View Full Version : "Evidence based medicine" we have a serious problem.


Kunga Dorji
06-16-15, 09:41 AM
Last time I checked. total evidence base in the health sciences was doubling every 7 years.

However for any practice to be accepted as evidence based in the profession of conventional medicine we need the agreement of a committee.
By definition the conservatism of conventional medicine means that a committee will be at least 5 years behind the evidence base before it publishes a written protocol.

One description of " a committee" is " a creature with 6 or more legs, a very large stomach and absolutely no brains".
I am sure that anyone with eyes that can see can see the problem inherent in this situation, and the lack of validity of the concept of "evidence based medicine" as preached by our regulatory authorities.

I qualified in 1985 so the "evidence base" is at least 16 times ad great as that which formed the nasis for my professional education as a doctor.

Anyone with eyes to can see should grasp this.
There is only one problem- of that massive expansion in the evidence base-- which bits are relevant?

I am pretty sure I have a handle on the big ones.
Do you?

KarmanMonkey
08-13-15, 10:35 AM
I had a discussion with someone just recently about the idea of evidence based practice:

Basically, if I only use interventions that have an established evidence base, how do I improve my practice? How do I try new approaches and create that new body of evidence?

Without risk and experimentation, we can never have change and improvement. And it is well established that any evidence base is useful as a general predictor of outcomes, but is a very poor way to adapt to an individual.

For example, studies have shown that given the same treatment and opportunities, women tend to outperform men in math and programming. Does this mean we should only teach math and programming to women? Does this mean that I can assume that a man in my class will perform poorly? Of course not!

Statistics are helpful in establishing trends, but not in responding to individuals and their needs.

dvdnvwls
08-13-15, 03:00 PM
The idea of being evidence-based is not a restriction on trying something different, nor is it a requirement that every new doctor (and only the new ones?!) learn everything that has ever happened since the beginning of time. It's simply a contrast with those authority-based systems (such as homeopathy, chiropractic, and astrology) where evidence is irrelevant or even bothersome to its practitioners.

I think the difference can be summed up in one little statement:

"We tried that a long time ago, and it didn't work."

What's special about that statement is that non-evidence-based practitioners don't say it - or at least they say it much too rarely and in an un-systematic way.

Many people today (and in all times I suppose) try to fix the failed authority-based systems around them by setting themselves up as the new authority. They always end up creating another failed system; it's just a matter of time. Making evidence the ultimate authority instead, is the only thing that works. Because we're human, many still try within the evidence-based system to set themselves up as authorities, and that is maddening and stupid and needs to be addressed - but not by tearing down the only thing (evidence as our authority) we have that has a chance of succeeding.

KarmanMonkey
08-14-15, 11:02 AM
It depends on how people weild that phrase, I suppose. In the context of the conversation the other day, the person was using it as an explanation on why they were not utilizing a technique; namely that there was not enough research to give clear evidence of its benefit. Not evidence that it didn't have benefit; just a lack of research.

I'd also argue that "we tried that a long time ago, and it didn't work." isn't always a strong argument. Especially when it comes to human systems, culture, attitudes, and technology make a world of difference!

In the 70s, people with developmental delays (then referred to as "retarded") couldn't work. There were some who tried to teach that population to live independently, and ultimately "proved" that it was not viable. For decades such people lived in institutions, and had no opportunities for growth or change.

Toward the turn of the century, people tried again. They used newer approaches, had a more accepting and understanding community, and a person centred approach. And lo and behold, most of the individuals could be quite successful.

Today there are even a larger portion of the population that are able to have productive lives, especially with the aid of assistive devices. I watched a video a little while ago of a youth (I think he was 15yo) who had been unable to communicate most of his life (for a combination of reasons), and as a result frequently became frustrated/agitated, dispondant, and had a great difficulty connecting to the world. He had never been able to participate in a classroom, needed constant professional care, and the family was considering placing him in long term care. 6 months after learning a tablet based communication tool, he was functioning at a high school level, and was making friends, and even securing a job.

Yes, that example also illustrates the need for new approaches, but it also illustrates how we must re-evaluate older conclusions and make sure that we are mindful of the impact of changing culture, understanding and technology.

I find that too often in practice and even in scholarly settings, people will quote and use studies and conclusions as if they were imutable gospell, when we need to look with a more critical eye.

Essentially there are plenty of authority-based systems that falsely believe they are acting in response to an evidence base.

My other criticism is when, especially in health care, doubly so in mental health, best practice and evidence-based approaches are often trumped by the public's expectations; that the hospital acts based on what the public and the families and the patients want/expect them to do, rather than acting based on what the evidence shows to be the best approach.

dvdnvwls
08-14-15, 01:35 PM
... 6 months after learning a tablet based communication tool, he was functioning at a high school level, and was making friends, and even securing a job.

Yes, that example also illustrates the need for new approaches, but it also illustrates how we must re-evaluate older conclusions and make sure that we are mindful of the impact of changing culture, understanding and technology.

I find that too often in practice and even in scholarly settings, people will quote and use studies and conclusions as if they were imutable gospell, when we need to look with a more critical eye.

I agree that these things are very important and too often overlooked parts of effectively using (and improving or maintaining the integrity of) the evidence-based system.