The “Evidence-Based Therapy” Game, Explained with Pancakes

What pancakes can tell us about the power and politics of therapy research.

The “evidence-based therapy” game, explained with pancakes. 🥞

I’ve got a pancake recipe. I conduct a randomized controlled trial (RCT) showing people like my pancakes better than no breakfast at all.

Now my pancakes are “evidence based.” Yours aren’t. I start telling everyone mine are superior.

Next, I compare my pancakes to a fake recipe—one I made up for the control group. It’s deliberately bad. I left out key ingredients.

This is called an “active comparator” condition. It’s the most rigorous research design, according to me. My pancakes are “the gold standard.”

I declare my pancakes scientifically proven. Yours? There’s no evidence. Maybe it’s even unethical to serve them.

You’ve been making pancakes using a time-tested recipe refined over generations, and all this feels a little rigged. So you start doing RCTs too.

Turns out people like your pancakes just as much. Maybe more over time.

You’ve finally set the record straight!

Nice try, chump.

I pick apart your research methods. I hold your studies to standards I never applied to mine.

Because only my pancakes can be “evidence-based.” Yours will never be. No matter how much research you do, I’ll just keep moving the goalposts. Besides, it’s now an established fact that mine are the “evidence based” pancakes.

Do you see how this “evidence-based” game is played?

Meanwhile, I’ve hired PR firms to blast out press releases. Journalists write headlines like, “Why do breakfast cooks reject science?”

Journal editors, reviewers, and grant agencies are all in my corner now—funding my work, publishing my papers, ignoring yours.

Mind you, my research never addressed basic questions like whether people actually like my pancakes better, or feel satisfied after eating them. None of my research trials ever compared my pancakes to yours on a level playing field. I’ve never studied your recipe. Never tried it. Don’t need to.

Because now everyone accepts as fact: only evidence-based pancakes count. And “evidence-based” means: mine.

If you question it, I’ll accuse you of being anti-science. No self-respecting breakfast cook would ever want to get a reputation as anti-science. I’ve now shut down serious discussion.

I pile up more grants and publications. There are now studies of my pancakes served on weekdays versus weekends, round plates versus square plates, with coffee versus tea. Look at all the evidence!

By now, you’ve done plenty of studies too. Your results are consistent: your pancakes are just as good. Maybe better in the long term.

Doesn’t matter.

My pancakes are still more “evidence based.” Because more studies exist. Quantity is now quality.

Heads I win, tails you lose. 🤣

Did you catch my sleight-of-hand? Everyone thinks “evidence based” means my pancakes are better.

Except it doesn’t mean that. It just means more studies. And the actual findings don’t matter.

In all this time, we’ve learned nothing about how to make better pancakes. My research still shows only that people like mine better than no pancakes, or bad ones that I invented as foils.

Still, prominent researchers and policymakers regularly declare my pancakes the “first-line” breakfast treatment. Because evidence.

And there’s still no evidence anyone prefers them.

In fact, there’s growing evidence people don’t much like them. They’re not satisfied after eating them. There’s no evidence people would choose them if given a choice. But a lot of people no longer get a choice.

All anyone remembers is that mine have the most “evidence.”

Also, your credit card company might refuse to pay for anything except my pancakes. Because science.

It’s good we’ve had this little talk.

Enjoy your breakfast, sucker. 🥞

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Read my companion post, CBT Research Doesn’t Show What You Think It Does

For a deeper dive, read my article, Where is the evidence for “evidence-based therapy? It’s written for professionals, but clear enough for anyone.