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My previous post provided tips for examining health claims. An area where health claims need to be examined cautiously is supplements, and one UK firm seems to deserve scrutiny more than most. British Supplements, was founded around 2015 by Chris Boyle. Rather than positioning himself as a traditional executive or scientist, Boyle markets himself as a rebellious outsider fighting against a corrupt health industry. He heavily promotes a narrative of “us versus them,” framing himself as a truth-teller. He regularly uses his platform to criticize mainstream competitors like Holland & Barrett, alleging they sell “private-label junk” filled with binders and excipients.
There is no publicly available record of any formal professional background, medical training, scientific schooling, or nutritional education for Chris Boyle. As far as I can see, he does not hold degrees or certifications in biochemistry, pharmacology, dietetics, medicine, or any related fields. In his public branding and communication, Boyle’s lack of formal scientific or medical training is not something he attempts to hide; rather, he weaponizes it as part of his “rebel outsider” persona to build trust with customers who are skeptical of the traditional medical and regulatory establishment.
Boyle’s firm is an online seller of mushroom and herbal products marketed under a “Clean Genuine” label. Operating with an antagonistic, anti-establishment brand voice, the company has constructed a conspiratorial marketing ecosystem designed to bypass UK advertising laws. It has fast grown into a highly profitable, multi-million-pound operation. Despite its “underdog” and “persecuted outsider” marketing narrative, it is now a major player in the direct-to-consumer wellness market, fueled by heavy advertising on social media and public transport. Recently, the company has even taken out a nationwide bus-advertising deal. To sell products like Turkey Tail and Lion’s Mane for serious illnesses without violating UK regulations, Boyle employs a “half-censorship” tactic. By partially starring out crucial terms, he tells customers that he is forced to censor the text due to a corrupt alliance between “Big Pharma” and the UK government.
His website employs customer reviews to make forbidden clinical claims. British Supplements encourages customers to leave detailed, condition-specific feedback, structuring its website collections such that searching for terms like “cancer” highlights these reviews. While the UK Advertising Standards Authority (ASA) demands that customer testimonials used in marketing are legally considered advertisements and must be clinically backed, the company falsely claims that “Article 10 of the Human Rights Act 1998” protects this type of “free speech”, dismissing regulators as tools of a “United Kingdom of North Korea.”
The brand positions itself within a broader web of alternative-medicine conspiracies. On social media and review platforms like Trustpilot, Boyle aggressively attacks critics. Negative reviewers are routinely insulted, with Boyle publicly labeling them as “woke,” “Karens,” “femboys,” or suffering from “mental breakdowns.”
This aggressive stance is more than just an offensive marketing strategy; it represents a growing public health challenge. By promoting unproven remedies to severely ill patients and actively cultivating distrust in evidence-based medicine and regulatory bodies, British Supplements not only financially exploit vulnerable consumers, it also endager the health of those who might believe in their unsubstantiated claims.
The Medical Journalists’ Association (MJA) has outlined six practical tips to help scrutinise health claims responsibly and accurately. They are primarily meant for journalists but, I think, they are also usefull for the general public, particularly when dealing with health claims in the realm of so-called alternative medicine (SCAM):
Check the source
Assess whether the claim originates from credible, peer-reviewed research and a reputable institution. Be wary of press releases, anecdotal reports, or media outlets known for sensationalism. Specifically for claims about SCAM, we might also add caution regarding the many third class SCAM journals.
Look for conflicts of interest
Investigate who funded the research and whether any authors or organisations stand to profit from the findings. Industry sponsorship can introduce bias, even in otherwise well-conducted studies. For claims about SCAM, we should remember that financial interest might be secondary to ideological ones.
Examine the study design
Consider whether the research used appropriate methods – such as randomisation, control groups, and adequate sample sizes – to support its conclusions. Observational studies, or case reports, or trials with the often-discussed ‘A+B versus B’ design, for example, cannot prove causation.
Consider the magnitude and relevance of effects
Distinguish between statistical significance and clinical importance. A tiny effect may be statistically significant in a large trial but meaningless in practice. Also ask whether the study population is representative and the outcome can be generalised.
Look for independent replication
Single studies should be treated cautiously until confirmed by other researchers. Consistent findings across multiple studies increase confidence in a claim.
Beware of over-interpretations
Scrutinise whether the authors or media coverage extrapolate beyond what the data support. For instance, generalising from animal studies to humans, or implying benefits without evidence of improved health outcomes.
