Saturday, February 5, 2011

Clinical Evidence: Is Any Of It Any Good?

Last week Newsweek told us "Why Almost Everything You Hear About Medicine Is Wrong," and goodness knows there have been times we have wanted to say the same. Facts and skepticism, not commerce or politics, not hopes and dreams, should drive evidence-based medicine. We're all about facts and skepticism. And so we also seriously doubt the article's chief claim, based on some pretty flimsy-sounding mathematical modeling, that the majority of clinical trial results are wrong.

Yet the article's main point strikes home. Human clinical trials are conducted by human beings, all with personal motivations and biases, on human beings, all with minds and bodies wide open to all sorts of suggestions and stimuli. The human experiment is messy. Life is messy. Even the finest, largest randomized prospective trials, using gold-standard placebo controls, may fall to shreds upon closer scrutiny.

One of our favorite scientific papers last year sheds a little light. Kaptchuk et al, publishing in the online journal PLoS ONE, found that "placebos administered without deception may be an effective treatment for IBS" (irritable bowel syndrome). That's right. Patients who were told they were being given "...placebo pills made of an inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in IBS symptoms through mind-body self-healing processes," did significantly better than patients who received no treatment at all.

Maybe it was the mere act of caring and caregiving, the human touch, that made the difference. We don't know.

So we do the best we can, and we keep our wits about us when we read and interpret (yes, interpret) study results. And here at HyperbaricLink, on our Diseases and Conditions pages, we always provide thoughtfully curated facts and clicks for you to study the state of the HBOT evidence yourself.

In hyperbaric medicine we're used to scathing headlines that make Newsweek's look tame. Who could forget this September gem from Slate: "Don't listen to Tim Tebow: Hyperbaric oxygen chambers are mostly useless." At least the author was kind enough to provide a link to hyperbaric oxygen search results in the Cochrane Reviews, where (equally messy and suspect) meta-analytical techniques abound but domain expertise and independence rule. Surely we're fortunate that HBOT has won the attention of The Cochrane Collaborative. We're also fortunate to have the UHMS, the ACHM, and other professional organizations with peer-reviewed meetings and publications to keep investigators and authors honest.

We'll keep consulting such reliable sources and keep placing our trust in the scientific method. And let's take those papers one at a time, please, and spare the sweeping generalizations.

O2.0 is the news blog of HyperbaricLink, the independent web guide to hyperbaric oxygen therapy.

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