Warning: This is an opinion paper by Dr Lisa Giusiana. No research has been done to prove or disprove this theory. Whether you are a practitioner or a patient, the intention here is to encourage you to think!
As doctors, we are trained to search the medical research literature for what has been proven effective as far as diagnostic methods and treatment protocols. It is somewhat assumed that whatever research indicates must be true, is highly regarded, must be followed in order to get a desired outcome, and most else is considered irrelevant among many in the professional community. These days, some doctors have gotten away from critical thinking and instead tend to rely on a cookie cutter approach to care as dictated by the research and findings of others.
Evidence based medicine
Clinical research attempts to establish evidence either for or against what is being tested. Evidence based medicine (or evidence based nutrition for those of us who do not use pharmaceuticals in practice) is intended to optimize the clinician’s decision making process by emphasizing the use of evidence collected from the research. Evidence based medicine/nutrition serves to establish a standard of care amongst health care professionals.
This is a very simplified explanation of clinical research, but essentially, the researcher will:
- Create a theory
- Test it
- Analyze the data
- Make a conclusion
Clinical research serves multiple purposes such as, but not limited to:
- Establishing patient safety: Is this product safe to use
- Efficacy: Is this protocol likely to produce the desired effect
- Is this protocol, treatment or method any better than what’s currently being used
For instance, if the researcher wants to know if treatment A is superior to treatment B for eradicating gut infections, they would recruit two groups of people. Let’s say Group A with an established gut infection receives antibiotics as their treatment. And Group B with the same gut infection might receive all natural herbal antimicrobials. Each group would undergo their specified course of treatment, symptoms would likely be monitored and recorded throughout the study, and at completion, all participants will be retested for gut infection. The data will be analyzed to see which treatment, if any, produced a superior outcome. Then, a conclusion can be made, something along the lines of, “In a study comparing antibiotic therapy to herbal antimicrobials for the treatment of gut infection, it has been established that there is no statistically significant difference in safety, effectiveness or validity of antibiotics vs herbal antimicrobials.” [This represents an example conclusion and is just one method of how clinical research establishes evidence.]
Putting it into practice
Let’s say you’re a doctor and a patient comes in with a gut infection. You need some guidance as to where to begin with treatment so you refer to the medical research. You find a research study in the literature that says a particular antimicrobial is effective against the infection your patient presents with. You recommend that therapy to your patient with eager anticipation of a positive outcome. After all, that’s what the literature claims. The patient gets well and everyone is happy.
But then, another patient comes in with this same infection. You use the same therapy you found to produce positive results in the past. But this time, your patient doesn’t respond. Or they have adverse effects, or maybe even get worse. What do you do? Where do you turn then? This is where the road ends for some doctors, and their patients too. When a doctor has been so entrained to only rely on the thought processes and ideas of others, they may not stretch their own thinking and look for what else is possible.
Considering the facts
If evidence based medicine establishes the guidelines for care, then why do patients fail to respond? Here are a few ideas:
Some patients simply do not respond. The research will usually report something like “70% of patients responded favorably.” Well that would suggest that somewhere around 30% may not respond favorably in that situation. If you, the patient, happen to be one of the 30%, you may not achieve the desired outcome in undergoing that therapy. An alternative or different approach must be found for you.
Misdiagnosis or under-diagnosis can play a role in outcome. There are many conditions that have similar symptom sets where accurate diagnosis may be missed. There can also be overlapping conditions or underlying issues that are not addressed. Unless you’re looking at the whole picture, things are easily missed.
When using the example of gut infections, let’s say the doctor is treating you for SIBO (Small Intestinal Bacterial Overgrowth), but you also have an overlapping case of SIFO (Small Intestinal Fungal Overgrowth). These two conditions have very similar symptom sets, and what works for addressing one may not necessarily be effective in addressing the other one. So if the SIBO protocol is actually successful but the SIFO isn’t addressed, you will still feel pretty miserable and either you or the practitioner may assume that care has failed.
Things to consider when a researched approach fails:
There are many factors that determine the effectiveness of a research based approach. Was the practitioner clear in delivering the protocol? Was the patient compliant? By how much? Was the case diagnosed properly? Was it managed well? How solid was the design of the study? Is the data accurate and honest? Those are the obvious, but I’d like to stretch the thinking on this topic.
One reason you may not get the desired outcome from an evidence based approach is that you simply were not one of the participants of the study. Whether the study included 10 patients or 10,000 is irrelevant. One can deduce a likelihood of how you will respond, but you really never know until you try. Your overall health, including everything your body has been through up to this point in time, is a contributing factor as to how you respond to care. Ultimately, what works for one may not work for another. It doesn’t mean the doctor was wrong in recommending it, it means that your body is unique and something different may be required.
What to do when a researched approach fails:
Quite commonly, the patients that seek my help have already been to multiple practitioners and tried a number of approaches, all of which have marginally improved or simply failed to resolve their issues. Obviously, I don’t want to take them in circles, recommending what they’ve already tried. So in situations like this, what’s a doctor to do?
It comes down to this: You’ve got to learn to think outside the box. Especially if you’re an alternative practitioner, learn to really look at the anatomy and physiology, even down to the cellular level. Study the mechanism of action of various foods, herbs, nutraceuticals and nutritional compounds to learn what metabolic, immune and endocrine pathways are affected by them. You may even consider conducting your own research study to try out some of these new theories you come up with. Remember, someone has to come up with the idea to research it in the first place. Otherwise nothing would ever be tested. And that someone could be you.
Pulling it all together:
Not everything that works has been run through a clinical trial to prove that it’s effective. And not everything deemed effective by clinical research is going to work for you, so you need to work with someone who can look at the physiology and think outside the box. Otherwise, you may find yourself stuck. ~ Dr Lisa
Now, I want to be clear. What I am NOT saying here is to randomly throw a soup of supplements at a patient and see what happens. Nor am I encouraging you patients to try every single thing you can get your hands on in some attempt to treat your own condition. I am clearly encouraging everyone to stop falling into the trap of a one-size-fits-all method of care. Think things through. Use critical thought processes. Create a plan. Know why you are using certain products. Original thought is priceless.
Second of all, there are many effective approaches available. There usually isn’t “only one way” to approach a condition. This diet and 3-supplement combo may work great for your friend, but not at all for you. You don’t necessarily have to get it right on the first try, although that is always the target. In fact, I’ve seen both doctors and patients get nowhere on a case because they won’t choose an approach for fear of making the wrong decision. Don’t take that mindset. You just need to do the best you can and stay open to what else is out there in the event your first try doesn’t resolve your issue.
When considering a new approach, I can’t tell you how often I hear, “Well, what does the research say?” In some ways, that’s music to my ears, that people are actually interested in what has been tested and proven. But sometimes, I see it as an assumption that just because there isn’t anything published on an approach must mean it will not work. This, in my opinion, is a dangerous area and possibly a hinderance to new thought that can produce new possibilities where everything else has failed.
Just because something has not been researched, does not mean it will not work. It simply means no one has taken the time and money to conduct a clinical trial. There are so very many products and protocols out there that simply have not gone through the research process. It’s expensive. It’s time consuming. And simply going through the extensive process of conducting a clinical trial certainly doesn’t guarantee that your hard work will ever get published. If research hasn’t been published, you’ll probably never read about it. But it doesn’t mean the approach isn’t useful or valid.
But really, when you do hit a dead end, what is your alternative? Are you just going to give up? Or will you keep fighting, keep learning, keep thinking, and keep creating new possibilities in the world?