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If I may, I will add an 7th to the six by the MJA. It is one that I have issued many times previously and that is, I think, essential in SCAM:
If it sounds too good to be true, it probably is!
Exaggerated or false health claims are endemic in SCAM. These 7 tips might be useful in disclosing them and in minimising the harm they can do.
Medical ethics rests on 4 core principles: autonomy, beneficence, non-maleficence, and justice, along with the crucial rule of veracity (truth-telling). In the realm of chiropractic, the most significant ethical issues/problems generally fall into the following ethical categories:
- Compromised Informed Consent & Veracity
Informed consent requires that a patient fully understands the nature, risks, benefits, and scientific backing of a treatment before proceeding.
1.1.The “Subluxation” Theory: A sizable segment of the chiropractic community still adheres to the erroneous belief that spinal “vertebral subluxations” cause a disruption in the body’s “innate intelligence,” leading to systemic disease. From an ethical standpoint, promoting an unproven, pseudo-scientific premise as medical fact violates veracity and compromises patient autonomy, as patients cannot give truly informed consent based on erroneous concepts.
1.2. Over-claiming Scope of Efficacy: While evidence might support spinal manipulation for acute lower back pain (if one were to interpret the dtat optimistically), most chiropractors claim they can treat many other illnesses, including non-musculoskeletal conditions such as asthma, allergies, infantile colic, ADHD, and high blood pressure. Marketing these services without robust clinical trial backing misleads vulnerable populations.
- Violations of Non-Maleficence
The principle of non-maleficence requires practitioners to avoid inflicting unnecessary harm or exposing patients to disproportionate risks.
2.1. Cervical Manipulation and Stroke Risk: One of the most severe ethical concerns involves high-velocity, low-amplitude (HVLA) thrusts to the upper neck, the hallmark modality of chiropractors. This procedure has been linked to vertebral artery dissection (VAD), which can cause strokes and deaths. The ethical failure is most obvious when chiropractors perform these adjustments without warning the patient of this and other adverse outcomes.
2.2. Paediatric Chiropractic: Performing spinal adjustments on infants and toddlers (whose spines are primarily cartilage and still developing) poses distinct physical risks. Because infants cannot consent and the evidence of benefit for childhood ailments is practically non-existent, this behaviour violates non-maleficence.
- Secondary Harm: Delay of Standard Medical Care
Harm does not only come from physical injury; it also comes from omitting or delaying necessary medical treatment.
3.1. Anti-Vaccine and Anti-Medicine Sentiments: A large proportion of the chiropractic profession advise patients against conventional medicine, pharmaceuticals, and vaccination. When a chiropractor discourages a patient from seeking standard medical care, they are actively contributing to potentially life-threatening delays in care.
- Violations of Beneficence and Justice
Beneficence means acting in the patient’s best interest, while justice involves the fair and equitable distribution of healthcare resources.
4.1. The “Maintenance Care” Business Model: A common predatory practice of chiropractors involves convincing patients that they require lifelong, regular spinal adjustments to “stay aligned” and prevent disease, often locked into expensive upfront contracts. Recommending continuous, costly treatments that lack clinical evidence of long-term benefit shifts the focus from patient welfare (beneficence) to practitioner financial gain.
4.2.Over-Utilization of X-rays: Some chiropractic clinics mandate full-spine X-rays for every new patient, regardless of symptoms, and repeat them frequently to “prove” alignment changes. Exposing patients to unnecessary ionizing radiation for marketing or diagnostic justification is a direct violation of both non-maleficence and the ethical use of healthcare resources.
For a more detailed account of the ethical problems in so-called alternative medicine, please see our book on this very subject.
Religiosity has been linked to a wide range of health outcomes, with evidence for both benefits and harms.
Alleged positive effects
Many studies have found positive associations between religious involvement and physical and mental health, including lower mortality, better self-rated health and greater psychological well‑being. However, most of this literature is methodologically weak, with selection bias, poor control for confounders and selective reporting, so firm causal conclusions are difficult.
Religiosity and spirituality have frequently been associated with positive effects on mental health, such as higher levels of life satisfaction, meaning in life, hope, optimism and lower rates of depression, substance misuse and some forms of suicidal behaviour. Proposed mechanisms include social support from religious communities, promotion of coping resources, encouragement of health‑promoting behaviours and cognitive frameworks that help some people make sense of adversity.
