Abstract
Evidence-based medicine (EBM) is generally considered as the most complete paradigm in the practice of clinical medicine. Its application should preclude all kinds of quackery. Therapeutic reformers of the second half of the twentieth century have convinced the medical community that the double-blind randomized controlled trial (RCT) versus placebo is the gold standard in clinical research to establish evidence of treatment usefulness. Nevertheless, this paradigm ignores the importance of non-specific effects in the healing process and can generate misrepresentations. Additionally, because of methodological limitations, RCTs as they are used in practice can give rise to new forms of quackery by promoting drugs that are not useful for the patients who actually receive them, or are so expensive that their value is open to criticism. This is precisely the case when surrogate outcomes, with questionable clinical significance, are used. These can divert attention from clinically relevant outcomes, such as safety issues that are probably the core of treatment evaluation. The boundaries between quackery and EBM that clinicians are faced with are not so clear-cut. There is a need for doctors to acknowledge their share in quackery and to be continually conscious of the possible pitfalls of their therapeutic practice.
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We thank Angela Swaine Verdier for revising the English of a first version of the draft.
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There are no conflicts of interest regarding this paper. All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that (1) No authors have support from any company for the submitted work; (2) N.F. has relationships (board membership or Travel/accommodations expenses covered/reimbursed) with Servier, BMS, Lundbeck and Janssen who might have an interest in the work submitted in the previous 3 years; B.R. has no relationships with any company that might have an interest in the submitted work in the previous 3 years; F.B. has relationships (board membership or consultancy or payment for manuscript preparation or Travel/accommodations expenses covered/reimbursed) with Sanofi-Aventis, Servier, Pierre-Fabre, MSD, Lilly, Janssen-Cilag, Otsuka, Lundbeck, Genzime, Roche, BMS who might have an interest in the work submitted in the previous 3 years; HD was expert witness for plaintiffs in 4 medico-legal cases against pharmaceutical companies for birth defects or suicide linked to antidepressants in the USA in the past 5 years; (3) none of the authors’ spouses, partners, or children have any financial relationships that may be relevant to the submitted work; and (4) none of the authors has any non-financial interests that may be relevant to the submitted work.
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Naudet, F., Falissard, B., Boussageon, R. et al. Has evidence-based medicine left quackery behind?. Intern Emerg Med 10, 631–634 (2015). https://doi.org/10.1007/s11739-015-1227-3
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DOI: https://doi.org/10.1007/s11739-015-1227-3