In a review of research on the topic of evidence it was reported that about 75-85% of all medical treatments are evidence based. In this review, evidence based included non-experimental evidence most often reported to mean unanimity among physicians that there was convincing non-experimental evidence. Only about 30-40% of all treatments in these studies were based on Randomized Controlled Trials (RCTs). Here is another similar review with citations.
There are levels of quality in evidence. RCTs are currently held as the gold standard of evidence, but some treatments don’t lend themselves to testing in this manner or are common sense. Even in RCTs there are always outliers that don’t conform. If we could do an RCT for every treatment that would be great, but we can’t. Evidence based treatment relies on doctors to make the best decisions based on all the evidence available to them at the time. So I’d say that 85% of medical treatments are based on evidence and a judgment call. That, is good.
There does seem to be a double standard in this area of discussion. When it comes to traditional medicine the levels of accepted evidence are understood. When it comes to complimentary and alternative treatments (CAM) anything less than an RCT is refused as evidence. Because of this bias chiropractic has been forced to prove it’s self by performing RCTs. And research has now found about 68% of all chiropractic procedures are backed by RCTs. Compared to 30-40% of medical treatments. That is also good.
I appreciate having good research to support my profession. I’d really like to stop hearing that chiropractic is not founded in evidence, but that may not happen. On a slight tangent, and to give you a thought provoking sampling, here are a few common treatments that either have limited evidence or research that actually finds that they don’t help.
- Therapeutic Ultrasound evidence is lacking, but accepted anyway.
- Episiotomy has been found to have “no health benefits” during delivery of a baby, and is done in 30-35% of vaginal births.
- Back fusion surgery has been found to be no better than conservative care for general low back pain but is commonly used (250,000-300,000 per year in the USA).
- Chiropractic manipulation has been seen to reduce high blood pressure, but more research is needed, especially into the “why.”
- Medication recalls, think Fen Phen