Fighting Against Evidence(sciencebasedmedicine.org)
sciencebasedmedicine.org
Fighting Against Evidence
http://www.sciencebasedmedicine.org/fighting-against-evidence/
8 comments
Well, Eric Topol[1] argues that evidence-based medicine, coupled with copious amounts of data and better tools, will allow treatments to be much more individualized, not less.
[1] http://www.scripps.edu/research/faculty/topol
http://www.econtalk.org/archives/2013/04/topol_on_the_cr.htm...
http://www.amazon.com/Creative-Destruction-Medicine-Digital-...
[1] http://www.scripps.edu/research/faculty/topol
http://www.econtalk.org/archives/2013/04/topol_on_the_cr.htm...
http://www.amazon.com/Creative-Destruction-Medicine-Digital-...
IMHO, the problem with "alternative medicine" is less what adults do (or do not do) to themselves, and more with what adults do to children that they have been entrusted with.
Thankfully there has been progress in recent years on this front, with adults who neglected to seek evidence-based medicine for the children that they were entrusted with being charged with homicide (http://en.wikipedia.org/wiki/Kara_Neumann_case). There is more progress to be made however.
Thankfully there has been progress in recent years on this front, with adults who neglected to seek evidence-based medicine for the children that they were entrusted with being charged with homicide (http://en.wikipedia.org/wiki/Kara_Neumann_case). There is more progress to be made however.
Western medicine has removed from the individual a sense of personal responsibility, and this must change.
I must heartily disagree. Well, perhaps not so much disagree as clarify: Western medicine as it is practiced, perhaps discourages personal responsibility (and how many times would you tell patients to eat better and exercise more if they never did?). Evidence based medicine is just that: based on evidence. There's no "removal" of personal responsibility, there are simply facts, as in your case you have brilliantly demonstrated: when something works for you, you continue to use it. My immediate reaction to "trying something" that you mentioned, however was "how many things did you try?" How many people won't research different options, much less put them into practice, simply because it would require them to try something different, or something hard (like exercise)? How many people would rather take some snake-oil to lose weight than eat less and exercise more? How many people will refuse vaccines because they believe it's a government conspiracy?
And let's not forget all the other confounding factors, such as big pharma with 85+% of their money dedicated to marketing, or the placebo affect, etc, etc.
I must heartily disagree. Well, perhaps not so much disagree as clarify: Western medicine as it is practiced, perhaps discourages personal responsibility (and how many times would you tell patients to eat better and exercise more if they never did?). Evidence based medicine is just that: based on evidence. There's no "removal" of personal responsibility, there are simply facts, as in your case you have brilliantly demonstrated: when something works for you, you continue to use it. My immediate reaction to "trying something" that you mentioned, however was "how many things did you try?" How many people won't research different options, much less put them into practice, simply because it would require them to try something different, or something hard (like exercise)? How many people would rather take some snake-oil to lose weight than eat less and exercise more? How many people will refuse vaccines because they believe it's a government conspiracy?
And let's not forget all the other confounding factors, such as big pharma with 85+% of their money dedicated to marketing, or the placebo affect, etc, etc.
Western medicine has removed from the individual a sense of personal responsibility in the following sense. We are told to ignore what may work for us and to instead try what works a large number of other patients. While the advice may be good advice, it leaves the patient with an attitude that their own ideas about how to treat themselves may be worthless. And this could encourage the patient to place their doctor upon a pedestal - only the doctor knows what is best for you.
Of course, some advice is just always good advice - eat right and exercise. But you don't need a doctor to tell you that. I have observed that it is the same people who take the best personal care of themselves, by eating right and exercising, also engage in alternative medicine. The very act of trying to take control of your own health leads you to focus in on what works (or what you "think" works) for you.
Of course, some advice is just always good advice - eat right and exercise. But you don't need a doctor to tell you that. I have observed that it is the same people who take the best personal care of themselves, by eating right and exercising, also engage in alternative medicine. The very act of trying to take control of your own health leads you to focus in on what works (or what you "think" works) for you.
