How supported by science is conventional medicine?

It is popular now to call for Evidence Based Medicine (EBM) where all treatments are based on the best scientific evidence. 
 
The gold standard for scientific evidence is generally considered to be a randomized, placebo-controlled, double blind trial, which I will call the Controlled Clinical Trial (CCT). I joke that it is Evidently Baseless Medicine since good studies will never happen for those medicines that are off patent. It is an expensive process requiring thousands of patients, and there is no big money to be made with no patent. The US Food & Drug Administration (FDA) requires a minimum of 2 CCTs for each indication for treatment for each medicine. Perhaps half of all existing treatments will never be supported by trials. 
 
That is why the pharmaceutical industry is trying to replace them with patented drugs in standards of care. 

Even where CCTs are performed there are problems. These are well summarized in Harris Coulter’s book, The Controlled Clinical Trial which is posted on my website.
 


Essentially, to get good results from a CCT you need very homogeneous patients with similar symptoms and in a limited age range – excluding pregnant women, children, the very old, and those sick with other serious co-morbidities. This was done in the trials for the Covid vaccines. But the results for CCTs limited in this way don’t extrapolate well to the general heterogeneous population. 
 


As Dr Healy points out in his book Pharmageddon, medical science has been hijacked by the pharmaceutical industry. The companies hide the “proprietary” raw data that might reveal any problems with a new medicine and only publish the sanitized “data” that they want to reveal. The term “emotional lability” was used to hide suicidal thoughts or attempts in Paxil trials. Participants who left the trials due to adverse events were not included in the “data”. 

Frequently published studies are ghostwritten by pharma hired writers and signed off on by eminent academics who may not even vet the result. With enough trial participants the drug companies can find some data point allowing them to claim the drug “works”, whether or not it is leads to a longer healthier life for the patient. Multi-billion sales drugs like Statins are shortening life-spans. Older drugs are being replaced by new 100x more expensive patented drugs that may be even less effective.

“And companies can ensure their drug never causes anything by making sure that trials are organized so that important adverse events cannot become statistically significant.”  
– Dr David Healy, Pharmageddon

Dr Healy is not the only one to notice these problems in modern medicine.


“Similar conflicts of interest and biases exist in virtually every field of medicine, particularly those that rely heavily on drugs or devices. It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of 
The New England Journal of Medicine .” 
– Dr Marcia Angell, 2009
 


“The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness. As one participant put it, ‘poor methods get results’.” 
– Dr. Richard Horton, editor-in-chief Lancet, Apr 11, 2015 editorial
 


And there are problems with research more generally:

“Simulations show that for most study designs and settings, it is more likely for a research claim to be false than true. Moreover, for many current scientific fields, claimed research findings may often be simply accurate measures of the prevailing bias.”  
– Dr John Ioannidis, PLOS Medicine, Aug 2005, 
”Why Most Published Research Findings Are False” 

And then there is the expense…

Why is conventional medicine so expensive? Well, of course, there are many reasons but there is one not usually discussed. Most of the world is subject to a medical monopoly of conventional medicine. In the USA at the turn of the 19th – 20th centuries competing schools of medicine – homeopathic, herbal, etc. – were kicked out of the medical schools and hospitals. The American Medical Association, which is a doctor’s trade union financed heavily by the pharmaceutical companies, prevented its members from even consulting with other doctors not in the club. The USA state medical boards also excluded competing traditions of medicine.  The Carnegies & Rockefellers who own many of the pharmaceutical companies used their foundations to orchestrate this coup. As all monopolies do, they used their market power to drive up the cost of medicine. Interesting fact: John D. Rockefeller’s medicine of preference was homeopathy until he died at the ripe age of 98 in 1937.

In some parts of the world there are competing systems of medicine. India has three systems of medicine, homeopathic, ayurvedic and conventional, and all three have pharmacies, medical schools and MDs with hospital privileges. So medical care in India is relatively affordable.

Even someone who completely rejects homeopathy for themselves should value its availability for others, to provide competition to keep medical care costs down.

Conventional medicine is expensive and has serious problems.