In addition, observational studies have linked religious participation with positive effects on physical endpoints, such as reduced smoking, more moderate alcohol use and in some cases better cardiovascular outcomes and lower all‑cause mortality, though effect sizes are usually modest. Cross‑national analyses show that religious people sometimes report better self‑rated health, but these associations vary widely by country and are sensitive to socioeconomic and cultural context.onlinelibrary.
Alleged negative effects
Some aspects of religiosity might be harmful: religious struggles—such as feeling punished by God, spiritual discontent or conflict with religious communities—are consistently associated with higher levels of depression, anxiety and distress. Some studies also suggest that rigid or punitive religious beliefs can exacerbate guilt, internalized stigma (for example around sexuality) and delay help‑seeking for mental illness.
In highly secular societies, belonging to a religious minority may correlate with poorer health, possibly via discrimination, lower social integration or economic disadvantage. A critical economic analysis even reports a negative relationship between religious background and some health indicators once socioeconomic factors are carefully controlled, challenging simple “religion is good for you” narratives.
Methodological problems
Much of the evidence relies on observational studies, making it difficult to be sure about causality: healthier or more socially integrated people may be more likely to be religiously active. Measures of religiosity and spirituality are heterogeneous, ranging from attendance to private practices to diffuse “spiritual well‑being”, which complicates comparisons and may inflate positive findings. In other words, the effects of religiosity on health are less that certain or clear.
You wake up with a headache on a rainy day.
Did the rain cause your headache?
Or was it perhaps the late-night coffee?
You then take a homeopathic remedy, and an hour later the pain is gone.
Did the remedy cause this?
Or was it the shower you took, the placebo effect, or something else entirely?
Perhaps you don’t care? But, if we want to make progress, we ought to care and find the answers. Sorting out coincidence from actual cause is crucial for making progress. Causality is one of the most important concepts in research, because humans are naturally prone to seeing patterns where none exist. We are all easily fooled, and regularly even by ourselves. Mistaking a correlation (two things coicidentally happening in sequence) for a cause (one thing creating the other) can lead to wrong decisions, useless treatments, wasted resources, and often to significant harm. To prevent this, scientists have long relied on structured frameworks to prove when one event truly triggers another.
In the late 19th century, the German physician Robert Koch wanted a foolproof way to prove that a specific microbe caused a specific disease. He developed the “Koch’s Postulates”, a four-step checklist that transformed medicine:
- The microbe must be present in every case of the disease.
- The microbe must be isolated from the sick host and grown in a lab.
- The lab-grown microbe must cause the same disease when introduced to a healthy host.
- The microbe must be isolated again from the newly infected host.
While these rules worked beautifully for many infectious diseases, they have limits. Some viruses cannot be grown easily in a lab, and some people carry bacteria without ever getting sick. And, of course, there are many diseases that are not due to microbes.
As medicine evolved to tackle chronic, non-infectious conditions like heart disease or cancer, Koch’s checklist thus fell short. For instance, smoking causes lung cancer, but you cannot easily “isolate” smoking in a lab, nor does every smoker get cancer. To solve this riddle, the UK epidemiologist Austin Bradford Hill introduced a broader toolkit in 1965, today known as the “Bradford Hill Criteria”. Instead of a strict pass or fail test, it uses several simple viewpoints to weigh the evidence:
- Strength: Is the connection large or powerful?
- Consistency: Do different studies produce the same result?
- Temporality: Did the cause occur before the effect?
- Biological Gradient: Does more exposure lead to more severe outcomes?
- Biological plausibility: Does the connection make sense with what we already know?
Without the guardrails of causality, medicine would still be based mostly on guesswork. Koch’s postulates gave us the clarity to cure deadly infections, and the Bradford Hill criteria allowed us to take on different public health threats like tobacco. By forcing us to ask how and why things happen, these criteria allow us to ensure that medical science is built on truth rather than mere coincidence.
In the realm of so-called alternative medicine (SCAM), causality has a particularly improtant role. This is because proponents often claim causality, while science rejects it:
Homeopathy:
Proponent claim: The fact that many patients get better after taking a homeopathic remedy proves that homeopathy works.
Reality: There are many other, more convincing explanations for this outcome.
Applied Kinesiology
Proponent claim: Muscle response strength proves nutrient deficiencies, toxin exposure, or food allergies.
Reality: No consistent relationship between muscle testing results and actual health status. The practice fails basic reliability tests; different practitioners get different results from the same patient.