How do you know what actually works for you, and what simply coincided with a change that happened for some other reason? It is literally impossible to tease out these questions without some kind of control.
edit: For example, you like drinking diet coke and one morning you find you don't have cancer. Was it the diet coke that drove away the cancer? Did you even have cancer? Just doing things you want to do and approving yourself for them, claiming that they cured you or something, is not responsible and in many cases isn't really even honest
edit: For example, you like drinking diet coke and one morning you find you don't have cancer. Was it the diet coke that drove away the cancer? Did you even have cancer? Just doing things you want to do and approving yourself for them, claiming that they cured you or something, is not responsible and in many cases isn't really even honest
> How do you know what actually works for you, and what simply coincided with a change that happened for some other reason? It is literally impossible to tease out these questions without some kind of control.
It depends on the question. For lots of medical issues you could serve as your own control. If your medical issue is a rash or acne or trouble sleeping well or high blood pressure or any other condition that persists over time and is measurable, you can just start tracking it then try various changes and see how the metric matches with the changes. Do two weeks on and two weeks off a few times - either there's a break in the chart - a big noticeable improvement - at the appropriate times or there isn't.
I agree this wouldn't work for cancer, but it would work for a lot of things. If the effect magnitude is large enough you don't need a big clinical trial to see it. And if the treatment is cheap and available enough there's no chance in hell that anybody is going to fund a big clinical trial - trials are really only done for drugs that can be patented, so whoever sponsors the tests has a way to get their money back.
So long as it takes hundreds of millions of dollars to get a treatment past the FDA's tests, there are inevitably going to be a huge number of perfectly valid treatment options that nobody has financial incentive to pay for testing in that particular way.
It depends on the question. For lots of medical issues you could serve as your own control. If your medical issue is a rash or acne or trouble sleeping well or high blood pressure or any other condition that persists over time and is measurable, you can just start tracking it then try various changes and see how the metric matches with the changes. Do two weeks on and two weeks off a few times - either there's a break in the chart - a big noticeable improvement - at the appropriate times or there isn't.
I agree this wouldn't work for cancer, but it would work for a lot of things. If the effect magnitude is large enough you don't need a big clinical trial to see it. And if the treatment is cheap and available enough there's no chance in hell that anybody is going to fund a big clinical trial - trials are really only done for drugs that can be patented, so whoever sponsors the tests has a way to get their money back.
So long as it takes hundreds of millions of dollars to get a treatment past the FDA's tests, there are inevitably going to be a huge number of perfectly valid treatment options that nobody has financial incentive to pay for testing in that particular way.
It really wouldn't work for a lot of things.
Many illnesses just get better over time. Doing nothing is as effective as doing something. But the patient does something and correlates that with getting better and then thinks there is a causal link.
Many illnesses just get better over time. Doing nothing is as effective as doing something. But the patient does something and correlates that with getting better and then thinks there is a causal link.
> it leaves the patient with an attitude that their own
> ideas about how to treat themselves may be worthless.
First, the concept of "Western Medicine" is a misleading one. It implies there it is the opposite of "Eastern Medicine". Evidence Based Medicine, the subject of this post, is a much better term. Any methodology is appropriate, so long is it is backed by science.
I think Evidence Based Medicine puts personal responsibility on the individual. Individuals need to realize that Marketing does not Equal better care, all that matters is the science.
Evidence Based Medicine has nothing to do with personalized medicine, it is simply a way of analyzing the efficacy of medicine...science.
I think Evidence Based Medicine puts personal responsibility on the individual. Individuals need to realize that Marketing does not Equal better care, all that matters is the science.
Evidence Based Medicine has nothing to do with personalized medicine, it is simply a way of analyzing the efficacy of medicine...science.
The "Eastern"/"Western" dichotomy also ignores the existence of many scientifically questionable/discredited practices that originated "in the West". Homeopathy and chiropractic are both examples of prominent "alternative medicine" from 'the West'.
Similarly, plenty of medical techniques developed in 'the East' are backed by evidence.
