It makes no sense to me that we spend many years studying anatomy and physiology and then we are supposed to rely on an (EBM) model that takes no account of physiology.
The statistics we use to determine p values or odds ratios are not specific to medicine, they can be applied in any population-based environment (playing cards for example) to equal effect. Their place in medicine specifically excludes any preconceived notions of understanding how the body works or the nature of the intervention – it values only the measurement of before and after, between one group and the other. This is why we accept that medical science can research treatments that we know to be harmful (drugs) in the hope that we can get some condition-improving effect. If we can measure short-term benefit in a (any) specific parameter, chances are a drug that has no place in normal physiology will be allowed to be used as a treatment.
If normal physiology was the basis for treatment, drugs would have no place in medicine. The body is designed to keep our chemistry within normal limits, which means all drugs are metabolised out of the system and therefore (hopefully) have no long-term effects. Apart from antibiotics (the rare exception), even if a drug “works” the patient is left with an indefinite need for the treatment as well as the condition they started with.
However, there are three things that are going to sabotage physiology-based medicine and increase the desire for population-based evidence.
1) A paradigm where the purpose of medicine is to treat conditions rather than restore and maintain health
2) An incomplete understanding of physiology
3) Collectivism (the belief that the group is more important than the individual)
There are any number of treatments for deviations from physiologic normal that make sense if your outcome is to treat a condition. You can attempt to bring down a fever using drugs, reduce a disc bulge using traction, straighten a scoliosis using manipulation and because your actions seem physiologically sound the treatment may appear to be justified. Chance, bias or confounding might then convince you the treatment worked when in fact it was harmful or did nothing useful.
The alternative is to acknowledge that there are only two deviations from normal that cause all disease – TOXICITY and DEFICIENCY. Too much of what’s bad for us and/or not enough of what’s good for us.
In the maintenance of homeostasis, our body has three systems that depend on inputs to produce the outputs we refer to as health and they are our metabolism (chemistry), our personality (emotions and thoughts), and our neurology (movement). When we limit our attention to the QUALITY of the inputs in those three areas (not too many bad inputs, enough good ones) we can then have a system of physiology-based medicine that is clinically useful because it refers to the unique collection of inputs that is the individual patient, who is the only person any of us can treat.
The collectivist and the scientist deny the importance of the individual, the clinician knows that all he or she can treat right now is the individual. The only treatment that individual patient needs is a reduction in their toxic (destructive) inputs or an increase in their essential (constructive) ones.