Evidence vs. Experience
“Is there evidence for it?” is the typical question, especially when complementary treatment is brought into play.
There might not be, but what if there are centuries of experience that it works?
Do we doubt, for example, that a heating pad helps when we have a stomach ache? No, of course not. But should we doubt it? It has never been scientifically investigated – and thus, evidence is lacking.
Now nothing works without evidence
Today, there is a strong tendency to call for scientific evidence for everything. This is likely a healthy approach that has led to great progress in many areas. But at the same time, there is a risk that we overlook the value of experience and intuition. Both have their merit and can complement each other in a fruitful way.
Not least because some of what there is scientific evidence for at the moment will likely be outdated in a few years.
Personally, I imagine that in a number of years, people will look back with wonder at the time when cancer patients were given chemotherapy in an amount attempted to be adjusted so that all cancer cells died, but the patient hopefully survived—although that is unfortunately not always the case.
Or as chemistry professor Touborg-Jensen at the Royal Veterinary and Agricultural University said to the students: “I am teaching you the prevailing prejudices of the time.”
This must be said to be a great recognition that the truth of today is not necessarily true tomorrow.
A valuable tool
Scientific studies provide the opportunity to test hypotheses and draw conclusions based on objective data. Through controlled experiments and statistical analysis, we can achieve a high degree of certainty that results are valid. This makes scientific evidence an indispensable tool in many areas, including medicine, natural science, and social research.
What history says
Experience provides – undervalued knowledge
Despite the strengths of science, it is important to remember that it does not have all the answers. Experience, intuition, and practical knowledge are also important sources of insight. For millennia, humans have used their experience to solve problems and make decisions. This knowledge can be difficult to quantify and measure, but it is often based on a deep understanding of complex connections that are not always captured by scientific models.
Medicine through generations
Before modern pharmacology existed, healers treated diseases based on traditional knowledge and experience with herbs and other natural remedies. Many of these treatments have later proven to be effective, even though the underlying mechanism was not understood. This to such an extent that many of the medicines we use today are either directly derived from natural substances or are synthetic copies of them.
Medicines of natural origin
Here are examples of conventional medicines derived from nature.
This commonly used painkiller and antipyretic drug originates from the bark of the willow tree. Indigenous peoples in America have used willow bark to relieve pain for centuries.
Morphine and codeine
Both originate from the opium poppy and have been used as painkillers since ancient times.
Taxol
This cancer drug was originally isolated from the bark of the Pacific yew tree. Indigenous peoples in North America used the bark of this tree to treat various ailments.
This anti-malarial medicine originates from a Chinese wormwood plant and has been used in traditional Chinese medicine for over 2000 years.
Reserpine
This blood pressure-lowering agent was originally isolated from the roots of an Indian plant.
Digoxin
Originally originates from the digitalis plant, also known as foxglove. It is the heart glycoside content of the leaves that makes the plant effective against heart rhythm disturbances and heart failure. Today, digoxin is produced synthetically in laboratories.
Quinine
Extracted from the bark of the cinchona tree, quinine has been used for centuries to treat malaria.
Holistic approach
Traditional medicine often has a holistic approach to disease that can complement modern medicine and give patients an increased sense of having influence over a course of treatment. This also increases quality of life.
Experience is important
Complexity
Many real-world situations are too complex to be fully captured by scientific models. Experience allows us to navigate these complex contexts.
Unforeseen events
Life is full of unexpected occurrences that cannot be predicted or modeled. Experience helps us adapt and respond to these unforeseen situations.
Upbringing
Parents and educators make thousands of small decisions daily about how to act in different situations. Although research-based methods for upbringing exist, it is often the parents’ experience and intuition that guide their choices.
Intuitive surgery
Surgeons have often developed an intuitive understanding of how to best remove tumors, based on their experience and observations from countless surgeries. This intuitive knowledge can be difficult to quantify and measure, but it plays a crucial role in the decision-making process during surgery.
The importance of experience in cancer treatment
Complexity
Cancer is a complex disease that affects each patient differently. Experience helps in understanding individual variations and tailoring the treatment accordingly.
Human factors
Cancer treatment is not only about biological processes but also about psychological, social, and spiritual aspects. Experience helps take these factors into account and create a more holistic approach to the patient. The better a patient feels, the better their immune system functions.