Similarly, plenty of medical techniques developed in 'the East' are backed by evidence.
Western medicine or, more accurately, allopathic medicine, is actually a much better term than Evidence Based Medicine because most of medicine is not especially evidence based. There are countless studies and books on this topic.
because most of medicine is not especially evidence based
This is nonsense. Most of medicine is evidence based. Most of what a surgeon does, for example, is being a glorified handyman - staple this bit to that, remove and replace this other bit, all of which has had ample opportunities for study and observation. Or riffling through a MIMS for pharmaceutical information, the bulk of which is backed by drug trials. Cut your finger? Apply some antiseptic perhaps, and cover with a band-aid, both items that have had plenty of testing.
Some parts of modern medicine may have fallen through the gaps, but it's absolute nonsense that 'most' has. The bulk of medicine is boring stuff that no-one ever thinks about. Where modern medicine is weak is in preventative medicine.
This is nonsense. Most of medicine is evidence based. Most of what a surgeon does, for example, is being a glorified handyman - staple this bit to that, remove and replace this other bit, all of which has had ample opportunities for study and observation. Or riffling through a MIMS for pharmaceutical information, the bulk of which is backed by drug trials. Cut your finger? Apply some antiseptic perhaps, and cover with a band-aid, both items that have had plenty of testing.
Some parts of modern medicine may have fallen through the gaps, but it's absolute nonsense that 'most' has. The bulk of medicine is boring stuff that no-one ever thinks about. Where modern medicine is weak is in preventative medicine.
"A simple average of the findings of the preventive care studies shows that about 50 percent of people received recommended care. (None of the studies reported a percentage of people receiving contraindicated preventive care.) An average of 70 percent of patients received recommended acute care, and 30 percent received contraindicated acute care. For chronic conditions, 60 percent received recommended care and 20 percent received contraindicated care. These values do not indicate exact levels of quality in the United States, but they do provide a quantitative sense of how much could be done in all areas to identify and eliminate overuse and underuse of care." Source: http://www.innovationlabs.com/summit/summit3/readings/Schust...
In other words, the percentage of the U.S. population who receives medical treatment based on best practices isn't even close to 50%. And more often than not even doctors who follow clinical guidelines aren't actually following best practices, because most clinical guidelines aren't even correct:
"A study published in JAMA in 1999 evaluating the quality of [clinical] guidelines showed, ironically, that they often fall short of established standards. The following year The Lancet published a report that found that only one of the 20 clinical guidelines examined met established standards of quality for three simple criteria: description of the professionals involved in formulating the guidelines; description of the sources of information used to find the relevant scientific evidence; and grading of the evidence used to support the main recommendations.
In 2000, Canadian researchers from the British Columbia Office of Health Technology Assessment evaluated the quality of the guidelines that addressed the testing of cholesterol levels. They found that four out of five of these guidelines did not reflect the best scientific evidence available. The Canadian Researchers also found that 'the greater involvement of clinical experts in the development process of the clinical practice guidelines, the less of recommendations reflected the research evidence.'" Source: Overdosed America, p. 127
In other words, the percentage of the U.S. population who receives medical treatment based on best practices isn't even close to 50%. And more often than not even doctors who follow clinical guidelines aren't actually following best practices, because most clinical guidelines aren't even correct:
"A study published in JAMA in 1999 evaluating the quality of [clinical] guidelines showed, ironically, that they often fall short of established standards. The following year The Lancet published a report that found that only one of the 20 clinical guidelines examined met established standards of quality for three simple criteria: description of the professionals involved in formulating the guidelines; description of the sources of information used to find the relevant scientific evidence; and grading of the evidence used to support the main recommendations.
In 2000, Canadian researchers from the British Columbia Office of Health Technology Assessment evaluated the quality of the guidelines that addressed the testing of cholesterol levels. They found that four out of five of these guidelines did not reflect the best scientific evidence available. The Canadian Researchers also found that 'the greater involvement of clinical experts in the development process of the clinical practice guidelines, the less of recommendations reflected the research evidence.'" Source: Overdosed America, p. 127
How does 'simple average of 50%', 'average of 70% receiving recommended acute care' and '60% received recommended chronic care' somehow mean 'not even close to 50%'? They're all 50% or higher.
