SBM in 2018 and Beyond

Back in 2008, when Science-Based Medicine (SBM) launched, social media was cute, “detox” teas were still mostly tea, and AI was something only sci-fi doctors worried about. Fast-forward to 2018 and beyond, and the healthcare landscape looks very different: wellness influencers have more followers than national health agencies, AI can draft treatment guidelines in seconds, and conspiracy theories travel faster than randomized controlled trials.

In the middle of all this noise, SBM has tried to be the stubborn friend who keeps asking, “Okay, but where’s the data?” The original mission of Science-Based Medicine was simple and ambitious: to examine medical claims through the lens of rigorous science, including not just clinical trials but also prior plausibility and basic biology. That mission has aged extremely wellmaybe better than most of the wellness fads it has debunked.

This article looks at SBM’s role in 2018, the challenges it faced then, and how the same principles are even more important in the years that follow. We’ll also talk about the messy realities of confronting misinformation, the rise of “integrative” branding, and how AI and precision medicine can either turbo-charge good scienceor super-charge pseudoscience.

What Exactly Is Science-Based Medicine?

Let’s clear one thing up: science-based medicine is not a new specialty or a rival tribe to evidence-based medicine. It’s a way of insisting that true evidence-based care must integrate:

• The best available clinical evidence
• Basic scientific plausibility (does this even make sense biologically?)
• Clinical expertise and patient values

Traditional evidence-based medicine (EBM) is built around formal steps: ask a focused question, find the best evidence, appraise it, apply it, and re-evaluate. But EBM can be gamed. A small, poorly designed trial, or a cherry-picked subgroup analysis, can be used to claim “evidence” for almost anything. SBM calls this out and asks a blunt question: Is this treatment not only supported by trials, but also plausible given what we know about chemistry, physiology, and physics?

That’s why SBM has spent so much time critiquing alternative medicine, which often lacks biological plausibility and reliable evidence, yet continues to market itself as “natural,” “ancient,” or “energy-balancing.” If a treatment violates basic science, you don’t rescue it with one small positive pilot study.

2018: A Snapshot of SBM’s Battlefronts

By 2018, SBM wasn’t just debunking copper bracelets and miracle juices. It was confronting a larger ecosystem where pseudoscience was quietly being invited into mainstream healthcare under friendlier labels like “integrative medicine” and “functional medicine.”

“Integrative” Branding and Legislative Alchemy

One of the big themes around 2018 was what some SBM writers called “legislative alchemy”efforts to rebrand certain alternative practitioners as primary care providers through legislation rather than evidence. For example, attempts to expand the scope of practice for chiropractors and naturopaths often came with language suggesting they provide full-spectrum primary care, despite limited or questionable evidence for many of their favored interventions.

From an SBM standpoint, the concern wasn’t turf protectionit was patient safety. When providers with weak pharmacology or diagnostic training manage complex conditions or substitute unproven therapies for effective treatments, the risk is not abstract. Delays in evidence-based care can and do lead to preventable harm.

Alternative Medicine: No, There’s Just Medicine

A recurring SBM message in 2018 was that there really isn’t “alternative” medicine. There’s medicine that works, medicine that doesn’t, and medicine we’re still studying. Treatments supported by robust data eventually become standard care; those that fail are (ideally) abandoned.

Yet many complementary and alternative medicine (CAM) offerings have:

• Little to no high-quality evidence
• Biological mechanisms that conflict with established science
• Studies plagued by bias, poor design, and selective reporting

SBM writers spent 2018and every year sincereminding readers that “ancient” is not a synonym for “effective,” and “natural” is not a synonym for “safe.”

The Social Media Infodemic: A Storm Forming

Even before COVID-19, SBM was sounding the alarm about health misinformation on the internet. Social platforms amplified charismatic voices, not careful ones, and unproven products found global audiences overnight. Studies in the years that followed confirmed that social media now accounts for a large share of health-related fake news and misinformation.

Influencers soon began promoting everything from miracle diets to full-body MRI scans as lifestyle accessoriessometimes in direct conflict with regulatory guidance and evidence. SBM’s critical lens, originally aimed at infomercials and fringe clinics, had to expand to handle viral TikToks, celebrity endorsements, and algorithm-driven “health hacks.”

