Evidence-based Medicine

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    Aug 30, 2007 4:07 AM GMT
    There were a number of threads relating to medical issues in which the subsidiary topic of whether personal experience (meaning, I ate a rutabaga and was cured of erectile dysfunction!) is important.

    First, I have to tell you that I do believe that personal experience IS important. However, most personal experience is biased, and is also not done under control settings. For example, the guy that ate the rutabaga and got the huge hard on finally had less stress in his life and met any one of the guys on my Hotlist...but I digress).

    There is actually a movement afoot in medicine called "Evidence-based medicine". It's not controversial in and of itself, but it is controversial because its birth is based in the misdiagnoses, tragedies etc. that arise when doctors use "seat of the pants" logic instead of science research. As my own personal doctor told me today, for every one story of insight out of the blue creating a cure, there are one hundred stories of insights out of the blue worsening illnesses, causing injuries (by misadvise) and, even, deaths.

    Take a look:

    Evidence-based medicine

    In my own field, I KNOW for a fact that "blind insight" from a person who does not know what has been done before and disproven, has created many more problems than it has solved.*

    *However, if a person DOES know all the research and DOES understand the scientific method, having "blind insight" IS wonderful and can lead to new discoveries (that, by the way, is what Einstein did do).

    John



    http://www.hsl.unc.edu/services/tutorials/EBM/index.htm

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    Aug 30, 2007 4:38 PM GMT
    Now, if only we could have evidence-based government. Oh, but then we'd have massive unemployment of people with nice suits and no useful skills.
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    Aug 30, 2007 5:48 PM GMT
    Mindgarden: There's a classic quote from Yes Minister ("The Challenge") in which Hacker (a Minister in Her Majesty's Government) has been given a brilliant plan by an academic to impose Failure Conditions on Local Government. Hacker is astounded and anticipates rapid promotion....

    Dr Cartwright: I fear I shall rise no further.
    Hacker: Whyever not?
    Dr Cartwright: Alas, I'm an expert.

    Ne'er a truer word was said, I fear!
  • art_smass

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    Aug 30, 2007 5:58 PM GMT
    I believe we're losing sight of the real issue here: Do rutabagas cure erectile dysfunction, or don't they?
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    Aug 30, 2007 7:12 PM GMT
    art_smass said: "...I believe we're losing sight of the real issue here: Do rutabagas cure erectile dysfunction, or don't they?..."

    That depends, of course, on what you do with the rutabaga.

    :-)
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    Aug 30, 2007 7:58 PM GMT
    Maybe that has something to do with why movie directors famously have non-speaking extras repeat the word, "rutabaga, rutabaga, rutabaga, rutabaga..."

    Oh, and I checked that Duke link, but I'm afraid that it looks more like just another management fad than anything useful.

    Also, Jasper Fforde explores, in his latest Thursday Next novel, the perils of efficient government. It can cause an alarming rise in the Stupidity Surplus, which must then somehow be grounded out with huge new legislation of astounding stupidity, lest it burst out in an uncontrolled fashion..
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    Aug 31, 2007 3:38 AM GMT
    Thank you thank you thank you. But I'm afraid as our society keeps moving in the direction of opinion being on par with facts real science, including medicine, is going to have an uphill battle with many people.

    And besides, it's not rutabagas that give ya hard-ons, it's beets. (Jitterbug Perfume?)
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    Aug 31, 2007 3:45 AM GMT
    Actually this was discussed at length in an earlier thread starring NYC. I did point him to several recent books that have in fact questioned evidence-based medicine. Here is the NY Review of Books article on the subject:

    http://www.nybooks.com/articles/20214
  • art_smass

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    Sep 01, 2007 4:59 PM GMT
    I found this quote online while researching rutabagas:

    "Eating plenty of flavonoid rich fruits and vegetables helps to support the structure of capillaries."

    Since erectile dysfunction can be linked to poor circulation, I believe I've discovered the evidence that eating rutabagas can improve the quality of your erection.

    I'm going to post a photo of myself eating one like it was an apple (or even a banana).
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    Sep 01, 2007 5:21 PM GMT
    When we know -everything- about -every- component of our body and -every- effect that -everything- has on it, then we can have 100% evidence based medicine.

    Until then, there will always be those "that's odd..." moments.

    It would be thoroughly unwise to fully reject one and fully embrace the other. It is a wise man that leaves his mind open to options and curious logic.
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    Sep 01, 2007 5:26 PM GMT
    OW pointed us to: http://www.nybooks.com/articles/20214

    That article summarizes some of the major flaws in the practice, currently of medicine in the US, as does mention the flaws of "evidence-based medicine."

    I do want to point out, though, a couple of things.

    First, the article also prominently mentions the major flaw of misdiagnosis, citing that 15% of diagnoses in the US are incorrect. Since the article itself is based upon statistics, this implies that doctors using evidence-based strategies will fail if they already made a misdiagnosis. So that's not really a flaw in evidence-based approach...but a flaw in the doctor's training, or powers of observation.

    Second, if you read the section critiquing evidence-based medicine, I think you'll agree that the author is really criticizing not the approach, but a misuse of the approach, in which doctors use a "binary" approach...meaning, the issues are black or white with no grey. For example, a patient may have a multitude of symptoms for which no exists protocol based in science exists. If he or she merely uses the protocol that most closely matches the symptoms, that doctor is misusing the concept of evidence-based medicine.

    In that latter case, the doctor better use some common sense and intuition to infer a proper treatment. That's not inconsistent with the evidence-based approach.

    I think the concept is better stated that doctors who use blind intuition (in other words, intuition not grounded in what the latest scientific findings are on the treatment of a problem) are doing their patients a disservice.

    Do we want to create a type of doctor who is merely a computer, spitting out a treatment only if the symptoms match exactly what has been shown to present for a disease? Of course not.

    Finally, to show you that I believe that non-traditional approaches do work...I offer the fact that I started to use ZiCam about 10 years ago (a homeopathic treatment for incipient colds) on the advice of friends who claimed it was miraculous. Guess what. It WAS miraculous. Systematically, every time I feel a cold coming on I put that stuff in my nose (it has the consistency of vaseline), and I have either forestalled the cold, or the symptoms I have experience during the cold are lessened and totally different (I always started with a sore throat...I have not had a sore throat since I started using Zicam).

    And now, there IS clinical (double blind) evidence that Zicam works.

    John

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    Sep 01, 2007 6:59 PM GMT
    I've been using Zicam for years, too. I am curious, though, why it calls itself a homeopathic remedy.
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    Sep 01, 2007 7:08 PM GMT
    Marketing. Well that would be my guess.