Also, there is a difference between 'not the best standards' and 'not evidence-based medicine'. What might have been the best standard when the doctor trained in 1980, gained from evidence, might have developed further. The doctor is still performing due to their evidence-based training; it's just not current best practises.
Also, there is a difference between 'not the best standards' and 'not evidence-based medicine'. What might have been the best standard when the doctor trained in 1980, gained from evidence, might have developed further. The doctor is still performing due to their evidence-based training; it's just not current best practises.
"Evidence-based medicine" is an ideal term for what we seek. Both our existing "mainstream" medical infrastructure and presently alternative therapies should be judged by how well they approximate this. Not all evidence is large, controlled studies - but they do constitute a particularly strong form of evidence.
"If I try something, and I feel better then I try more of it."
Conclusion: laudanum for everything!
Conclusion: laudanum for everything!
My favorite semi-facetious/sarcastic journal article: http://www.bmj.com/content/327/7429/1459
"Conclusions As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute."
And a less facetious one http://www.bmj.com/content/333/7570/701
Both of which point out obvious shortcomings of slavish reliance on large, randomized controlled clinical trials for every circumstance.
"Conclusions As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute."
And a less facetious one http://www.bmj.com/content/333/7570/701
Both of which point out obvious shortcomings of slavish reliance on large, randomized controlled clinical trials for every circumstance.
"Do you know what they call 'alternative medicine' that's been proved to work? Medicine."
(from http://www.altairiv.net/Storm.html)
(from http://www.altairiv.net/Storm.html)
This quip really annoys me. It only seems true because of a confusion or blurring of two very distinct concepts. There is tested treatment, which has been tested and come out effective. This can be put in dichotomy with untested or failed treatment. That is logical. Some treatments have been tested and passed some haven't. This is an entirely different dichotomy to that of mainstream and alternative or complementary medicine. Many forms of medicine have been thoroughly tested and come out effective and are not offered by pharmacies and national health services. Unless you want to claim that absolutely all proven effective treatment is offered by mainstream medical providers then this has to be acknowledged. Then on the other side there is a large array of medicine that is provided by mainstream medical providers that has not been proven effective. Many antidepressants consistently score the same or worse than a placebo in blind tests.
The distinction between alternative medicine and mainstream medicine is not proof, but the provider. So while Minchin may be eloquent he is confusing terms to make his point.
The distinction between alternative medicine and mainstream medicine is not proof, but the provider. So while Minchin may be eloquent he is confusing terms to make his point.
The difference is not in the provider, but in what is being provided. Alternative providers provide alternative medicine. What you call "mainstream" providers provide tested, evidence-based medicine.
Certainly there are some who provide both, but they should probably know better.
Certainly there are some who provide both, but they should probably know better.
> What you call "mainstream" providers provide tested, evidence-based medicine.
I think there is more nuance than that. Modern medicine is a mix of things that people have been doing for a long time and things that newer that are proven to work in randomized, controlled trials (for certain values of "work").
The things we've been doing for a long time might not work.
An important difference between the field of modern medicine and the field of alternative medicine, in my biased view, is that modern medicine actively attempts to figure out what works based on evidence, and evidence hugely changes practice and standards of care. In contrast, I do not believe that the same is equally true in general in alternative medicine, at least not with well designed studies.
I think there is more nuance than that. Modern medicine is a mix of things that people have been doing for a long time and things that newer that are proven to work in randomized, controlled trials (for certain values of "work").
The things we've been doing for a long time might not work.
An important difference between the field of modern medicine and the field of alternative medicine, in my biased view, is that modern medicine actively attempts to figure out what works based on evidence, and evidence hugely changes practice and standards of care. In contrast, I do not believe that the same is equally true in general in alternative medicine, at least not with well designed studies.
