Health Based Medicine vs Evidence Based Medicine? vs SBM? vs PBM? vs DBM? vs HBM?

Today, we have Evidence Based MedicineScience Based MedicineData Based MedicineInstinct Based MedicinePatient Based MedicineExperience Based MedicineFunctional Medicinedisease based medicinehospital based medicine, pseudo-evidence based medicine, and a jokes: Seven Alternatives to Evidence Based MedicineCrap Based Medicine?  What’s going on?

What should medicine be based on? Health. We need:

Health Based Medicine.  

The leading candidate today is EBM, so called Evidence Based Medicine. ” is defined as “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” (Wiki). Wiki goes on to say “Trisha Greenhalgh and Anna Donald define it more specifically as “the use of mathematical estimates of the risk of benefit and harm, derived from high-quality research on population samples, to inform clinical decision-making in the diagnosis”.

The rub, simply, is to be found in the reasons Evidence Based Medicine exist. Medicines are dangerous. Standard medical technique is to ‘fight’ the illness.  To war against the disease. We need EBM to reduce risk and harm for the patient, because medicines create risk, and harm patients.

According to BMJ “Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” If it is, we are only half way to success.

Science Based Medicine is the ‘new kid on the block’. Science Based Medicine vs Evidence Based Medicine says “Science-based medicine (SBM) is not a replacement for the more familiar concept of evidence-based medicine (EBM). Instead, it emphasizes some neglected aspects of EBM. This article explains the differences and the need for the distinction.”

What are those ‘neglected aspects of EMB’ that are provided by SBM? Frankly, the above post does not give a single difference worth quoting.  It simply rants with phrases like “That’s insane!”, “quasi-scientific obfuscation”, and “the quack leapfrogs”, but provides no actual answers.  It is interesting that proponents of SBM claim EBM is a ‘subset’ of SBM, while also suggesting that SBM ignores evidence that is attended to by EBM. SBM sounds like PBM (Propaganda Based Medicine) to me.

Both EBM and SBM ignore anecdotal evidence.   Anecdotal evidence is one of the monsters of modern medicine. Specific cases of illness that were cured.  In many cases, specific instances of illnesses – that are judged to be incurable – were cured. Anecdotal examples abound. Even more confounding to EBM and SBM proponents, in many anecdotal cases no ‘medicines’ were used – no prescription medicine, no Evidence Based medicines, no Science Based Medicines. How can this happen? Do EBM and SBM study these cases? Nope.

Is it possible to ‘cure’ a disease, without a medicine?  Of course it is.  It happens every day. It’s just not acknowledged by EBM, SBM, or any other current “based medicine”.  If you are suffering from dehydration, the cure is not ‘medicine’, it is water.  If you are suffering from scurvy, the cure is not ‘medicine’, it is nutrition. If you are suffering from malnutrition, the cure is food, not medicine.  There are many,many types of malnutrition, more than we know.

If you are suffering from unhealthiness, the cure is to improve your health. No medicine is needed.  No medicine will help. The only solution will be found in Health Based Medicine, which often does not use ‘medicines’ – improving healthiness instead.

How many illnesses are better served by Health Based Medicine than EBM or SBM? We don’t know.  Obviously, dehydration and scurvy are best treated with health – medicines don’t work.

How many other illnesses are best treated by health? Make a list. Make a list of illnesses that are ‘incurable’ today.  It’s a long list.  It’s also a ‘growing list’.

The list starts with some of the oldest illnesses, arthritis. Why is arthritis incurable? Because, in many cases – especially in cases of slowly progressing arthritis – arthritis is not an illness, it is an unhealthiness. The progression, the gradual worsening of arthritis, continues because the unhealthiness continues. Arthritis has actually been compared to ‘rust’.The Orthopedic Institute, for example, says “One such form of chronic injury is arthritis, which might be thought of as a “rusting” of the knee joint.” If your car is rusting, can you cure it with ‘medicine’? Of course not.  That’s why modern medicine claims arthritis is ‘incurable’. EBM, SBM agree to search for the best painkillers.

