You might be wondering whether I am suggesting that all the quantitative research that has gone before is useless? That the massive industry of investigative clinical research has accomplished nothing? That past and present clinical trials are all a complete waste of time and money? The short answer to these questions is “No”. No, they have not accomplished nothing and No, they were not a complete waste of time and money.
Appreciating what I am saying does not mean we dispose of all quantitative clinical research. But it does change how we perceive it and what we expect of it.
Consider the analogy of geocentrism which I made earlier. When Copernicus and Galileo convinced the general scientific public that the earth was not the centre of the universe, it did not change what people perceived. But it did profoundly change how they perceived it. They still saw the sun and moon and other celestial bodies move across the sky, but they interpreted it differently. And it opened up to a new understanding of what they observed. So it is with this discussion of EBM. Appreciating the “fallacy of quantification” does not necessarily change what we see in the medical literature, but it does profoundly change how we interpret and understand it. We regard the results of studies with a very different mindset. We can understand why there is so much variability and discrepancy of results. We comprehend why medical treatments seem to come and go almost like fads. Why one week coffee appears to cause cancer and the next week prevent it. We understand why there are extravagant research claims dealing with everything from cleanses and weight loss to herbal remedies and spiritual regimens. It helps us understand the Dr. Oz’s of this world. We are more thoughtful about statements like the one from Woodson Merrell suggesting that there is evidence to show that people who live a more connected life tend to lead longer and more fulfilled lives. We understand why we don’t believe things, even when they appear in reputable journals. We understand why approaches and techniques, which are shown to be most effective in the literature, do not seem to work very well in our own practices. We can grasp why we are often confused and perplexed after reading “evidence-based” reviews or observing “evidence-based” debates. We can make sense of why we encounter not just conflicting evidence, but downright contradictory evidence. We can appreciate why and how research can be manipulated to serve commercial interests. By removing the specious veil of objectivity, we can understand how the enterprise of Evidence-Based Medicine can be exploited by industry, why clinical research appears to be so malleable and plastic in the hands of commercial interests. We are no longer surprised by so much variability in results. We actually come to expect it.