Evidence

Posted by Liz on May 19, 2014 in menopause | 0 comments

A few weeks ago, I found myself in the midst of a discussion about the value of acupuncture for a variety of diseases. And I quickly realized that there was no value in continuing the dialogue as the person who had started the discussion had no interest in hearing anything but his own point of view.

This is commonplace in allopathic, or Western Medicine.

There is a word that is thrown around a lot in scientific circles: evidence. If something has not proven beneficial according to scientific standards that rely on a specific framework of measures, then it has no value. However, in my small circle, value is defined a bit differently and evidence, taken as a grain of salt because not everything can be explained away by science. Or by a clinical trial that creates an artificial environment to evaluate benefit. And practitioners who rely on nothing but this artifice, I posit that perhaps it is their patients who suffer the most, the reason being that even the standards aren’t truly standardized.

Several years ago, Mike Clarke from the School of Nursing and Midwifery at Trinity College in Dublin wrote a great article  about the need to standardize results of studies for a specific disease ( in this case, rheumatoid arthritis). He defined the problem as follows:

“Every year, millions of journal articles are added to the tens of millions that already exist in the health literature, and tens of millions of web pages are added to the hundreds of millions currently available. Within these, there are many tens of thousands of research studies which might provide the evidence needed to make well-informed decisions about healthcare. The task of working through all this material is overwhelming enough without then finding the studies of relevance to the decision you wish to make…”

So what do you do? A few key points:

• Consider that every study has the potential for bias. Perhaps researchers are using 7 instruments to measure depression and only highlight findings from 3 of these in order to preserve the most positive or significant results. Clearly, the reader is being led towards certain outcomes and away from others. And regardless of what one believes, statistical analyses do not always reveal the truth.
• Study designs, types of patients studied, age of patients studied, gender, you name, can differ so it’s difficult, if not impossible to draw definitive conclusions when comparing results of one to another.
• Another issue of great interest to practitioner of Western medicine is whether or not a study is controlled. This means that two groups are compared that are identical in every way except one group is given an experimental treatment and the other, a placebo or standardized treatment. Note that often, real world conditions are often recreated rather than conducted in a real world setting and many studies are not controlled, meaning that the science behind the findings is questionable. And, what is often missing in these studies is the individualization of treatment – no one patient responds the same way as the other. Importantly, Eastern medicine recognizes this and adjusts treatment accordingly.
• I can’t emphasize this last point enough: alternative and complementary medicines are still incompletely understood among many practitioners of Western medicine. What’s more, agents are not regulated carefully and manufacturing practices may vary. Consequently, studies of these agents or modalities are often inconclusive. And of course, often underfunded and under-appreciated.

I’ve written several times about the importance of consulting a practitioner or medical expert before embarking on any regimen for peri- or postmenopausal symptoms. In fact, you should consult several and then compile the information to devise a plan that works best for you. You may need to try different combinations before you find the key to your individual health. Yet, if you only see someone once, at least that dialogue may be useful for initially defining a regimen that may work best for you and what you’re going through. For those of you who live off the beaten track without access to a good practitioner,  excellent resources like Medline or the American Botanical Council may be be of help in discerning what’s what.

The short answer is that there are no short answers. But with careful guidance and a bit of prudence, you may just be able see the light and smooth out the bumps on this rollercoaster ride we’re all on.