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Seeing beyond the Double Blind Study: A Reflection on Evidence-Based Medicine and Scientific Truth by Lily C. Chan

August 19, 2015 Intima: A Journal of Narrative Medicine
Courtesy wondermark.com

Courtesy wondermark.com

Erica Griffith’s astute essay, “Psychedelics in Psychotherapy” (Intima, Fall 2012) has given words to the core issues I wanted to address in “Believing in Chinese Medicine.” I originally wrote the piece thinking it would be largely interpreted as a one on the immigrant-family experience, but Griffith’s essay provides a more critical and historical account of what are fundamentally the same issues I grapple with in it: First, the tensions that exist between two very different systems of medical philosophy, and second, the power of social, cultural, and political context in medical care. Together, the two pieces of writing paint pictures of how certain medical treatments are relegated to “second place” as one system of medical philosophy—in this case, evidence-based medicine (EBM) and 'scientific truth'— emerges as a gatekeeper of sorts. EBM, as Griffith documents, has become the institution that legitimizes or refutes novel treatments.

While evidence-based medicine and the double-blind study is certainly a valid lens through which to view illness and health and has resulted in many wonderful, life-improving and life-extending treatments for thousands of people each year, the marginalization of intangibles or unquantifiable issues such as the patient experience and physician-patient rapport is an unfortunate side effect.

The Oxford English Dictionary defines a placebo as “a harmless pill, medicine, or procedure prescribed more for the psychological benefit to the patient than for any physiological effect.” The very fact that the ethics of placebo usage in clinical care is a mainstay of the contemporary bioethics debates implies the placebo effect is a somehow less legitimate way of unburdening the patient of his or her ailment—the underlying assumption is that using the placebo effect clinically is akin to being deceptive towards the patient, and by extension, suggests that a treatment grounded in the mind (note: not the brain), regardless of the ultimate clinical benefit — is inferior to a treatment that is grounded in the comforting proof of a clearly delineated mechanism. Hmm.

U.S. medical training is more or less standardized; we ultimately cram into our heads the same mnemonic devices to prepare for the same multiple-choice board exams. As much as I and my colleagues will draw upon the diversity of our experiences, creativity, and compassion to treat our future patients, the process of medical education is still one in which we are trained to use a single system of thought—one that prizes scientific, mechanistic proof. Under this system of thought, medicaments such as LSD and TCM—both which provide benefits through patient experience and not solely through molecular mechanism as far as the medical community can tell—are regarded with much suspicion.

I hope these two pieces of writing remind readers of the power of dominant, often self-affirming philosophical systems, and encourage them to be willing to—even if only occasionally— see beyond the messages that have been so ingrained into us throughout our medical educations. The fact that a system of medical thought has not been approved by the dominant philosophical system doesn’t make it categorically less legitimate.

And finally, and perhaps most importantly of all, we physicians and physicians-to-be are healers, not merely dispensers of medications that have been approved by rigorous double-blind studies.


Lily Chan is a medical student. Her piece, “Believing in Chinese Medicine” appeared in the Fall 2014 Intima.

 


Source: http://wondermark.com/1k45/
Tags medical training, double-blind studies, doctors, LSD, TCM, psychedelics, psychotherapy, Chinese medicine, EBM
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