As a naturopath, patients often ask me questions like “Do you think I should I take this new treatment I heard about?”
Here are some of the things I consider when I try to answer such questions for an individual patients:
When a patient comes to me and asks me about an experimental, conventional or alternative medicine treatment that they are interested in I do my best to research the answers to the following questions.Then I ask the patient what their gut tells them about the treatment. This is very important information and should never be ignored when deciding on a new treatment.
- How many other treatments exist for that condition?
a. How effective are those treatments?
b. What is the potential for harm with those other treatments?
- How impairing is that condition? Is it life threatening, extremely painful, debilitating, or only embarrassing or inconvenient?
- Are there potential for harms?
a. Has anyone been harmed?
b. What is the likelihood for harm?
c. Is the treatment expensive or difficult?
- What it that treatment’s mechanism of action?
- Is this mechanism plausible? How likely is it that it could occur?
- What is known about the treatment from its use in traditional cultures or indigenous cultural practices of consuming or taking the food or remedy?
a. Has the food or treatment been used for thousands of years without noticeably negative consequences?
b. Is it a new substance or process that has no historical track record of use?
- Is there any scientific evidence of benefit or harm?
- Is the only evidence anecdotal?
- Have any studies been done?
- What type(s) of studies have been performed using this treatment or modality? What is the level of evidence?
a. Case reports (anecdotal)
b. Cohort, population (correlational) studies- how generalizable are the results used in cohort to that patient? And all the below items.
c. RCTs or randomized controlled trials
i. How many patients or persons used in the study? This speaks to statistical power (ability of the study to find a reliable result)
ii. Was there any blinding or a placebo used?
iii. End-points and surrogate markers used-Were the study’s end-points reliable predictors of the practical outcomes in question?
iv. How well did the study control confounders?
v. What do the numbers look like?
What do the confidence intervals look like? What is the magnitude of effect?
What are the numbers needed to treat?
Are the results clinically meaningful?
Is there a dose-response or any trends with increasing exposure to the intervention or treatment?
Do the confidence intervals include the results?
Are the confidence intervals wide or narrow?
What is the level of statistical significance?
Where any statistical tricks used to make the results look clinically relevant when they are not that impressive?
Do the researcher’s conclusions match the numbers seen in the results?
vi. Potential conflicts of interest- who funded the study? Do they have any interest in the outcome in the sense that they could stand to benefit financially from a favorable outcome.
- Is the study a review, a systematic review, a meta-analysis or a combined study?
a. What types of studies were used in the review or meta-analysis
i. Correlational studies
b. What is the combined or “N” number of study participants (total number of persons from all the studies included in the review or meta-analysis)
If the answers to these quests can be found, it is then possible to translate these answers into language that anyone can understand which can give the patient a basis for evaluating the relative desirability of a treatment he or she is considering.
This list can be printed and taken to your own physician or healthcare provider. You could then ask your healthcare provider to give you their answers to these questions. If they are not using these criteria upon which to evaluate new treatments, you could ask them upon what basis is it that they are providing you with treatment recommendations. Their answers may be very revealing to you.