Have you recently run into the terms evidence-based-medicine (EBM) and science-based-medicine (SBM)? Did you think they’re the same, or at least similar? Turns out while both seek to improve the general state of medicine, one has a blind spot that lets in the “alternative” therapies that are nearly never efficacious, as discussed in Skeptical Medicine:
Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” (Sackett et.al.) …
EBM appears to place its emphasis on clinical science (controlled trials) and relegates basic science to the bottom (Level 5 evidence includes claims based on physiology, bench research or “first principles“. It should be noted that practice should never be based solely on basic science because such evidence is insufficient in clinical practice.
So the complaint here is that the plausibility of the treatment is not considered in EBM. A treatment that contradicts established scientific principles is not treated as needing extraordinary evidence because of this particular property.
EBM as it stands today can lead to a rabbit hole filled with unlikely and implausible claims.
SBM begins with basic science.
SBM recognizes full well that basic science is not sufficient to justify practices. Indeed, much of pseudoscience stems from this mistake. SBM asks us to consider the basic science plausibility of a claim before committing to a randomized controlled trial. It asks us to consider both basic science and clinical research. There really should be no conflict. Some avid proponents of EBM appear to think that SBM proponents value basic science over clinical trials. This is not the case. SBM supporters simply want to consider the basic science first, or at least alongside clinical trials. Claims that contradict basic science should require far more evidence from clinical trials than should plausible claims. The more extraordinary the claim, the more extraordinary must be the clinical evidence.
The piece is not easy; a grasp of statistics, at least, is necessary. But it does explain why SBM is superior to EBM in that it will recognize extraordinary claims require extraordinary evidence. So at least remember this: if some snake-oil salesman suggests that one of the many alternative therapies out there is for you, and cites that it’s all evidence-based medicine, ask him if it’s science-based, and if he answers affirmatively, then ask him to explain the difference. If he gets that right, then ask how he squares the impossible basis of his treatment with it being SBM….