What do you need to cure arthritis? Health. Health does not require medicines, medicines fight illness.

How many other illnesses are best served by health? Make a list of ‘chronic illnesses’. Why are chronic illnesses “chronic”? Why do chronic illnesses progress slowly, but inexorably? Because chronic illnesses are actually chronic unhealthinesses. If the illness is progressing, the progression has a cause. In many cases, the cause is not illness, it is unhealthiness. It is likely that ALL chronic illnesses are better served by health improvements, by Health Based Medicine, than by ‘medicines’.

What about non-chronic illnesses? Can we treat all illnesses with health, instead of medicines?  Should we try to treat all illnesses with health, instead of medicine?

No.  There is a fundamental difference between medicines and health. Health is slow, honest, and true. Improving health is NOT useful in emergencies. In emergency situations, medicines are required.

But in non-emergency situations, Health Based Medicine can provide more, better, “health”.

Evidence Based Medicine, Science Based Medicine, Hospital Based Medicine, Patient Based Medicine, Disease Based Medicine all ignore health. They are very successful tools in critical situations, where patients are very ill, and in need of medicine. But they fail when the patient needs health.

We need Health Based Medicine.  We need a health based theory of healthicine, more than we need an evidence based theory of medicine.  

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This post was written for, and initially published on the site: HealthBasedMedicine.com 

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About Tracy Kolenchuk

Founder of Healthicine.org. Author of two books about healthicine; Healthicine: The Arts and Sciences of Health and Healthiness Healthicine: Introduction to Healthicine
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  • I agree we need to improve health. The obstacle is we do not know how to use the tools that have been provided. SBM and EBM claim to be able to measure your “health”. They cannot. They first determine a consensus of what is “healthy” and then compare you to that goal. For this to work their “goal” would have to be the proper one for you. It would have to have taken into account your biochemical individuality. The medical industry only wants to define disease. They have defined” the range of values that 95% of non-diseased people would fall within as the “goal.

    For you to disrupt a latent disease process you need accurate information. Choose Health Now can use clinical test data with a proprietary analysis algorithm (trend analysis) to measure your movement on your health continuum. Why is movement a critical factor? Think of the PSA Test. For years this was the screening test for prostate cancer and the test used a comparison to a normal value. Now we know that percent change in PSA provides better clinical information, than the comparison to a set “reference range”.

    Personal Health Trend Analysis has superior sensitivity, because the testing is specific to you and only you, which eliminates the comparison to “normal values”. Changes between your first and your second sample are identified through an algorithm analysis of thousands of data points on multiple clinical electrophoresis tests. This approach to individual health is the opposite of current genomic testing. They use genetic information to divide the population into groups (preferably of one million or more in size). Since each group has a similar genetic makeup, they are expected to respond to drugs or therapy in the same way. Also Trend Analysis identifies changes found in your proteins now; not some future possibility.

    The use of laboratory tests can inform you of what is happening on your health continuum, if you have movement that is “toward wellness, no movement, or away from wellness”. You now have the opportunity to use an intervention of your choice to keep a negative biochemical change from progressing to disease.

  • Very interesting comments George. Much of what you are saying falls into alignment with my theories of Healthicine, as published in Introduction to Healthicine, Theories of Health, Healthiness, Illness and Aging. http://www.amazon.co.uk/Introduction-Healthicine-Theories-Healthiness-Illness-ebook/dp/B00KOGV3ME

    I suggest going further. We not only need individual measures of health, we each need individual goals, based on an analysis of each individual’s measurement results. I also refer to i-illness, to represent individual diseases. Most medicines are tested against a group of people, and of course the ‘statistical’ results are often nonsense when applied to individuals.

    I also suggest going beyond the concept of ‘wellness’, which is simply the absence of disease. We need to study the healthiness of people who are not sick and who might not be sick for a very long time, if we are to truly understand healthiness. Healthiness is much more than wellness.

    It appears that a Personal Health Trend Analysis has huge potential for managing illness – I want more. I want us to learn to manage healthiness.
    to your health, tracy