Intended for healthcare professionals

Rapid response to:

Editor's Choice

Evidence debased medicine

BMJ 2010; 341 doi: (Published 13 October 2010) Cite this as: BMJ 2010;341:c5715

Rapid Response:

"One of the first duties of the physician is to educate the masses not to take medicine."

The caption of this response is one of the many brilliant sayings of
that great brain, Sir William Osler. In the twenty first century, I could
only echo that great sentiment as a truism, despite all the tall talk
about the "so called" evidence based medicine. Napoleon Bonaparte went one
step further, but one could ague that he was not a physician. Napolean was
at the receiving end of such a medical practice in Persia where he died.
"Medicine is a collection of uncertain prescriptions the results of which,
taken collectively, are more fatal than useful to mankind." Napoleon,
though, was more accurate scientifically today. Latest science says that
uncertainty is the only certainty in the world. This is truer in medical
science, if there is one. A proverb is a short sentence based on long
experience. If that were so, this one from Voltaire takes the cake: "The
art of medicine consists in amusing the patient while nature cures the

Time and again I had written in responses to the journal as also in
my articles elsewhere that our evidence base has been built on loose sand.
) Of course, no one seems
to take it seriously. They would have, if it had any financial interest
behind it. The present RCTs and linear relations help generate billions of
dollars in chemical therapeutics even if that results in thousands dying
of our efforts directly or indirectly. (

This morning I had a message from one of my old students who is a
leading dermatologist in India doing innovative research in his area. "I
always wondered when I used to listen to you during my student days and
respected your views all along. In dermatology evidence is found only in
28% of published studies. All molecular biology companies come with an
offer to give authorship if we buy their equipment for our lab! Doesn't
that mean that most molecular biology studies are prototype and try to
find out how what is known fits into their study?"

Foundations of our evidence in modern medicine like the statistical
risk calculations, (especially the relative risk reductions in place of
absolute risk reductions that are sold to gullible doctors in most of the
"scientific" articles without mentioning the NNT figures) and, the RCTs,
which have no true science base, are very shaky indeed. We need to have a
new science of man, which is sadly missing in this whole bargain. Physics
changed in 1925 and there is no more physics, but we still use the same
old physics laws for our statistics. Matter is not made up of matter.
Matter and energy are interchangeable.
( Human molecules
communicate with one another which can now be documented through the
photon lights emitted from each DNA.

What is the science base of our reductionism, organ based
specialization and our reliance on Mendelian inheritance? Instead of
trying to rehash the existing evidence base it is better to think of a new
evidence base for health and illness. Health is a state where each human
body cell is in sync with other cells. Illness is when this communication
breaks down. ( We need a new non-
linear, holistic, dynamic, scientific base for future medical research.
Nature has provided a robust repair mechanism inside the human system
which has been weakened by our modern life style. Even though both Claude
Bernard and Louis Pasteur did note that the "terrain is more important
than the seed" we have gone whole hog on the seed, risk factors, and what
have you. Modern medicine has forgotten the essence of illness care which
is basically to strengthen the terrain.
Yours ever,

Competing interests: No competing interests

17 October 2010
BM Hegde
Editor in Chief, Journal of the Science of Healing Outcomes
Mangalore-575 004, India.