BiologyMedicine

Cautions of Biomedical Evidence

Biomedical evidence is the foundation for Western medicine and research. It helps with the creation of pharmacologic therapy. It can prove the success of treatment and elucidate the relationship between variables. It can validate scientific claims and inform future directions for research. It helps with deciding funding for different health policies and programs. It also allows for regulation and standardization of clinical practice. However, biomedical evidence is not the only way to validate medicinal practices and research studies. It is important to understand that traditional healing techniques, which do not use biomedical evidence, can be just as valid as Western healing techniques. This notion allows people to interact with traditional healing practices without a Western bias (i.e., the inclination to consider Western practices as “right” and other practices as “wrong”). Practicing medicine without this Western bias is crucial for clinical providers to respect patients’ cultural backgrounds and develop cultural competence, which means the ability to provide care for people of different languages and cultures.2 By understanding the drawbacks to biomedical evidence, people may view traditional medicine more openly and Western medicine a bit critically.

Powerful groups with educated people and resources use biomedical evidence to make informed decisions about political and health policies for foreign communities, but this far-casting (i.e., decision-making by powerful groups who are not native to a community)2 can hurt communities. Data provides objective evidence regarding patient signs, which makes situations seem familiar and controllable, but they cannot reflect the feelings and specific situations of the individual patients.2 Because of this, powerful groups sometimes implement policies without important knowledge on what that the community is experiencing. The term “statisco-tuberculosis” was coined by Susan Erikson, who is a medical anthropologist,3 to describe statistics that can negatively impact access to treatment by allowing nonnative groups to arbitrarily decide disease fulfillment criteria using numerical data that does not regard patient suffering.2 She asserts that numbers can objectively convey information about different samples but statistics are man-made and subjectively interpreted.2 Because health statistics focus on signs rather than symptoms, implemented policies may not be completely suitable in communities where medicine has a stronger focus on symptoms rather than signs. The data allow human suffering immeasurable by questionnaires to be ignored when it really should be considered when businesses are making decisions that affect entire communities. Furthermore, data from cross-cultural studies may also be misleading.

Randomized controlled trials (RCTs) that test drugs on a sample significantly different from the target population encumbers its generalizability. The sample may react differently to the drugs than the population who will purchase and use them due to the different social determinants of health (e.g., individual behavior, social environment, physical environment, health services), which may indirectly affect responses to the drugs. For example, a sample may be comprised of Tibetan individuals in poverty who cannot get enough exercise, eat food with enough nutrients, are heavily influenced by religious and family figures and do not have access to health services. The population may be Americans in the middle class who get some exercise, eat food with lots of nutrients, are autonomous, and have access to health services. In this case, the health and responses to the drugs of the sample may not be representative of the population. Because generalizable conclusions to the population are weak, biomedical evidence from cross-cultural RCTs are questionable. Weak biomedical evidence can also hinder access to treatment.

Lack of biomedical evidence negatively impacting treatment for diseases highlights the importance of biomedical evidence in Western medicine. For example, gene therapy was researched heavily as treatment for Cystic Fibrosis (CF) because hope and enthusiasm replaced concrete data suggesting success,4 which is typically necessary for receiving research funding. The fact that there wasn’t biomedical evidence supporting the advancement of gene therapy for CF was overshadowed by community eagerness and faith in gene therapy. This emphasizes the importance of having substantial biomedical evidence in initiating and developing treatment for diseases to avoid wasting time and resources researching treatment that will not be effective. Hope that gene therapy would be successful misinformed the direction that treatment for CF should take.

Overall, biomedical evidence is an excellent tool that supports Western research and medicine. It informs decisions for health policies. It proves the efficacy of drugs. It guides treatment development. However, it is important to understand that biomedical evidence can be flawed and potentially hinder research, clinical practice, and treatment. This is not to say that western medicine and research are undermined. Rather, they should not be viewed as simply superior to traditional medicine and research practices. Practicing without a Western bias may help clinical providers with respecting patients’ diverse cultural backgrounds and developing cultural competence.

Bibliography

[1] Seeleman, Conny, Jeanine Suurmond, and Karien Stronks. “Cultural competence: a conceptual framework for teaching and learning.” Medical Education 43, no. 3 (2009): 229-237.

[2] Erikson, Susan L. “Global health business: The production and performativity of statistics in Sierra Leone and Germany.” Medical anthropology 31, no. 4 (2012): 367-384.

[3] “Susan Erikson,” Simon Fraser University, Accessed May 5, 2020, https://www.sfu.ca/fhs/about/people/profiles/susan-erikson.html.

[4] Lindee, Susan, and Rebecca Mueller. “Is cystic fibrosis genetic medicine’s canary?.” Perspectives in Biology and Medicine 54, no. 3 (2011): 316-331.

About the author 

Clare Jocelyn Mangubat is a nursing student at the University of Pennsylvania. She is currently involved in a research study as a Study Assessor, a pilot study as a Co-Investigator, a research journal as an Associate Editor, and a psychology clinical program as a Senior Group Leader. She plans on getting her Master’s in Nursing to be a Psychiatric-Mental Health Nurse Practitioner.