For the actual research, it is necessary to understand the restriction of research otherwise it is a double-edged sword that has negative effect on health.
Although my articles base on scientific evidence, it does not mean that you can see the whole fact of health. This is because there are at least three restrictions of science which are:
1. Science only provide one-side of fact
Though scientific procedure used in research is non-bias and the RCT research can manage the mistake from the confounding factor and bias of the researcher to see the fact within the research area, the use of scientific evidence is restricted with the fact that most health researches require research fund from drug and food industry. It means that the fact from the research is only the one-side fact which drug and food industry would like to prove in order to sell the products. Another side of fact is the fact that if it has been proved, the manufacturer cannot distribute the products, which we rarely see this case. This is because if there is no research fund, it is impossible to produce the research result. Sometimes, there is the research but the result cannot be support the product sale and the drug company does not give permission to publish the research.
For example, the research on the antidepressants, Prozac which the company conducted many researches and half of the results found that it was more effective than placebo. The drug company published only the research that showed the effectiveness of Prozac which was better than placebo. For the research with the negative results, the company prohibited the publishing. They sold their product in high volume. This matter was revealed when the research team from Harvard published the research result to review the use of antidepressants Prozac and concluded that this medicine actually had the same result with placebo. The patients were getting better because of the placebo effect. That was to say when Harvard research team exercised the right to disclose the government document and requested the FDA to disclose the results of this medicine, the truth had been revealed. The results indicating the ineffectiveness of the drug was hidden without publishing in medical magazine, only the results of effectiveness. When combining all results and analyzed with meta-analysis, it confirmed that the antidepressants had similar effect to the placebo taken by most patients (90%)[20, 21].
2. Science gives one-side knowledge
Scientific evidence usually created from the study on the relationship of two things such as between some molecule in drug or food and illness development or recuperation. Thus, research process requires the exclusion of confounding factor to the unknown scientific knowledge by narrowing down the research environment. This technique called reductionism; it is as we have a beautiful photo of scenery and crop only the sky and enlarge the photo. Finally, we cannot recognize the photo, only the pixels that some are blue, yellow and orange dots. If the scientist conducts the research by narrowing down the research are only to cover the orange dots, he would say the sky is orange. Another one who researches on orange dots, he would say the sky is orange while the other might say the sky is yellow if his research area is in the yellow dots area. Thus, we are annoyed that why the researchers report different result. This is because scientific method lose the ability to overview the overall picture. As the information user, we know how to step back and look at the overall photo so that we can see the blue sky of the whole picture. It is the same with human body that has the relationship between cells and molecules such as food, drug, germs and environment in the ecosystem, which has the complex relationship. One causes another matter. Thus, it is necessary to see the overall picture to know what it is. To know only the level of evidence and quality analysis is not sufficient. The step back to see the overall research is required. The relationship between the two in the actual environment may provide different research result.
3. The prejudice of physician
Todays, it is the evidence-based medicine so the physician obliges to cite the scientific evidence in decision making to give treatment and recommendation to the patient. However, the physician choses the evidence to use via the two filters:
Factor 1. What can or cannot be reimbursed. This is because most patients do not pay for themselves but the third party such as insurance company, 30 Baht Fund and Social Security Fund. Some treatments such as to train patient with diabetes to strengthen muscle cannot be reimbursed but to prescribe diabetes drug does. The physician will do only the list that can be reimbursed. Though the scientific evidence clearly indicates that doing exercise gives better result than using drug, I would call it the reimbursement-based medicine rather than evidence-based medicine.
Factor 2. Personal benefits of physician which may intervene the decision of physician in several ways such as money (such as this kind of treatment can be paid higher than another treatment) or the latent pay (such as using this drug or equipment to receive the fund for oversea seminar) or reward (such as to convince numbers of patients to be able to publish the research for academic position) or punishment (such as teaching the patient to take care themselves rather than prescribing drug for them, the physician wastes his time and miss his lunch).
It is clear that although scientific evident is the fact, the utilization bases on the understanding in environment is required otherwise it is a double-edged sword to your health.
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