The patient’s experience
Cancer patients often have a deep understanding of their own body and disease. Their experiences can be invaluable for doctors and other healthcare professionals when developing individualized treatment plans.
The experience of doctors
The doctor’s experience also plays an important role in cancer treatment. Doctors who have worked with cancer patients for many years often have deep insight into the disease and its complexity. They can recognize patterns and connections that do not necessarily appear in scientific studies.
In addition, they can—ideally—take into account individual patient factors, such as lifestyle, psychosocial situation, and general state of health, when making treatment decisions.
Treatment guidelines
However, this is where treatment guidelines in some cases conflict with common sense and experience. These are created by the Danish Medicines Council (Medicinrådet) and must, as a rule, be followed. In practice, it has largely proved impossible for doctors to get permission to deviate, even when they find it most beneficial for the patient—at least if it costs society money.
Coherence
In most cases, scientific evidence, common sense, and experience support each other. An experienced doctor can, for example, use evidence-based guidelines as a starting point, but adjust the treatment based on the patient’s individual needs and clinical assessment.
Complementary medicine
Complementary medicine encompasses a wide range of treatment forms that are not part of conventional medicine, such as acupuncture, homeopathy, and herbal medicine. These are most often based on experience, tradition, and belief.
Why is there a debate?
Patients’ freedom of choice
Many patients wish to have more treatment options and feel that complementary medicine can offer a more holistic approach.
Limitations in conventional medicine
Some chronic diseases can be difficult to treat with conventional medicine, which can lead to the search for alternative solutions.
Evidence-based treatment vs. experience
The discussion about the relationship between scientific evidence and experience, especially within cancer treatment, has been the subject of debate for many years.
The requirement for scientific evidence is undoubtedly a cornerstone of modern medicine. Clinical studies, randomized controlled trials, and meta-analyses provide us with the most reliable knowledge about which treatments work best for which patients. This form of evidence is crucial for developing new and more effective treatment methods and for ensuring that patients receive the best possible treatment. However, this evidence does not have the capacity to take into account how the patient will react psychologically and, to a certain extent, also physically to the treatment. Here, the individual patient’s degree of need for holism in their life is quite decisive.
Complementary aspects
Clinical studies with a slant
It is important to emphasize that scientific evidence is not an unambiguous concept. A clinical study can, for example, be designed in a way that favors a particular result. There can be bias in data collection or analysis, and the results can be difficult to generalize and apply to all patients.
Additionally, it can take a long time to complete large clinical studies, and new forms of treatment can therefore be on the market for years before solid scientific documentation is available.
Individualization of treatment
Although guidelines based on the best available evidence exist, it is important to remember that each patient is unique. Therefore, doctors should listen closely to the patient and adapt the treatment to their needs and wishes.
An open and honest dialogue between doctor and patient is crucial for making informed decisions about treatment. The patient should have the opportunity to receive information about both evidence-based treatment options and the experiences the doctor has with various treatments.
Research into complementary treatment forms
There is an increasing need for research into complementary and alternative treatment forms that can supplement conventional treatment. These forms of treatment can have a positive impact on the quality of life for cancer patients. This also applies to those that do not necessarily prolong life.
It may be relevant to look towards cultures where there is a long tradition of viewing people, diseases, and treatments from a holistic perspective. They certainly do not have poor results—neither in their prevention nor their treatments of cancer.
Conclusion
The need for both scientific evidence and common sense based on experience is crucial within medical science. It is not a question of either-or, but rather of finding the right balance between the two. By adopting an integrative approach that unites the best aspects of both worlds, one can ensure that patients receive the best possible treatment.
Links
Point of view: Reality is diverse (Sygeplejersken) (Danish Language)
Experience vs. Evidence (Wolturnus) (Danish Language)
How to assess evidence for a drug’s effect (Danish Medicines Agency) (Danish Language)(Lægemiddelstyrelsen)
What is scientific evidence? (Videnskab.dk) (Danish Language)
Evidence in practice (Sygeplejersken) (Danish Language)
Five myths about evidence (Aarhus University) (Danish Language)
Book: Is there evidence for evidence? (By Ditte Dalum Christoffersen, Kit Stender Petersen) (Danish Language)
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