Medical scientists and particular the disciples of Scientism are fond of asserting that the only real Evidence Based Medicine (EBM) is the randomised clinical trial where a medicine is compared with a control (placebo). I’ve long been of the position that RCTs have their limitations, particularly because they exclude the effects of the consultation itself, a vital part of the medical process in any encounter. While RCTs are of immense importance to clinical medicine, we should never ever abandon Outcome Studies – especially long term outcome studies that simply measure patient satisfaction with the entire medical process they underwent – over a long period of time. A classic example of such a study is David Spence’s famous outcome study at the Bristol NHS Homeopathic Clinic. The six year study shows an incredible degree of satisfaction by patients attending the clinic – no matter what they received in treatment and no matter how it worked.
Until recently I thought that Outcome Studies were the main alternative to RCTs but then I came across this article in the British Medical Journal (the eminently respectable BMJ) which offers some interesting alternatives to Evidence Based Medicine that I’d never heard of. In over three decades of clinical medicine I can vouch that I’ve seen all these forms of medicine in practice! A brief summary of them can be seen here. Enjoy!