Confronting the Evidence

The upcoming Pangea Conference will feature thought-provoking sessions on vaccines, the ethics of CAM use in children, and the integrative care of children with autism.  How much of what will be discussed is truly evidence-based and when does it matter?

One of the challenges in medical care is in reconciling the weight of different kinds of evidence.  How do I know when to advise for or against certain treatments?  Should all children get a chicken pox vaccine (or two)?  Should a child with cancer take antioxidant vitamins?  Should parents of an autistic child pursue sensory integration therapy?  All of these questions have not so simple answers.  At this year’s Pangea Conference, many of our sessions will feature stimulating dialogue about these very answers.  Do we trust our experience and intuition?  Or do we follow guidelines based on randomized controlled trials?  How much of both?

Both coastal Times featured mainstream media articles Sunday on this very issue.  "Scientists Do The Numbers," from the Los Angeles Times, warns against medical dogma based solely on epidemiological studies.  For example, a study concluding that drinking a certain amount of coffee a day decreases your risk for colorectal cancer ignores the fact that a) may be true and b) may be true, but there is no proof that a) causes b).  The same can be said for the controversial hormone replacement therapy guidelines skewered by results from the Women’s Health Initiative trial.  The N.Y. Times Magazine story – "Do We Really Know What Makes Us Healthy?" – discusses the HRT story as well as other treatment flip-flops based on conflicting epidemiological studies.  Much of what we believe is true based on common-sense, good theory and experience has not panned out in these types of trials.  What does this mean for day-to-day practice?  Should I stop advising kids to eat more fruits and vegetables because a well-designed randomized trial or two fails to show benefits (however they are defined)?  As one of my dear colleagues recently quipped, do we really need a prospective, placebo-controlled study of jumping out of airplanes to know we need a parachute? 

In the world of holistic medicine where we integrate CAM therapies based on thousands of years of experiential data (Traditional Chinese Medicine and acupuncture, for example), we debate these issues daily.  And we welcome the debate; it’s one of the many reasons why Pangea is unique.