Keywords: Patient participation, evidence-based medicine, anecdotal evidence, home remedies, placebo.
Citation: Graedon J, Graedon T. Considering the evidence: experience vs. experiment. J Participat Med. 2016 Feb 13; 8:e1.
Published: February 13, 2016.
Competing Interests: The authors have declared that no competing interests exist.
We love data. Solid scientific evidence is critical to good decision making by both health professionals and patients. There is something wonderful about a well-designed study with results that are convincing and communicated clearly. That is the only way patients can determine whether recommended therapies are appropriate for them.
That said, for thousands of years healers all over the world relied on their experience to discover what helped people get better. Frequently, empirical observations led people to use the same plants for similar purposes in widely dispersed areas of the globe. Amazonian tribes that never communicated and didn’t even have a common language have been found to employ identical herbs for common ailments.
Modern medicine often disparages anecdotes as not worthy of serious consideration. Randomized double-blind, placebo-controlled experiments are considered the gold standard for decision making. Anything less gets short shrift.
And yet some of the greatest medical discoveries evolved from shrewd observation or serendipity. Penicillin was the result of a laboratory accident that was properly followed up instead of discarded.
The most successful class of antihypertensive medications was developed after people noted that a bite from the Brazilian jararaca viper made blood pressure drop precipitously. Studying the mechanism of this hypotensive effect led to the development of captopril and other ACE (angiotensin converting enzyme) inhibitors like lisinopril and ramipril. They are among the most prescribed blood pressure medicines in the world.
Informal observation over the centuries, based on personal experience rather than experiments, has led “old wives” of many countries to embrace garlic as a way to battle colds, flu and other nondescript respiratory infections. Medical experts have long dismissed this remedy due to a lack of scientific evidence. A recent randomized controlled trial of aged garlic extract, however, found that it activated two types of immune system cells and led to fewer missed days of school or work because of colds. To have a randomized placebo-controlled trial such as this confirm the hunches of myriad grandmothers suggests that we can all benefit from both types of evidence: experience and experiment.
This is not the first time that science has confirmed a home remedy. For years people have been reporting the benefits of tart cherries for joint pain from gout or arthritis. This too was believed to be an old wives’ tale. But when scientists actually studied cherries, they found that this fruit inhibits COX 1 and COX 2 enzymes as FDA-approved arthritis drugs do; it also has high antioxidant activity and anti-cancer effects in animal studies. These are just a few examples in which experiments have vindicated observations based on experience. That is why we think there should be more respect for the N of 1 experiment. Just because a personal observation is “anecdotal” does not make it invalid, merely untested.
There is, in fact, a dawning recognition that what works for one person may not be appropriate for someone else. Evidence-based medicine puts a premium on data from thousands of patients in randomized clinical trials. Personalized medicine tailors a treatment to one unique individual. This new concept is being explored in oncology, but is likely to apply to many other areas as well. The challenge for medicine is to reconcile evidence-based medicine with personalized medicine.
E-patients often work hard to find out what therapies make a real difference for their own health. Online communities help them share this hard-won knowledge with others. Even if it can’t be generalized to all other patients with the same diagnosis, one person’s findings may help someone else.
To bring evidence-based medicine to bear for an individual patient’s benefit health care providers will need to listen to and honor each patient’s unique experience.
- Percival SS. Aged garlic extract modifies human immunity. J Nutr. 2016 Feb;146(2):433S-6S. Available at: http://www.ncbi.nlm.nih.gov/pubmed/26764332. Accessed February 13, 2016. ↩
- McCune LM, Kubota C, Stendell-Hollis NR, Thomson CA. “Cherries and health: a review. Crit Rev Food Sci Nutr. 2011 Jan;51(1):1-12. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21229414. Accessed February 13, 2016. ↩
Copyright: © 2016 Joe Graedon and Terry Graedon. Published here under license by The Journal of Participatory Medicine. Copyright for this article is retained by the authors, with first publication rights granted to the Journal of Participatory Medicine. All journal content, except where otherwise noted, is licensed under a Creative Commons Attribution 3.0 License. By virtue of their appearance in this open-access journal, articles are free to use, with proper attribution, in educational and other non-commercial settings.