Exactly. Of the 11,714 drugs approved for marketing by the FDA, ~7,624 (65%) of them were approved with absolutely zero evidence of either safety or efficacy because they were grandfathered in by the 1962 amendments of the pure food and drug act.
But of course the folks that big pharma pays to astroturf on Internet forums will never tell you that.
But of course the folks that big pharma pays to astroturf on Internet forums will never tell you that.
Eh, I think the quip is entirely an appropriate expression of how things should work. It is also not horrifically inaccurate as a description of how things do work, 1) as far as it goes, and 2) in the medium to long term. Both of these caveats are important. It does not say that all mainstream medicine is proved - we should hopefully be moving in that direction, particularly with the EBM push, but while granting there is a lot of baggage the comment does not say "everything we call medicine is alternative medicine since proved", it says "when we prove alternative medicine, it just becomes medicine" - which it does, eventually, as demonstrably effective treatments are adopted by mainstream practitioners - which, over time, they do tend to be.
The implication in this quip is that anything that is proven to have positive medical value will end up being accepted into the mainstream.
Counter-example: http://en.wikipedia.org/wiki/Medical_cannabis
How many decades has it taken?
Counter-example: http://en.wikipedia.org/wiki/Medical_cannabis
How many decades has it taken?
Eight, more or less, and at the start of that period, scientific medicine was barely out of infancy. I don't believe anyone has suggested that either perfect wisdom, or immunity to political considerations, are among the traits of that field of science.
The problems with this are that:
1) You're implying that the vast majority of effective treatments are alternative medicine, and saying that 100% of effective treatments were at one point alternative medicine.
2) Most of what you refer to as medicine has not, in fact, been proven to work. In the U.S. (and all other countries) there is no legal requirement to prove that a drug is safe or effective before selling it, you only need to provide weak evidence that the drug is plausibly safe and effective. Oh, and you're also allowed to purposely bias the trials as much in order to produce this modicum of required evidence.
I think it's funny that the people who believe the most in medicine (and science in general) are the ones who don't read many books. Although to be fair that's exactly the same as with every other field. But still, I feel like statements like the above basically just glorify our culture of ignorance.
1) You're implying that the vast majority of effective treatments are alternative medicine, and saying that 100% of effective treatments were at one point alternative medicine.
2) Most of what you refer to as medicine has not, in fact, been proven to work. In the U.S. (and all other countries) there is no legal requirement to prove that a drug is safe or effective before selling it, you only need to provide weak evidence that the drug is plausibly safe and effective. Oh, and you're also allowed to purposely bias the trials as much in order to produce this modicum of required evidence.
I think it's funny that the people who believe the most in medicine (and science in general) are the ones who don't read many books. Although to be fair that's exactly the same as with every other field. But still, I feel like statements like the above basically just glorify our culture of ignorance.
> I think it's funny that the people who believe the most in medicine (and science in general) are the ones who don't read many books.
This is an odd statement. It's certainly true that as people learn more about a subject, they tend to realize how much they don't know and become more humble. But that doesn't mean that they start preferring non-science methods, which it seems like you are implying.
This is an odd statement. It's certainly true that as people learn more about a subject, they tend to realize how much they don't know and become more humble. But that doesn't mean that they start preferring non-science methods, which it seems like you are implying.
Firstly I find it amazing that people would argue against "Evidence Based Medicine" at all. Isn't the alternative "Medicine without a shred of evidence that it works"? Why would that even deserve the name "medicine"?
Secondly, I find it scary that there is so much tip-toeing around charlatans selling snake oil. It seems similar to when the British Chiropractic Society sued Simon Singh [1] for libel, and then had to back down as they couldn't actually prove that chiropracty was at all based on scientific evidence. These scammers need to be called out and challenged. If you want to sell something as "medicine" (at least in the USA) it had better get FDA approval [2], and classification as a "drug". Although this approval process still leaves the onus for testing on the drug developer, it also provides a means for FDA dis-approval if the drug is subsequently found to be dangerous or ineffective. Not perfect, but better than nothing.
