Gold Standard trials are not good EBM

This is a work in progress. It is not finished.

The current gold standard, randomised, double blind, placebo controlled trials, are not good EBM (Evidence Based Medicine). They are not a good way to find out which treatment works the best. You might be shocked by this statement but it is quite true.

Before you start getting all puffed up and annoyed by what you think is an arrogant, uneducated statement, please think for yourself. Don't just blindly continue to believe what you have been taught.

Ask yourself if it's possible that the current gold standard actually only does one thing. It raises the cost of medicine and buries much cheaper, simpler, and possibly more effective treatments. With the mean cost of a trial being $12 million, and the intervention being unpatentable at the end, who in their right mind would invest in such a trial? They just wouldn't. As most trials are funded by pharmaceutical companies (and the fairly obvious publication bias this comes with), all it leads to is expensive and possibly ineffective medicine, of dubious quality. What about meta analyses you might say? If they start with bad data, meta analyses cannot help.

Add to this the paper by John Iodanis et. al, showing fully 50% of peer reviewed papers will be found to be false within 5 years of publication and you start to see how hard it is to continue to believe that the current gold standard is anything but good evidence.

So what is the answer? Hopefully it lies in unbiased Govt funding for randomised, double blind, placebo controlled trials on cheap pharmaceuticals, herbs and natural products. Two countries, India and Pakistan, are realising they cannot afford to look after their massive populations using overly expensive pharmaceuticals and are looking towards large scale trials on cheap pharmaceuticals, herbs, natural products and supplements. They may (or may not) then do trials comparing the better non pharmaceutical products with the better pharmaceutical products for a reasonable comparison.

Until the above has been happening for a number of years, my statement stands! The current gold standard, randomised, double blind, placebo controlled trials are not EBM.

References are coming.