Leading science in the wrong direction can be caused by different aspects. The fraud, as an important cause, can be an aspect, but omitting the bad intention factor, the science can be sometimes directed by ideas that are directly implemented into practice, driven by forces that have their roots in totally unscientific grounds.
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In that regard, a field of science in which many lives are affected, such as medicine, should be approached with caution, where every method implemented is approved by thorough scientific researches. Evidence-based medicine, in a narrow meaning, is an approach in which methods and practices are being used only if their benefit is proven in researches, where evidence is obtained through the course of large-scale and reliable studies.
In the article The Double-Blind Gaze, Dr. Steven Bratman, analyzed the importance of double-blind studies as an aspect of evidence-based medicine, extending the concept of the latter so that evidence-based imply evidence that is free of confounding factors, such as the placebo effect, the re-interpretation effect, observer bias, natural course of illness, regression to the mean, and the study effect. (2005, p. 65)
Steven Bratman admitted that he was initially practicing the implementation of alternative medicine, and what is more, he was reporting benefits that he could observe with his own eyes. (2005, p. 65) The reason that Bratman ceased using alternative medicine is his notice of the double-blinded study. The usage of double-blinded studies, as he admitted, not only cast doubt on alternative medicine but also on conventional medicine, where traditional researches cannot distinguish and explicitly state whether a particular treatment works.
Explaining this statement, the author referred to confounding factors that prevent the researchers from drawing correct conclusions, “causing the appearance of efficacy where none exists.” (Bratman 2004) In that regard, a double-blinded study can efficiently eliminate the influence of these confounding factors, and accurately answer the main question of medical researches, i.e. “Does Treatment A benefit Condition B?” (Bratman 2004)
Addressing the issue of evidence-based medicine, the common definition denotes it as “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” (UNC Health Sciences Library n.d.) In that regard, Steven Bratman stated that evidence-based medicine is based on the understanding that medicine is grounded in double-blind studies. (Bratman 2004)
The implementation of evidence-based medicine made it possible for scientific medicine to be influenced by traditions and quackery. Although the latter is becoming less common in modern society, it might be resembled with tendencies in assigning medications based merely on opinions and views. In that sense, the success of evidence-based medicine was not that popular, where according to Bratman, he was a follower of the conventional medicine practice.
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This can be explained in the fact that the main sciences on which medicine is based, e.g. anatomy, physiology, biochemistry, biophysics, microbiology, pathology, pathophysiology, molecular biology, genetics, etc., provided people with extensive knowledge base for the last centuries. This knowledge base promoted that conventional medicine relied merely on the results of mostly either theoretical aspects, where the practical evidence might be based on personal experiences or researches with weak validity, which were evaluated, as it was stated previously, with many confounding factors.
The reaction of the organism and the surrounding natural and social environment is so diverse and multiple-factor, that their influence and interaction are often hard to predict. The world is filled with variations. People are different and live in different climates and under the influence of various factors of the natural, social, and personal environment. If the external factors of the environment can be controlled, that cannot be said about personal and social factors.
In that regard, in a study of the effect of pills that promote losing weight, even if the study was properly designed in terms of randomization and the implementation of a control group, such factors as personal motivation to lose weight (The Skeptic’s Dictionary 2009), might change the outcome of the study.
The main confounding factors outlined by Bratman, in general, refer to the fact that people tend to delude themselves, where even in direct observations, people might be distorted and led to form invalid conclusions. (Shermer 2002, p.158) In that sense, most of the factors are either effects or biases of particular intervention by the observer or the participant.
Another important factor is the placebo effect, where it can be a confounding factor and at the same time a requirement in conducting a double-blinded study. A controlled placebo in a study allows receiving information on the effectiveness of a particular treatment compared to the results obtained from the placebo effect and can be regarded as the best method to assess the real effectiveness of a new treatment and medicine.
Nevertheless, there is some ethical consideration when using placebos, where the risks of using them should be minimized in terms of the agreements of the participants and the situations where the life of the patient is at risk.
Accordingly, the concept of double-blind studies merely shows that highly variable data, such as the effect of medical treatment, needs thorough researches. This statement puts the responsibility on the doctors and the practitioners when implementing treating and diagnosing patients.
In that regard, the result reported by Crawley et al in 2003, “showed that of 520 clinical questions for which answers were sought in the medical literature, in 53% of these cases the literature confirmed the management decision, but in 47% of these cases the literature changed the medication, diagnostic test, or prognostic information given to the patient.” (UNC Health Sciences Library n.d.)
Thus, it can be seen that the importance of double-blinded studies cannot be overestimated, where evidence-based medicine’s importance can be seen directly related to the findings of such studies. Living in the epoch of medicine which is based on evidence, implies strictly following its recommendations, which saves the lives of millions around the world and minimized the usage of treatments with unproven effectiveness.
The patient needs a treatment that effectively influences the outcome of the illness. In that regard, modern researchers who implement a double-blinded design are capable of producing proven facts, which will form the basis of clinical practice. The form the foundation of evidence-based medicine, which unlike conventional medicine based on theoretical frameworks, allows the diagnosis and the treatment of the patient with the highest level of effectiveness and safety.
Bratman, S (2004) Double-Blind Studies A Major Scientific Advance of the 20th Century Mendosa. Web.
Bratman, S (2005) The Double-Blind Gaze. Skeptic. 11 (3) 64-73.
Control Group Studies (2009) The Skeptic’s Dictionary. Web.
Shermer, M & Linse, P (2002) The Skeptic Encyclopedia of Pseudoscience. ABC-CLIO.
What is Evidence-Based Medicine? UNC Health Sciences Library. Web.
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