Covid-19 Response and the Tyranny of Evidence-Based Medicine
Why are the vast majority of practicing physicians doing absolutely nothing to help patients with early Covid-19?
Here is an excerpt from a recent conversation with a junior colleague (JC) on early outpatient treatment of Covid with ivermectin (IVM):
JC: Countries like mine depend heavily on guidelines from the WHO (World Health Organization)…, and right now there’s nothing that supports the use of those drugs in Covid-19.
Me: That’s the problem. The guidelines are consistently wrong. Did you know the WHO receives more than 50 percent of its funding from industry? They are corrupt, as are the Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA).
JC: So, you’re saying these agencies that are promoting best practice guidelines in medicine are all corrupt? So then whom do we trust? We might as well just do what we want when treating patients.
Me: No. We use science, logic, deductive reasoning, judgment, and clinical experience.
Most doctors have become so dependent on guidelines that they have lost the ability to problem-solve, to think critically, and to practice real clinical medicine. Medicine has gone off the rails, and patients are suffering the consequences.
When the first wave of what was then known as the Wuhan virus hit in March-April 2020, medical attention was almost completely focused on management of the acutely ill patient. This was notable for its very high failure rate, particularly post-intubation.
A handful of intrepid doctors, including Zev Zelenko in upstate NY and Didier Raoult in Marseille, France, addressed early outpatient treatment using repurposed existing drugs such as hydroxychloroquine (HCQ). These physicians achieved remarkable clinical results, but instead of being embraced and emulated, they were censored and harassed. As should now be obvious to even the most naïve, Pharma and other stakeholders had to suppress successful, cheap remedies to pave the way for the rollout of the “vaccines” that were already developed.
How was this accomplished? By using the tyranny of Evidence-Based Medicine (EBM). “These treatments are not evidence-based!” they screamed. “Where are the randomized controlled trials (RCTs)?” they demanded. Kind of hard to have RCT data on a brand new disease, but so what. The authorities had spoken.
In their excellent book, Tarnished Gold: The Sickness of Evidence-Based Medicine, Steve Hickey and Hillary Roberts write:
“EBM encourages totalitarian medicine. It is displacing the doctor-patient unit as the ultimate decision-making authority. Peer review is used as censorship. EBM is a self-referential closed system, where critical appraisal means checking whether a study conforms to its rules. So-called evidence-based medicine wrongly claims the authority of medical and scientific gold-standards. EBM repackages and uses concepts from legal proof, in an attempt to impose a medical dictatorship.”
EBM is a movement that began in the early 1990s with the noble intention of incorporating high quality research into clinical practice. Over the last 20 years, EBM has steadily replaced traditional medicine, which depended on understanding pathophysiology and pathology (i.e. basic science), along with careful patient management including following response to treatments.
EBM was quickly hijacked by industry to promote the use of their products through clinical practice guidelines, which are based on little more than a consensus of “experts,” the majority of whom receive financial support from industry. Ironically, many guideline recommendations are based on low quality, or no evidence.
EBM arrogantly claims for itself the mantle of “science,” but is actually pseudoscientific. It relies heavily on studies of large populations and therefore statistics, which are inherently unreliable and easy to manipulate. The conceit of EBM is that the results of large population studies can and should be used to dictate treatment of individual patients. It exalts metanalyses, statistical compilations of many studies, that can be created to support almost any pre-conceived idea. The vast majority of physicians are unable to understand, let alone deconstruct, the statistics used in most studies. “Evidence” is not science. Evidence can always be found to support any hypothesis, no matter how absurd. Remember that according to the “evidence,” Paul McCartney has been dead since 1966!
Whoever controls the “evidence” controls “the science” and through the bogus and corrupt guideline process, controls clinical practice.
EBM creates an arbitrary hierarchy of evidence, with RCTs and metanalyses at the top and clinical experience, insultingly called ‘anecdotes,’ at the bottom. This is absurd on its face. The logical conclusion is that clinical experience is not needed to practice medicine! Just buy a guideline cookbook and go out there and heal! Perhaps that’s where things are headed. Or perhaps we are already there.
If hundreds of thousands of patients die unnecessarily, their doctors will not be held responsible. “I was just following the guidelines” has replaced “I was just following orders.”
About the author: Dr. Amerling is a native New Yorker. He graduated Stuyvesant High School and received a BS from the City College of New York.
He then took leave and earned his medical degree at the Catholic University of Louvain in Brussels, Belgium.
Dr. Amerling completed his Internship and Residency in Internal Medicine, and began a Nephrology Fellowship at New York Hospital, Queens in Flushing, N.Y. He completed Nephrology Fellowship at the Hospital of the University of Pennsylvania in Philadelphia.
From1990-2016, Dr. Amerling was on staff at the Beth Israel Medical Center (now Mount Sinai Beth Israel). There he developed the peritoneal dialysis program, and a program for continuous renal replacement therapy in the ICU setting. He served as Director of Outpatient Dialysis from 1995-2012.
Dr. Amerling is board certified by the American Board of Internal Medicine for Internal Medicine and Nephrology. He is Past-President of the Association of American Physicians and Surgeons. He is on the editorial board of Blood Purification.
Dr. Amerling is an invited presenter at numerous medical conferences, both nationally and internationally. As author or co-author, Dr. Amerling’s work has been published as chapters in textbooks and also in peer-reviewed medical journals, including the Journal of the American Society of Nephrology. He has published many op-Eds on health care economics and politics.
In October 2016, Dr. Amerling accepted a position as Professor at St. George’s University School of Medicine and taught there until July 2021.
He is currently Associate Medical Director of America’s Frontline Doctors.