Reiki
Proponent claim: Practitioners channel “healing energy” from assumed sources that improves health and prompts recovery.
Reality: No such energy exists. Well-controlled studies show Reiki performs no better than placebo. The claimed energy has no basis in physics or biology.
Acupuncture
Proponent claim: Inserting needles at specific points along “meridians” releases blocked qi and cures various conditions.
Reality: Most ot the patient-blind acupuncture trials show no difference from placebo acupuncture (needles placed randomly or not penetrating skin). Cochrane Reviews find acupuncture does no better than placebo. The meridian system has no anatomical basis.
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These 4 examples illustrate the fundamental problem: SCAM proponents routinely mistake correlation for causation, or propose causal mechanisms that have no basis in established physics, chemistry, or biology. Without satisfying the above-mentioned criteria, these claims remain unproven speculation rather than scientific fact.
To put it bluntly:
CAUSALITY MATTERS!
People use unproven so-called alternative medicine (SCAM) even when evidence quite clearly indicates that the SCAM in question does not work.
Why?
Here are some of the factors that can play a role:
- The Placebo Effect Makes People Feel Better
SCAM “helps” even though it doesn’t work. The placebo effect is a real neurobiological phenomenon that can reduce pain, improve mood, decrease stress, and affect lots of other, mostly subjective endpoints. In some situations, placebos can be as effective as real treatments. This creates genuine subjective improvement that convinces many people the SCAM in question is effective.
- False Hope and the Need for Control
When conventional medicine offers little, people “grab at straws” because hope drives them. For seriously ill patients, suggesting unproven interventions can provide hope and a sense of control over their illness. The ritual involved in administering SCAM creates profound impact because people feel they’re getting the attention they crave.
- Confirmation Bias
People selectively gather evidence conforming to their beliefs, while neglecting contradictory evidence. If someone feels better after acupuncture, for instance, they attribute it to the treatment rather than natural recovery, placebo, the attention from the therapist, or simply the restful time spent on the treatment bench. Experience or stories from others bring helped by a treatment are not evidence, of course, but they can be very compelling.
- The “Expensive = Good” Heuristic
It feels reassuring to spend some money on one’s health. “If it’s expensive, it must be good!” Traveling abroad for exotic SCAMs creates hope through fundraising. And expectation boosts the placebo response.
- Anti-Science Beliefs Predict SCAM Use
Anti-science beliefs and conspiracy theories increase the willingness to take risks and try SCAM. People who are suspicious, untrusting, eccentric, and see the world as dangerous tend to see meaningful patterns where none exist. If you believe that Big Pharma is trying to kill you, you are likely to employ SCAM.
- Dissatisfaction with Conventional Medicine
It’s “frustrating and demoralising when medical therapies do not offer the benefits people need or expect”. When doctors can’t provide answers or effective treatments, people are likely to seek SCAM. Sadly, I have to admit that some conventional healthcare professionals can behave such that one simply cannot be surprised, if patients look elsewhere.
- Humans Are Wired to See Patterns
Humans evolved to quickly detect patterns and understand how events might be causally related. We seek explanations rather than seeing randomness, but this makes us prone to seeing connections where none exist. This cognitive vulnerability is why we mistake correlation for causation. We are easily fooled, and most easily by ourselves.
8. Misinformation
Over the years, I have come to realise that all of these factors – and many more – can play a role, but that none of them is as important as misinformation. SCAM has been in the limelight sice decades, and the public is bombarded with misleading information about SCAM. It comes from journaalists, book authors, influencers, marketeers, bloggers, social media, and many other sources. And it continuously brainwashes the public into believing that even the most deplorably useless SCAM is effective, safe, and supressed by the establishment. I sympathise with everyone who is being sent up the garden path in this way and thus may get deprived of his/her savings or – much worse – health.
This recent survey caught my attention; here is the abstract:
Homeopathy is one of the most widespread alternative methods of treatment in Bulgaria in the last 25-30 years. The aim of the research is to study and analyze the knowledge and attitudes of Bulgarians over the age of 18 regarding the application of homeopathy as a curative method in general medical practice. A cross-sectional survey among a sample of the general Bulgarian population was conducted during a 4-week period in April-May 2022. The data were collected using the Google Forms platform via an online questionnaire. A total of 508 completed responses were collected (women-450, men-58). The overwhelming number are familiar with homeopathy and have used it before for their own health problems (97% of women and 86% of men). A large number of those who have used homeopathy report an improvement in their health (88% of women and 74% of men). The majority of respondents believe that homeopathy is useful for health care (93% of women and 79% of men). Further representative studies are needed to determine the role of homeopathy as a complementary method in general medical practice.
