Evidence-Based Medicine Can Fail People With Brain Injury

Source: David Mark/Pixabay

Evidence-based medicine: A ubiquitous phrase. A phrase used as if it conferred authority. A phrase treated like a religion. Before the pandemic, you couldn’t turn around without seeing it in newspaper articles, blog posts, and magazines. On social media, doctors with loud voices lobbed it at advocates for types of medicine they disagreed with. They used it to maintain their power status and to assert the superiority of their way of doing medicine. The phrase "evidence-based medicine" reflected the homogeneity of their groupthink, which claimed familiar evidence that'd been proven long ago as the best, most current science, whether or not recent research had disproved it or replaced it with something better.

"Evidence-based" inherently denied the essential element of art in medicine. And it denied that science evolves continually.

But proponents didn't admit to either reality. They promulgated meta-analyses as authoritative research, not what it really is: gathering background studies preparatory to designing original research studies. Meta-analyses don't replicate recent groundbreaking original studies, either. Replication is what confirms the evidence original research provides; it can also evolve it. But the proponents of the phrase "evidence-based medicine" focused on espousing the idea that science was certain, not on what medicine and research are supposed to do.

The focus on evidence-based roots itself in the past, in what was proven long ago, and has now become certain knowledge that's familiar. It resists change or a different way of thinking. This stance denies the present-day desires of the ill and injured to be cured and to live in the future healed. Only forward-thinking researchers and cure-focused clinicians listen to those desires and continually seek ways to meet them. Their work quickly leaves "evidence-based medicine" studies in the dust.

Unfortunately, such professionals are few and hard to find. Then the pandemic hit. And suddenly evidence-based — a form of medicine inherently based in the past — had nothing to say about a completely new virus. Suddenly, doctors who’d groomed the public for years to believe that science was certain now had to reveal the truth: Science is not certain. Science evolves. Long-held assumptions in medicine get proven wrong. And medicine is an art that informs science, practiced by open, imaginative minds. These same doctors who set the public up for certainty in science now don't seem to understand why the public is looking for certainty in our battle with the novel coronavirus. And in brain injury care, they haven't learnt this lesson from the pandemic; they continue to stay in the medicine they know from the past.

I wrote about how evidence-based medicine robs people with brain injury of healing in my book Concussion Is Brain Injury: Treating the Neurons and Me. This situation has now become critical in the face of Long Covid and preventing permanent disability from it.

How Evidence-Based Medicine Fails

Scientifically objective evidence is considered superior to the art of medicine. Yet evidence-based medicine prescribes coping to treat brain injury — coping with deficits, worsening social situations, deteriorating brain function, and death while physically alive. In no other area of medicine would this be considered treatment.

Treatment isn’t feeling better about the deficits; it’s actually feeling better.

Treatment restores lost cognition and automaticity, restores emotional centres to normal functioning, regenerates damaged physiology, and heals the autonomic nervous system, internal organs, muscles, hormones, and skin.

Pacing, compensating strategies, acceptance, meditation do not lead to recovery but put people into a repetitive pattern of being unable to sustain work and relationships, with worsening health.

Evidence-based medicine doesn’t respect the brain’s regenerating and electrical properties as central to repair. The brain being the final frontier, by necessity, requires treatments that are mostly in the research phase, requires physicians to work within a healthcare team, requires respecting the internal experience of the person with brain injury as believable and pointing the way to treatment, and requires understanding the deficit is physiological, not psychiatric and then using logic and reason to think through how to use the brain’s sensory inputs and plasticity to change itself. By ignoring serious cardiac ramifications, evidence-based medicine is essentially medical malpractice that consigns a person to early death and low quality of life, especially if given fatiguing medications to inadequately prop up their heart.

Copyright ©️Shireen Anne Jeejeebhoy 2017-2021