Mere anecdote: evidence and stories in medicine

Abstract

In evidence-based medicine, randomized controlled trials are said to be the highest evidence of what works, while anecdotes have low value or are not even considered to be medical evidence. Similar hierarchical views of evidence have infected other disciplines, including evidence-based education and evidence-based government. Here, I explore the artificial divisions of acceptable from unacceptable evidence, numbers from narrative and sciences from humanities. I challenge the deprecation of stories in medicine. Some stories are based on experiments while others are based on more or less plausible theories. Some stories offer vast and impressive statistics gathered from many observations while others present one noteworthy event. Published reports are themselves stories of what experimenters did. Systematic reviewers generate their own observations of collected stories of experiments. Reviewers of systematic reviews in turn report their observations of systematic reviews. All of these stories become evidence of what works in medicine.

Therapeutic Effects of Highly Purified De-Glycosylated Gcmaf in the Immunotherapy of Patients With Chronic Diseases

“…In describing the following individual cases, we are well aware that these reports, because of their heterogeneity and very small numbers, can be considered anecdotes. However, it is worth noticing that a very recent study on the evaluation of clinical practice prompts for re-evaluation of individual cases such as those presented here (Nunn, 2011). Thus, it is well known that some studies present large and impressive statistics obtained from many observations while others report a small number of noteworthy events, as we do in this study.…”

“…Thus, it is well known that some studies present large and impressive statistics obtained from many observations while others report a small number of noteworthy events, as we do in this study. According to this novel, authoritative, epistemological approach, "all of these stories become evidence of what works in medicine" (Nunn, 2011). Therefore, we suggest that the clinical cases reported below may be considered as evidence for the effectiveness of GcMAF in different conditions and may encourage further studies on this topic.…”

Antipsychotic Agents

“…This question falls within the currently in fl uential approach of evidence-based medicine or evidence-based therapeutics [ 159,177,191 ] . Typically, this approach to developing rational therapeutics policies and practices relies heavily on combining fi ndings across related therapeutic trials by the method of meta-analysis [ 45,76,77 ] .…”

Clinical Observation of a Novel, Complementary, Immunotherapeutic Approach based on Ketogenic Diet, Chondroitin Sulfate, Vitamin D₃, Oleic Acid and a Fermented Milk and Colostrum Product

“…It is worth noticing, however, that a study on the evaluation of clinical practice re-evaluates the importance of individual cases in determining the effectiveness of clinical procedures (Nunn, 2011) and, according to Cox, cases such as those reported here "expand expertise, are the unit of clinical work, provide a frame-work for complex details and explain decisions" (Cox, 2001). We chose to report single cases rather than statistics following the indication of Aronson, according to whom the description of single cases generates and tests hypotheses, elucidate mechanisms and remind or educate (Aronson, 2005).…”