I really feel that science and evidence are losing in this battle due to the lack of PR and marketing. Last year saw the release of a few major studies showing the lack of strong evidence for the efficacy of multivitamins [3]. This hasn't stopped almost everyone I know from still buying and popping those pills all the time.
[1]: http://en.wikipedia.org/wiki/BCA_v._Singh [2]: http://www.fda.gov/Drugs/DevelopmentApprovalProcess/HowDrugs... [3]: http://www.medicaldaily.com/vitamins-and-supplements-waste-y...
Secondly, I find it scary that there is so much tip-toeing around charlatans selling snake oil. It seems similar to when the British Chiropractic Society sued Simon Singh [1] for libel, and then had to back down as they couldn't actually prove that chiropracty was at all based on scientific evidence. These scammers need to be called out and challenged. If you want to sell something as "medicine" (at least in the USA) it had better get FDA approval [2], and classification as a "drug". Although this approval process still leaves the onus for testing on the drug developer, it also provides a means for FDA dis-approval if the drug is subsequently found to be dangerous or ineffective. Not perfect, but better than nothing.
I really feel that science and evidence are losing in this battle due to the lack of PR and marketing. Last year saw the release of a few major studies showing the lack of strong evidence for the efficacy of multivitamins [3]. This hasn't stopped almost everyone I know from still buying and popping those pills all the time.
[1]: http://en.wikipedia.org/wiki/BCA_v._Singh [2]: http://www.fda.gov/Drugs/DevelopmentApprovalProcess/HowDrugs... [3]: http://www.medicaldaily.com/vitamins-and-supplements-waste-y...
> Firstly I find it amazing that people would argue against "Evidence Based Medicine" at all. Isn't the alternative "Medicine without a shred of evidence that it works"?
You're reading too much into the name. Suppose I discover that whenever I eat carrots I get a horrible rash the next day. I track it carefully and find the effect is 100% reproducible. Eat carrots for a week, have a rash for a week; stop eating carrots for a week, it goes away. Eat them again, it comes right back. I cycle several times, the effect persists.
That is pretty powerful evidence that the right medicine for my rash is to avoid eating carrots. But this sort of knowledge doesn't count as "evidence" under EBM because it wasn't part of a massive random controlled trial. And it never COULD count as evidence under EBM because nobody can profit by the advice "stop eating carrots" enough for it to be worth doing a massive placebo-controlled random trial - "not eating carrots" can't be patented.
So long as FDA-type drug tests are ridiculously expensive, there is bound to be a LOT of perfectly valid medicine that IS evidence-based - there's evidence for it - but doesn't count as "evidence based medicine" according to the EBM enthusiasts.
You're reading too much into the name. Suppose I discover that whenever I eat carrots I get a horrible rash the next day. I track it carefully and find the effect is 100% reproducible. Eat carrots for a week, have a rash for a week; stop eating carrots for a week, it goes away. Eat them again, it comes right back. I cycle several times, the effect persists.
That is pretty powerful evidence that the right medicine for my rash is to avoid eating carrots. But this sort of knowledge doesn't count as "evidence" under EBM because it wasn't part of a massive random controlled trial. And it never COULD count as evidence under EBM because nobody can profit by the advice "stop eating carrots" enough for it to be worth doing a massive placebo-controlled random trial - "not eating carrots" can't be patented.
So long as FDA-type drug tests are ridiculously expensive, there is bound to be a LOT of perfectly valid medicine that IS evidence-based - there's evidence for it - but doesn't count as "evidence based medicine" according to the EBM enthusiasts.
The problem is not with the concepts of SBM and EBM but with the fact that they are not understood and applied well by doctors, and often just translate into not being able to think beyond 'results' handed down from the establishment.
It would be nice if we had some sort of independent research verification system. Basically a group or individual that validates the most important (or highest paying) publications.
I still don't understand why a consortium of insurance companies doesn't run studies looking for better outcomes with out-of-patent and un-patented drugs.
Their tests would be of already approved drugs.
In many situations they could save a bundle and in others they would dissuade drug companies from pushing the advertising and costs.
