Publié sur : Conference theme: experience of a unit of pediatric oncology with drugs, prescription, observance and market - 2011
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The pitfalls of Evidence-Based Medicine (EBM): the new dogma and tragedy. Consequences in drugs prescription.
Nicole Delepine

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SYMPOSIUM

Conference theme: experience of a unit of pediatric oncology with drugs, prescription, observance and market.

The pitfalls of Evidence-Based Medicine ("EBM"): the new dogma and tragedy. Consequences in drugs prescription.

EBM in theory based on "scientific evidence" was set up by the Nazi Reich by a theory of eugenics (sterilization of mentally ill) and racial theories of the fascist U.S movement. Renaissance of EBM took place in 1980 in Canada and USA. Originally this technology would have been invented to simplify the teaching of medicine which became too complex.

Background of the dogma

EBM is a binary method, dogmatic, underdeveloped, made of three years of repositories called "referential" or guidelines which must be strictly respected and soon becomes mandatory and enforceable recommendation.
This "global epidemic with no vaccine" appeared on the so called civilized world. Its was born in the private Baptist Mc Master University Hamilton in Toronto and financed by pharmaceutical giants (Pfizer and Astra Zeneca and tobacco industry).

This is in theory a teaching method designed as an explicit approach to evaluations researches and methods of use to solve a clinical question. But wasn't it the best method to impose new drugs all around the world instead of demonstrating effective drugs and scheme of treatment? Who is the winner? Is it the pharmaceutical industry and accomplice or the patient?

What is medicine "based on evidence?"

Initiated in France in the 1990's as medical references, it's based on four steps: formulation of the medical problem, search of articles and statistics in literature which would be the most relevant and the best evidence. After this arbitrary choice, meta-analysis and assessment of their level after one year of validity the authorities include data in a treatment formulated as a "referentiel" and protocol!
And exit the liberty to chose drugs for your patient: collective medicine applied for cohort patients. That is no more individual medicine. Means of implementation are training-formatting procedures and protocols, enforceable and sanctionable recommendations, fear, management assessment deadly "maniac".

Imperialism of the statistical average and probability calculations becomes the law. Standings, schedules replace the differential diagnosis instead of the clinical medicine.

Results

EBM is a deposit scientist or belief at all quantifiable. "The darkness is back but this time we're dealing with people who cling to the right. Facing this, we can not remain silent" said Pierre Bourdieu.
EBM leads to code-barred marketable products by protocols (JJ Lottin). It also leads to automation of physicians and drugs prescription which are not the best for patients but which follow guidelines. Two solutions for doctors facing this dilemma could be suicide or escape with abandon medicine. Or fight! Big fight is needed because the French law requires the submission from 13.08.2004 to this medicine known as evidence-based statistics with the help of officials.

An example: the "Protocol" against the oncologist and the patient.
The patient behind a cancer specialist is told: "there is no protocol for your condition. There is no protocol for your stage of disease, we can not do anything!"
And the oncologist has not the right to give him a drug the best for him, the individual treatment because not recognized by the new dogma and authorities.

Conclusion

The EBM method leads to fetishization of (false) evidence from arbitrarily withheld documents on the fact that conclusions are based on published randomized clinical trials and therefore biased (the negative trials are never published) and accepted by the "big magazines" dependent on the pharmaceutical industry.

The limits are methodological, financial, cultural and ethical. The threat: the trap of a difference has become impossible to do, between "no evidence of effectiveness" and "evidence of ineffectiveness".

Some treatments or drugs for which evidence is lacking may be wrongly classified as "not proven effective". The tragedy is the invincible fall of medicine we saw, powerless to salvage medicine and patients.

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