Does Evidence Really Matter?

Abstract

When I was in my mid-40s, I took up golf and quickly realized that it is a challenging game. More than 10 years later, after many games of golf and several visits to golf schools, I still consider it a good day if I break 100 over the course of 18 holes. My only consolation is that I am not alone: according to a few golf books that I have read, fewer than 10% of those who golf will ever legitimately score less than 100. I was therefore a little skeptical when, after the recent death of Kim Jong Il, the “Great Leader” of North Korea, I read of the miraculous accomplishments with which he was credited, including the claim that in his first game of golf he shot almost a dozen consecutive holes-in-one. Many of Kim Jong Il’s other miraculous accomplishments seem similarly implausible. In fact, many of you may be wondering, as I have, whether anyone in North Korea really takes those claims seriously. In an article that appeared in the Globe and Mail shortly after Christmas 2011, Canadian North Korea watcher and former Pyongyang resident Erich Weingartner was quoted as saying, “There’s still a lot of people who regard at least Kim Il-sung [the first of the 3 Kim family rulers and father of Kim Jong-il] as a god figure”. When asked to comment, Professor Paul Evans, director of the Institute of Asian Research at the University of British Columbia, cautioned that we should be careful not to conclude that people in North Korea are any more prone to believe the implausible than the rest of us. After all, he pointed out, North Americans had just gone through the Christmas season, when Christians accept as truth the story of a virgin birth, angels descending from the sky, and a star moving through the night sky to lead the Three Kings to their destination. What does all of this have to do with pharmacy? To begin with, belief is an extremely important human attribute. Not everything can be proven or disproven. We may believe that someone loves us, but can science really prove or disprove that belief? Should we abandon our belief in love on the basis that it cannot be scientifically proven? On the other hand, when a question can be subjected to scientific inquiry, what obligation do we, as professionals, have when beliefs and science collide? Pharmacy faces a number of issues where a good argument can be made that we, as a profession, are failing to address inconsistencies between the available evidence and our own response to that evidence. Complementary and alternative medicine is one such area. In his book Snake Oil Medicine: The Truth About Complementary and Alternative Medicine, Bausell makes the case that, with few exceptions, most complementary and alternative therapy, in and of itself, has no beneficial effect. That is not to say that patients don’t experience what they perceive to be beneficial effects, but rather that the beneficial effects can be largely, if not entirely, attributed to a family of psychological and physiological effects that collectively constitute what is known as the placebo effect. Despite the evidence to that effect that has accumulated in recent years, Bausell himself acknowledges that if current trends continue, most North Americans, at least those who can afford it, will soon be engaging in complementary and alternative medicine practices. In recognition of this non–evidence-based reality, many community pharmacies are expanding their complement ary and alternative therapy offerings, faculties of pharmacy are introducing courses in this area, and community colleges are offering certification programs in various practice areas within complementary and alternative medicine. In fact, comple mentary and alternative medicine has reached the point where it is considered a sign of closed-mindedness to question the merits of its therapies, therapies for which there is rarely the type of scientific evidence required for traditional medicines. Some may argue that complementary and alternative medicine is, at worst, harmless, but that is not always the case. Serious adverse effects do occur. In addition, is it appropriate to ignore the fact that large sums of money are being spent on products with little or no evidence to support their purported benefits?