So, the researchers collected 508 responses on Google Forms. This method does not allow calculating a response rate, i.e. a percentage of those who saw the questionnaire and decided to reply. It might well have been 1% or lower. Who can reasonably be assumed to have resopnded? My guess is that those with an interest in homeopathy did and those without it did not respond. Thus, we should not be surprised to see that 97% of women (~90% of the respondents were women) had used homeopathy, 88% reported improvements, 93% belilieve it to be useful for Health care. I have previously compared such SCAM surveys to someone studying our views about hamburgers by placing themselves outside McDonalds and interviewing customers about the subject.
What these figures do not tell us is that presumably ~90% of Bulgarians could not care less about homeopathy! Despite this rather obvious suspicion, the authors ignore the fatal flaw in their survey and state that “the prevailing opinion that homeopathy is beneficial to health care in general is noteworthy. In other studies it is found that patients expected their family physician to refer them to CAM, including homeopathy, to have updated knowledge about CAM, and to offer CAM treatment in the clinic based on appropriate training. It can be assumed that homeopathy could be part of an integrative approach in health care, given the increased number of people wishing to use it, as well as the large number of doctors who have completed a training course in homeopathy in Bulgaria.”
Of course, this would be trivial, if it were not rather typical for a large chunk of “research” getting published in the realm of so-called alternative medicine (SCAM). I did put research in ” “, because it is, in fact, not research as we know it. Too many SCAM “researchers” have settled for conducting pseudo-research, i.e. investigations, like the one above, which can only produce findings that favour SCAM in one way or another. As this sort of thing is happening a thousand times over every month, it gradually erodes science and creates a general (erroneous) feeling (not least on the political level) that SCAM must be good for our health, after all.
And why do SCAM researchers prefer pseudo-research to proper science?
In my view, the answer is clear: they have realised or feel instinctively that proper hypothesis-testing research would not generate the results they so ardently need in order to promote their creed/ideology/business.
As explained in my previous post, plausibility matters. The post was predominantly about biological plausibility – but things can be a little more complex, and it would be foolish to deny the fact that there are two kinds of plausibility; biological and clinical.
Biological plausibility concerns compatibility with established physiology, biochemistry, and pathology. It asks whether a credible pathway exists by which an assumed cause could produce an effect. And it takes into account current knowledge from biology and other natural sciences. Within the Bradford Hill framework, biological plausibility helps distinguish mere statistical associations from actual causes. For more details see my previous post.
Clinical plausibility, by contrast, is based on much softer criteria, such as clinical observation and real-world outcomes. Here, the core question is whether a claimed effect fits observed patient patterns, e.g.:
- temporal relationships,
- dose-response gradients,
- reproducibility across cohorts,
- alignment with known clinical phenotypes.
Supported by case series, observational studies, clinical trials, or epidemiological studies, an intervention can be clinically plausible long before its underlying biology is understood. This has historically been the case for many drugs; an apt example is aspirin which has been used clinically long before a biologically plausible mechanism was discovered..
The two forms of plausibility should be complementary. Ideally, a robust causal claim satisfies both mechanistic logic and clinical observation. Biological plausibility without clinical evidence remains speculative. Clinical plausibility without a known mechanism invites skepticism and further inquiry.
The deficit of biological plausibility is a major indictment of many forms of so-called alternative medicine (SCAM). They often offer no tenable mechanism and fail under rigorous testing. Conversely, demanding full mechanistic clarity before accepting consistent clinical data is likely to hinder progress in healthcare.
In relation to so-called alternative medicine (SCAM), the issue was summarised more than 20 years ago as follows:
In summary, the way to prove the efficacy of most CAM therapies is with well-designed RCTs, and there is no reason to believe that clinical trial designs cannot be developed that allow even complex CAM therapies to be evaluated. The procedures involved can be sophisticated, complex and expensive, however, and this confronts investigators with the challenge of identifying which of the myriad of existing and future CAM therapies merit the effort and expense of definitive RCT evaluation. The challenge should be met as it is in conventional drug discovery, through plausibility-building research. Whenever possible, efforts should be made to establish a credible mechanism of action for a candidate CAM therapy, because this will increase its biological plausibility and reduce the risk of false-negative RCT results. When biological plausibility is lacking, clinical plausibility alone must be the basis for determining whether or not to proceed to the costlier phase of definitive RCTs. The creation of a plausibility-building CAM research strategy will require thought, instruction, funding, and collaboration among conventional clinical investigators and CAM advocates. The advantages are many: fairness, low cost and the creation of rules of engagement for CAM evaluation that foster balanced partnerships between CAM advocates and mainstream clinical scientists.