The statistics on everything they test would show their general level of bias (assuming drugs aren't getting any worse.)
Their tests would be of already approved drugs.
In many situations they could save a bundle and in others they would dissuade drug companies from pushing the advertising and costs.
The statistics on everything they test would show their general level of bias (assuming drugs aren't getting any worse.)
Many insurance companies (I think that now perhaps all of them in the US, thanks to ObamaCare) have to pay out a certain percent of what they take in to health providers. Thus if they want to increase premiums, and therefore profits, the only way to do it is to increase the cost of care. Preferably, they increase the cost of care for everyone, which drives more people to buy insurance, and means that some other company isn't able to undercut them on premiums by reducing costs. Of course, they als get more float, which insurance companies love. That is the model that health care insurance companies follow, and ObamaCare was a huge gift to helping them out.
Um, no offense, but do you have any idea what insurance companies are really all about? That sounds, well, crazy to me (as someone with a) a serious medical condition and b) who used to work for an insurance company).
Because if treatment gets cheaper they have less business?
We do - cochrane reviews (http://www.cochrane.org).
From their about us page:
"Cochrane is a global independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making the vast amounts of evidence generated through research useful for informing decisions about health. We are a not-for-profit organisation with collaborators from over 120 countries working together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest."
From their about us page:
"Cochrane is a global independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making the vast amounts of evidence generated through research useful for informing decisions about health. We are a not-for-profit organisation with collaborators from over 120 countries working together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest."
Evidence-based medicine.
As opposed to what, speculation-based medicine? Call me old-fashioned, but shouldn't all modern medicine be 'evidence-based' by definition??
As opposed to what, speculation-based medicine? Call me old-fashioned, but shouldn't all modern medicine be 'evidence-based' by definition??
> As opposed to what, speculation-based medicine?
Well, yes. The idea is that "speculation-based medicine" (better known as "alternative medicine") is, despite the name, not actually medicine.
Hence the Tim Minchin joke: "You know what they call alternative medicine that's been proved to work? ...Medicine."
Well, yes. The idea is that "speculation-based medicine" (better known as "alternative medicine") is, despite the name, not actually medicine.
Hence the Tim Minchin joke: "You know what they call alternative medicine that's been proved to work? ...Medicine."
I wasn't under the impression that alternative medicine was the only thing that was not "evidenced based" - that while clearly it's an extreme example, there is plenty of traditional medicine that doesn't make the cut. Wikipedia seems, at a skim, to concur: http://en.wikipedia.org/wiki/Evidence-based_medicine
Evidence-based techniques can become discredited when the state of the science advances, and I would agree that those techniques would not then become "alternative medicine"... unless perhaps they remain in practice. Unless somebody is still doing it, I'd just call it "discredited".
Things like psychoanalysis do not typically get the "alternative medicine" label, but they probably should.
Things like psychoanalysis do not typically get the "alternative medicine" label, but they probably should.
You'd think so, wouldn't you? However: http://en.wikipedia.org/wiki/Alternative_medicine
I don't know, there are plenty of cases where the stuff we thought qualified as "evidence", and definitely turned into medical practice, turned out to be wrong.
Examples: stress causing ulcers, cough medicine for children, diet (carbs good or bad? cholesterol horrible or inconsequential?), prostate cancer screening, certain kinds of corrective surgeries.
Examples: stress causing ulcers, cough medicine for children, diet (carbs good or bad? cholesterol horrible or inconsequential?), prostate cancer screening, certain kinds of corrective surgeries.
and like many orthopedic surgeries have turned out to be not better than noninvasive alternatives ( my personal pet peeve is the knee: http://www.nejm.org/doi/full/10.1056/NEJMoa1301408 , http://www.nejm.org/doi/full/10.1056/NEJMoa0708333 ).
In general surgical procedures are much more based on anecdotes and personal experiences (of the surgeons) than long term evidence of efficiency (for various reasons).
In general surgical procedures are much more based on anecdotes and personal experiences (of the surgeons) than long term evidence of efficiency (for various reasons).
