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Chapters:

00:00 Understanding Evidence-Based Medicine

11:41 Biases in Research and Their Impact

19:41 Evaluating Research Quality

28:19 Reproducibility and Its Challenges

28:47 Evidence-Based Marketing: Relative vs Absolute Risk

32:16 New Chapter

42:02 Towards a Patient-Centred Model

44:54 The Nuances of Bias in Medicine

45:30 Relative Vs Absolute Risk and the ‘Number-Needed-to-Treat’

46:38 Taking Control of Your Health

Takeaways:

Evidence-based medicine is often misinterpreted and oversimplified.

Understanding the difference between relative and absolute risk is crucial for making informed decisions.

Biases in research can significantly affect outcomes and interpretations.

Industry funding plays a significant role in shaping medical research.

Not all published studies are of high quality or rigor.

Patients should take an active role in their health decisions.

The importance of critical thinking in evaluating medical literature.

Many biases can influence research results.

A double-blind randomised controlled trial is considered the gold standard.

Patient-centred care is essential for better health outcomes.

Navigating Evidence-Based Medicine: Myths and Realities

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Dr Ron Ehrlich (00:02 .222)

Hello and welcome to Unstressed Health. My name is Dr Ron Ehrlich. Well, today’s subject is evidence-based medicine. And that term is one that you will often hear prefacing any health advice that you get. Yes, this advice is evidence-based. And your doctor will say to you, yes, this treatment is evidence-based. And the public health officials will say, this evidence is, this treatment, a policy is evidence-based.

And to the uninitiated, that would seem very reassuring, but to anybody that’s taken a slightly deeper dive into that term, you will know that it is not quite as straightforward as it sounds. Another aspect to it is when doctors, when you ask your medical practitioner for X, Y or Z, and they say, there’s no evidence to support that, which implies that they have read all the evidence that there is.

And anybody who has taken a deeper dive into that will know that that is just simply not possible. It would be better for that practitioner to simply be honest and say, I’m not aware of any evidence to support that. And that would be an honest answer. But evidence-based medicine is an issue. And one of the most cited medical health practitioners in the world, Professor John Ioannidis from Stanford University, has alerted us to the fact that there is difficulty in distinguishing between evidence-based medicine and evidence-based marketing.

And that is very much the topic of today. What is evidence-based medicine? What are some of the challenges, some of the biases, some of the pitfalls, and what can we do about it? How can we approach it? But in order to solve a problem, it always helps to know whether there is a problem, what that problem is.

And this is a story, particularly for a busy health practitioner that is very easy to miss, but once you hear it, very difficult to ignore.

My guest today is Dr. Lewis Ehrlich. Now, Lewis is the principal of the Sydney Holistic Dental Centre, a practice that I founded over 40 years ago with my brother, Dr. Joshua Ehrlich. He is co-principal there with Dr. Yin Yin Teoh and Dr. Craig Wilson.

And it is a patient-centered practice and it has dealt with the issues of evidence-based for our entire professional life. And we’ve kept a very open mind about it.

Now, this is actually a two-part podcast because in this first part, I talked to Lewis about evidence-based medicine. The reason I do is not only because he is a dentist in a holistic practice.

But some four or five years ago or three or four years ago when the pandemic arose and there was a whole deal of great deal of controversy about what evidence was, Lewis decided to do a degree at Oxford University, the home of evidence-based medicine. This is where the fathers, if you like, of the Cochrane collaboration, which was put together to give some weight, to give some meat behind what evidence-based really was about.

The heads of the Department of Evidence-based Medicine at Oxford were his teachers and I was so impressed with him undertaking such a study that I wanted to get him on to share his insights and all that he has learnt along the way.

I hope you enjoy this conversation I had with Dr. Lewis Ehrlich

Dr Ron Ehrlich (03:03 .16)

Welcome back to the show, Lewis.

Dr Lewis Ehrlich (03:05 .233)

Thanks, Uncle Ron. Good to be back on.

Dr Ron Ehrlich (03:07 .502)

You can just call me Ron for this podcast. Listen, you know, we have we’re talking today about evidence based medicine and it’s a word that or an expression that many doctors use and it gives them peace of mind, I guess, and many patients listen to and feel reassured by. But I think we both know that it’s not everything that it’s cracked up to be.

We’re going to cover some of those challenges. wondered if we might just start with what exactly is evidence-based medicine? How was it originally conceived?

Dr Lewis Ehrlich (03:41 .766)

Yeah, evidence-based medicine is basically giving a framework for making clinical decisions. you know, making them based on evidence that’s there or not there, and that’s an important distinction. The purpose of evidence-based medicine is to actually make sure that you’re doing decisions in your practice that are actually based on evidence. And it’s important to realize that it’s flung about as a term, but a lot of people don’t actually know what that means.

And I can speak from personal experience because in dental school and in my bachelor of science degree, and I’ve studied for now 21 years, I still, even after all those years, I still didn’t really know how to analyze scientific literature. And I think a lot of people speaking to people at Oxford, they actually don’t know too much about it. Medical doctors that I was there with, was there with neurosurgeons, oncologists, psychologists, psychiatrists, you name it, everyone was in the classroom.

And we all asked the question to each other, how much work did you do in medicine or in dentistry or in any other field that they were involved in on analyzing rigorously the data that was presented? And it wasn’t very much at all, you know? So then the term evidence-based medicine or there’s no evidence to support that or there is evidence to support that is…

Dr Lewis Ehrlich (05:37 .704)

is flung about a lot with health practitioners. And I think there’s a bit of a issue throwing terms out like that because it’s one thing to say that, but it’s another thing to actually understand how to critique studies, which a lot of people aren’t armed with and I was one of those people. So that’s why I went and did it.

Dr Ron Ehrlich (06:03 .598)

Yes, well, we’re going to dive into a bit more of the detail and answer some of those challenges because it is a word that’s bandied around. It’s almost like a doctor. Once the doctor says, this is evidence based, they feel justified to continue. another common term is, well, there’s no evidence to support. And that would suggest that they have read all the evidence that there is there. And I think we both know that it takes around 600 hours a wee to keep up with all of the evidence. So that’s not a real statement in and of itself. But you chose and you’ve acknowledged the fact that you’ve been in practice, you’ve been studying now for over 20 years and you weren’t well placed to understand what it actually meant. Before we dive into it, tell us a bit about what you did and why you did it.

Dr Lewis Ehrlich (06:57 .148)

Yeah, so I recognize that a lot of scientific research studies that you would read, I actually didn’t have any skillset specifically to go and read it and go, is this good data? Is this accurate data? Are the findings relevant? Can you throw them out? Is the statistics solid? Is it just basically good research?

at the end of the day, it’s like, if somebody brings you a dental product, for example, and