Ultimately, in my view, not a dogmatic stance but a balanced integration of both biological and clinical plausibility should underpin rational decisions about which medical hypotheses to pursue, adopt, or discard.
Evidence‑based medicine (EBM) was developed to make clinical decisions more reliable by grounding them more solidly in good research. Thus, randomised clinical trials, systematic reviews, and meta-analysis became crucial for healthcare. That development brought undeniable progress, but it also created a problem: if we focus exclusively on such evidence, we might neglect an important question:
IS THE TREATMENT IN QUESTION BIOLOGICALLY PLAUSIBLE?
Put simply, EBM asks “Does it work in this study?” without first asking “Could it reasonably work at all?”
The neglect of biological plausibility can lead to wasted resources, misleading conclusions and, in some cases, the promotion of nonsense. The issue is, of course, particularly relevant in so-called alternative medicine (SCAM) known for its frequent lack of plausibility. A simple example might explain this more clearly: in homeopathy, we see an abundance of poor-quality studies with a positive result. This could easily lead to the overall impression that homeopathy works, while in fact it cannot reasonably work at all.
So, how can we reasonably take account of this complication? It turns out there are several options:
Option 1 Gatekeeping
One way to account for plausibility within EBM is to use it to decide what we test in the first place. Before launching an expensive clinical trial, we can ask for a clear explanation of how the proposed intervention might reasonably work. If no such rationale can be articulated without contradicting science, it is reasonable to conclude that the intervention lacks sufficient plausibility to justify the time, money and ethical burden involved in testing it on patients. In practice, this kind of gatekeeping often happens informally, but making it explicit and mandatory could help keep overtly implausible interventions from consuming scarce resources.
Option 2 Prior probability
Plausibility can also be integrated into how we interpret trial results. Some trialists treat a statistically significant result as an infallible signal that the therapy was effective. When a trial result is “statistically significant”, it means the data we observed would be unlikely if the treatment had no effect. Prior probability is another way of expressing plausibility. If a hypothesis is highly plausible given existing scientific knowledge, a positive trial fits into a broader, coherent picture. If a hypothesis is highly implausible, a positive trial is more likely to be a false positive, an artefact of bias, chance, methodological flaws, or fraud. In other words, for low‑plausibility claims, we need stronger and more consistent evidence before accepting them as true. The less plausible a claim is, the more extraordinary the evidence must be.
Option 3 Guidelines
Guideline development offers another opportunity to embed plausibility into EBM. When expert panels prepare recommendations, they typically grade the strength of evidence according to study design, risk of bias, and consistency of results. They might also add a distinct step in which they rate the plausibility of the intervention. This rating could be justified explaining how well the intervention fits with established knowledge. Guideline writers could then let this plausibility rating influence the strength of their recommendations.
Health technology assessments have been moving in this direction for some time. It makes guideline documents more transparent: clinicians could see not only what the trials showed, but also how the intervention was judged to fit into or contradict broader scientific understanding.
Option 4 Causation
Finally, causation frameworks are being used to bring plausibility into EBM. When we decide whether an association is causal, we often rely on criteria such as consistency, temporality and strength of association. Biological plausibility is another of these criteria. Using it systematically means asking whether there is a logical pathway from intervention to outcome that passes through known mechanisms and observed effects. If such a pathway can be sketched in a way that accords with science, plausibility is high. If not, plausibility is low, and we should be more cautious about drawing causal conclusions from statistical associations alone.
EBM has revolutionized healthcare, but evaluating evidence in a vacuum can carry the risk of validating the absurd. To minimise this risk, we might consider integrating biological plausibility into EBM, a possibility that has long been discussed by many experts in the field. This approach is not a rejection of EBM, but a vital safeguard for it which ensures that the evidence aligns with and strengthened by fundamental science and existing knowledge. By demanding extraordinary evidence for extraordinary claims, medicine can better protect its resources, maintain intellectual integrity, and ensure that clinical practice rests on a foundation that is both statistically sound and scientifically reasonable.
