Modern gastroenterology presents itself as a rigorously evidence-based discipline. In reality, only 13% of its treatment recommendations are supported by what medicine itself classifies as “high quality evidence,” meaning randomized controlled trials (RCTs). In other words, 87% of gastroenterology operates on lower tiers of evidence — expert consensus, clinical experience, observational data, and patient reports. This fact was recently outlined in a research paper called Levels of Evidence Supporting Recommendations in Gastroenterology.

It matters to me, because the very same label — low quality evidence — is routinely used to dismiss entire medical systems, most notably chinese Medicine. The irony is difficult to miss: a field that largely rests on low-grade evidence excludes other approaches for doing exactly the same.

The numbers may surprise some people. I lost faith in gastroenterology long ago, but even so, the figure was lower than I expected. What it really highlights is how completely randomized controlled trials have come to dominate medicine’s self-image — often far beyond what they can reasonably support. However, there is a larger issue. I have come to wonder whether randomized controlled trials should be the Holy Grail of medicine at all.

If you’ve ever felt dismissed about your illness, you are not alone. In our current healthcare system, doctors often don’t listen to patients so much as they listen to labs and imaging. At the same time, the research system doesn’t listen to doctors either — it listens to “high quality evidence.” Patients, meanwhile, are turned into abstract data points. They have no real voice.

RCTs are treated as the gold standard not because they answer all relevant questions, but because they answer a very narrow set of questions cleanly. They cannot evaluate complex interventions in real people with layered diagnoses, evolving symptoms, and long histories. Instead, they test simplified treatments on carefully selected populations that rarely resemble actual patients. The result is idealized recommendations — often pharmaceutical — that are then applied wholesale to a far messier reality.

This is why a rule of thumb is commonly taught in clinical pharmacology and internal medicine training programs — one that I also heard in TCM school:

A new drug is an experiment until it has been in general use for about seven years.

This is what physicians know, and what they quietly tell their own families. The irony was not lost on my classmates, since many traditional treatments are not seven years old, but hundreds or even thousands. The deeper point is that while everyone claims to care about evidence, “high quality evidence” has proven itself neither comprehensive nor especially trustworthy. Many drugs that passed RCTs and received full regulatory approval later harmed or killed patients — Propulsid, Zelnorm, Lotronex, Zantac, and Reglan among them. PPIs may yet join that list.

Ironically, the research that ultimately exposes these harms is usually classified as low quality. It consists of physician observations, patient reports, and post-market surveillance — exactly the forms of evidence our institutions routinely downplay. No randomized trial required.

Research based on doctor and patient reports has always been part of evidence-based medicine. What has changed is not the science, but our willingness to ignore what is directly in front of us. We have developed an extraordinary capacity to overlook lived experience in favor of abstraction.

Those receiving non-mainstream treatments — herbal medicine, acupuncture, supplements, lifestyle interventions — generally know whether their health has improved, worsened, or remained the same. They are not unreliable witnesses. We have simply trained ourselves not to trust them. After living in a top-down medical culture for so long, this distrust feels normal.

Which raises an uncomfortable question: who, exactly, gets to decide whether a treatment works? When my patients tell me they are better, worse, or unchanged, should I automatically doubt their words and demand a test? That is often the reflex in standard care, when testing is available. But it is not a neutral reflex. It reflects a hierarchy of knowledge that consistently privileges instruments over people.

Large volumes of so-called low quality research already exist showing improvement in IBS symptoms among patients treated in Eastern hospital settings. Beyond that, TCM has been studied using randomized controlled trials and has frequently matched or outperformed standard care. This has been known since at least 2006, when a Cochrane Review evaluated Chinese herbal medicine for IBS. More recently, a systematic review published in Frontiers in Pharmacologyconcluded that TCM “can be considered an effective and safe treatment for IBS,” based on accumulated evidence that includes RCTs.

So we are left with layers of evidence. At the top sits a narrow but tidy form of research with limited applicability to real patients. Beneath it lies expert consensus, long-term clinical use, and patient experience — messier, harder to quantify, but deeply grounded in reality. Contrary to expectation, TCM compares favorably to modern gastroenterology on both levels. And if only 13% of gastroenterology is supported by high-grade evidence, then the evidentiary playing field is far more level than most people realize.

What differs most is not the data, but the narrative. People simply do not know this history, and we should ask why.

The real oversimplification lies not with patients, nor with practitioners working outside the mainstream, but with research frameworks that mistake cleanliness for completeness. Whether only 13% of gastroenterology rests on high quality evidence is ultimately less important than whether people are getting better. And that is a question no randomized trial can answer on its own.