Beyond 2018: New Technology, Old Problems

If 2018 was a turning point, the years after have been a stress test for science-based medicine. We’ve watched a pandemic, a surge in conspiracy theories, and a wave of technological change all collide with the core question: How do we decide what’s true about health?

AI, Big Data, and Precision Medicine

The rise of precision medicine and artificial intelligence promises a future where treatment is tailored to your specific genes, environment, and lifestyle. Research shows that combining large datasets with machine learning can uncover patterns that would be impossible for humans alone to see, potentially improving diagnosis, risk prediction, and treatment selection.

That sounds very SBM-friendly: more data, better tools, smarter decisions. But there’s a catch. AI systems are only as good as the data and assumptions built into them. Biased data can reinforce inequities; opaque algorithms can make flawed decisions harder to detect. SBM’s emphasis on transparency, plausibility, and critical appraisal is exactly what’s needed to keep AI from becoming a high-tech black box that we trust just because it looks impressive.

Ironically, AI itself is now used in ways that undermine science-based medicinethink AI-generated deepfake doctors promoting supplements they’ve never heard of, or chatbots dispensing overly confident advice without context. The future challenge for SBM is to champion AI as a tool for evidence, not as a shortcut to bypass it.

Misinformation 2.0: From Clickbait to Deepfakes

Health misinformation has evolved from chain emails and late-night TV ads to highly polished videos and AI-generated testimonials. Studies now document how social media algorithms preferentially surface engaging contentoften the sensational, emotional, or conspiratorialover sober, evidence-based explanations.

For SBM, that means:

• Debunking claims isn’t enough; explanations must be clear, engaging, and shareable.
• Communicators must understand psychologywhy people believe some claims even after correction.
• Partnerships with platforms and policymakers are crucial to reduce the reach of dangerous misinformation.

In other words, SBM has had to learn not just how to be right, but how to be heard.

Core Principles That Will Still Matter Tomorrow

Looking beyond 2018, several SBM principles stand out as evergreen:

1. Prior Plausibility Is Not Optional

A clinical trial doesn’t start from zero. If a treatment claims to realign cosmic energy or imprint healing messages into water, the prior probability that it works is already extremely low. SBM insists that we weigh new findings against basic science rather than treating every hypothesis as equally likely from the start.

2. Evidence Has a Hierarchyand Context

Not all studies are created equal. Systematic reviews of high-quality randomized controlled trials carry more weight than uncontrolled case series or cherry-picked anecdotes. But even good trials must be interpreted in context: sample size, effect size, bias, and relevance to real-world patients all matter.

SBM has consistently pushed back against “one shiny trial” thinking, where a single small positive study is used to market a supplement or device while larger, negative data are ignored.

3. Patient Values Are Centralbut So Is Honesty

Science-based medicine is sometimes caricatured as cold or impersonal, but modern EBM explicitly includes patient preferences and values as a core component of good care. What SBM adds is a commitment to intellectual honesty: patients deserve to know not just that a therapy is “popular” or “natural,” but what we actually knowand don’t knowabout its benefits and risks.

That means being willing to say things like:

• “We don’t have strong evidence yet.”
• “This is biologically plausible but still experimental.”
• “This sounds appealing, but the best studies so far show little to no benefit.”

SBM as a Long-Term Project, Not a Trend

One interesting thing about SBM is its durability. The blog has been publishing for well over a decade, consistently applying the same core principles to different fads and eras: from homeopathy and chiropractic in its early years, to functional medicine, detox culture, and social media pseudoscience in later years.

Trends change; the scientific method doesn’t. Whether the claim of the week is about alkaline water, gene-hacking supplements, or quantum healing, the SBM playbook remains roughly the same:

1. Ask what’s being claimed.
2. Check whether it’s plausible given established science.
3. Review the totality of evidence, not just cherry-picked positives.
4. Communicate the results clearly and transparently.

If anything, the future will require more of this, not less.

Experiences from the Front Lines of Science-Based Medicine (Extra Section)

Principles are great, but they come to life in real experiences. Over the years, people who care about science-based medicineclinicians, patients, researchers, and skeptical readershave learned some hard, very human lessons about what it means to defend evidence in the real world.