Yes, thanks for digging that up. My wife had a knee operation for chondromalacia that turned out to be a mistake, but it was earnestly recommended at the time.
Hope she's doing well, I cannot recommend daily PT enough, that and diet (emphasis on anti-inflammatory nature) can produce amazing results. I've also had success with LLLT (http://en.wikipedia.org/wiki/Low_level_laser_therapy) but it may well be a placebo effect, the science of it is still kinda inconclusive. At least best to our knowledge so far it's non-harmful.
I remember hearing an interesting talk discussing this. I forgot the author, but I'll try to relate a bit of the content.
Doing proper experimental testing for surgeries often has significant ethical problems. For instance, to do it correctly you need to do "fake" surgery on some patients. This is to account for the placebo effect. However, doing this exposes the patient to health risks, which is arguably not ethical.
Then there is the tricky problem of the case where a technique does work, and not performing it causes a patient to die. Yes, they died in the name of science, but it still goes against the goals and ethics of many doctors.
On the other hand, performing ineffective surgery also exposes patients to significant risk, and may even cause death. So it's a really difficult topic.
Myself, I'd still like to see the experiments done, even if the cost if not saving some lives we could have at times.
Doing proper experimental testing for surgeries often has significant ethical problems. For instance, to do it correctly you need to do "fake" surgery on some patients. This is to account for the placebo effect. However, doing this exposes the patient to health risks, which is arguably not ethical.
Then there is the tricky problem of the case where a technique does work, and not performing it causes a patient to die. Yes, they died in the name of science, but it still goes against the goals and ethics of many doctors.
On the other hand, performing ineffective surgery also exposes patients to significant risk, and may even cause death. So it's a really difficult topic.
Myself, I'd still like to see the experiments done, even if the cost if not saving some lives we could have at times.
Terry, why do you regularly use racially charged language? I understand your meaning fine, I'm just curious whether there's any specific reason you use racial language so much, or if it's just sort of one of your things.
Did you put this comment in the wrong thread? There is no one named Terry here (the author of the submitted article is Steven Novella). It doesn't look like you read the article that was submitted to open this thread before you typed your comment here.
benched is replying to TempleOSV2, who is hellbanned.
I don't think that he is well; I wouldn't read to much into it.
I understand that he has schizophrenia, but they're people with thoughts and reasoning, too, though they may be more loosely aligned with the consensus style of cognition. For example, the statement he made makes perfect sense semantically - it's just said in a way that a lot of people find offensive.
>I understand your meaning fine
You do?
You do?
I thought the overall meaning was clear, no matter how poorly stated: "Doctors do not do calculus" -> "medicine is not a hard science" "People who are not in hard sciences should not be trusted"
Then he has the output of a markov chain or whatever that he seeded with biblical texts. You can safely ignore those sections.
Basically (racist language aside), his comment boils down to "Anyone who isn't STEM sucks." It would be an extremely low-quality comment even if it were articulated well.
Then he has the output of a markov chain or whatever that he seeded with biblical texts. You can safely ignore those sections.
Basically (racist language aside), his comment boils down to "Anyone who isn't STEM sucks." It would be an extremely low-quality comment even if it were articulated well.
I don't know. I think there's a variation of what he said that I'd agree with. Based on experience, my general opinion of medical doctors (good surgeons excepted) is pretty low. Like meteorologists, their heads may be filled with knowledge, but they aren't really held to ... anything. (Perhaps because both study highly complex systems, nobody expects them to be correct.) People in STEM are kept honest by things like mathematics, compilers, the laws of physics. (To be fair, those things are also regular and amenable to formalism, making them things one can be honest about.)
On the other hand, I take it as my own personal responsibility to take care of my own health. This means that I have to rely on a sample size of one. If I try something, and I feel better then I try more of it. My prescription for myself may not work for anyone else, it could be specific to me.
I personally believe that Western medicine is awesome because it is evidence based. At the same time, Western medicine has removed from the individual a sense of personal responsibility, and this must change.