, such as homeopathy, unrefined plant products, prayer, and acupuncture. Initial plausibility retreats before two 20th-century development ideologies of relativism -- a principle that all facts and opinions have equal or similar value, and postmodernism -- that regards facts as social constructions.[1]

Once thought to be too esoteric for relevance to medicine, these twin ideologies now mold the thinking of policy makers and granting agency officials. Ancient and traditional cultural practices are not diminished for lack of plausibility, but are investigated by RCTs because they are there.

The second is a paradoxical consequence of "evidence-based medicine" (EBM). EBM, in the form of RCTs and their systematic reviews (SRs), is a means for accumulating and ranking data. EBM is not a means for interpreting the significance of the data. Significance depends in part on plausibility. EBM is independent of physiology and ignores plausibility.[2]

Plausibility depends on prior reliable observations, physical and chemical laws, pharmacological principles, and advocates' economic and legal misadventures. The National Center for Complementary and Alternative Medicine spends $100 million/year on implausible research and training grants. In performing RCTs on implausible proposals, clinical research has taken a wrong turn and departed from rationality.

That's my opinion I'm Dr. Wallace Sampson, a member of the MedGenMed Editorial Board.

 


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Readers are encouraged to respond to the author at wisampson@aol.com or to Paul Blumenthal, MD, Deputy Editor of MedGenMed, for the editor's eyes only or for possible publication via email: pblumen@stanford.edu

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