When Evidence Meets the Exam Room

Imagine a primary care doctor in 2018 facing a familiar scenario: a patient comes in clutching a printout about a “natural cure” for a chronic disease. The article is polished, the testimonials are moving, and there’s even a vague reference to a “Harvard study.” The doctor, who actually reads the scientific literature, recognizes that the cure is based on a tiny pilot trial, exaggerated claims, and a big dose of wishful thinking.

On paper, the SBM-aligned response is simple: explain the evidence calmly, show why the study is weak, and recommend proven therapies. In practice, it’s a delicate dance. That patient is not just choosing between treatments; they’re choosing between worldviewsone that promises quick answers and simple narratives, and one that admits uncertainty and trade-offs. Clinicians quickly learn that being right is not enough; you also have to be empathetic, clear, and patient.

The Emotional Toll of Debunking

For many science communicators, the emotional weight of debunking can be surprisingly heavy. It’s not fun to tell someone that the supplement they’ve invested time, money, and hope in probably doesn’t work. It’s even harder when that person has a serious or incurable illness and is desperate for options.

Writers and skeptics who align with SBM often describe waves of frustration when the same myths resurface year after year. One month it’s miracle cancer diets; the next, it’s “frequency devices,” stem cell tourism, or yet another detox regimen. The names change, but the narrative is the same: conventional medicine is hiding the truth, and this new thing is what “they” don’t want you to know.

Over time, many learn a kind of emotional resilience. They accept that pseudoscience never fully disappears; it just shapeshifts. The goal isn’t to win once and for all. The goal is to keep building small pockets of clarity in a world that’s always a bit foggy.

Patients Caught in the Middle

On the patient side, experiences are just as complex. Some describe feeling whiplash as they scroll through contradictory advice: a respected medical center warns against unnecessary screening tests, while an influencer markets full-body scans as “the responsible thing to do.” It’s easy to see why “trust your gut” can feel more comforting than “trust the totality of peer-reviewed evidence.”

Patients who eventually land in the SBM camp often talk about a turning point: a moment when a promised miracle didn’t materialize, a side effect went unmentioned, or a practitioner dismissed legitimate concerns with hand-waving about “toxins” or “blocked energy.” That disappointment can be painful, but it can also push people toward a deeper appreciation for messy, nuanced, science-grounded care.

Learning to Communicate Like a Human, Not a PDF

One of the most valuable lessons from the last decade is that scientific accuracy and good storytelling are not enemies. In fact, they need each other. SBM-aligned clinicians and writers increasingly recognize that:

• Plain language builds trust.
• Personal anecdotes, when clearly labeled, can make statistics feel meaningful.
• A bit of humor can lower defenses and invite curiosity.

The best science-based communicators sound less like journal articles and more like honest, well-informed friends. They acknowledge uncertainty, admit limits, and still make a compelling case for vaccines, evidence-based treatments, and critical thinking.

Why SBM Still MattersAnd Always Will

If there’s one big takeaway from the lived experience of SBM in 2018 and beyond, it’s this: defending science-based medicine is not a one-time campaign. It’s an ongoing practice of curiosity, humility, and courage. Whether you’re a doctor trying to counter a viral TikTok, a patient sorting through conflicting advice, or a writer dissecting the latest “miracle cure,” you’re part of that project.

The tools will changeAI, precision medicine, new therapiesbut the underlying questions stay the same: What’s really going on here? What does the totality of good evidence say? And how do we explain that in a way real people can actually use? As long as those questions matter, SBM will, too.

Conclusion

“SBM in 2018 and Beyond” is not just about one year or one blog; it’s about a way of thinking that helps us navigate an increasingly noisy, confusing healthcare world. Science-based medicine doesn’t promise miracle cures, but it does promise honesty, transparency, and a relentless commitment to realityeven when reality is complicated.

In a future filled with AI-generated advice, precision medicine, and ever-evolving wellness trends, SBM’s insistence on plausibility, rigorous evidence, and clear communication may be more important than ever. Trends will come and go. The need for good scienceand people willing to defend itwon’t.