Should we beware the tyranny of the randomized controlled trial? | Association of Health Care Journalists – by Tara Haelle (@TaraHaelle) – Jan 2017
The intersection of scientific research, evidence and expertise can be a dicey one, particularly in an age in which evidence-based medicine is replacing the clinical expertise of practitioners.
In The New York Times Sunday Review, Jamie Holmes wrote about how the challenge of assessing the quality of evidence against expertise and less stringently conducted research can lead readers to confusion and frustration.
It can lead to a further distrust of science, Holmes suggested, noting the example of dental flossing in the wake of an Associated Press story that questioned the evidence in favor of the practice. Continue reading
The Levels of Evidence and their role in Evidence-Based Medicine – free full-text /PMC3124652/ – Jul 2012
This article explains how different kinds of evidence for different types of studies are graded. It makes even clearer the crime of the CDC to allow a bunch of addiction specialists to issue practice guidelines out of their area of expertise based on low-quality evidence.
As the name suggests, evidence-based medicine (EBM), is about finding evidence and using that evidence to make clinical decisions.
A cornerstone of EBM is the hierarchical system of classifying evidence. This hierarchy is known as the levels of evidence.
it is important to understand the history behind the levels and how they should be interpreted. This paper will focus on the origin of levels of evidence, their relevance to the EBM movement. Continue reading
Alternatives to Opioids in the Pharmacologic Management of Chronic Pain Syndromes: A Narrative Review of Randomized, Controlled, and Blinded Clinical Trials – free full-text /PMC5785237/ – 2018 Nov
This recent review finds that there is very little evidence beyond a few weeks for the “effectiveness” [see qualification at end of review] of any non-opioid medication that has some beneficial effect on pain.
The goal of this review was to report the current body of evidence-based medicine gained from
- blinded studies
on the use of non-opioid analgesics for the most common non-cancer chronic pain conditions. Continue reading
American anti-intellectualism and its impact on physicians – KevinMD | Karen S. Sibert, MD | Physician | Nov 2018
Our country is increasingly controlled by corporations throwing their massive financial weight behind any new opportunity for profit, especially in the high-tech and medical spheres where so much money is to be made.
Issues that used to be considered in terms of social or moral values, like crime and healthcare, are now redefined on corporate financial statements, where they are evaluated on the basis of profit or loss, while moral concerns have evaporated under the hot sizzle of high finance.
The “practice of medicine”, once a proud, independent, and highly intellectual profession, has been eviscerated by increasing standardization. Diagnosis is a computed decision tree and treatment is ordered by universal guidelines, in an effort to create “mix and match” or “plug and play” interchangeable “units of healthcare”. Continue reading
The trouble with Meta-Analyses – Thoughts About How They Should Contribute to Medical Science and Practice – by Milton Packer – Nov 2017
Many have critically examined the methodology of meta-analysis, and others have set standards for their execution. Despite such guidance, meta-analyses continue to proliferate, but we should ask: do they really contribute?
Esteemed organizations regard the conclusions of a well-executed meta-analysis as a higher level of evidence than a single well-done clinical trial.
This commentary explains why this cannot possibly be true. Continue reading
Systematic Pushback Against Evidence-Based Medicine | The Accad & Koka Report – By Michel Accad | Dec 2018
After what I’ve experienced as a patient with an invisible genetic defect, I realize that the drive to standardize healthcare (to lower costs) can be damaging to those of us who are far from the “average” patient (who does not and cannot exist).
Additionally, I no longer trust the “evidence” upon which “Evidence-Based Medicine” (EBM) rests because it’s produced by research that can be too easily swayed by financial interests. (See Biased Research due to Financial Influence)
When Gary Klein told us that he had co-authored a paper critical of evidence-based medicine (EBM), it was music to my ears. I quickly dug into his bibliography and found the paper in question, written by Klein and his team: “Can We Trust Best Practices? Six Cognitive Challenges of Evidence-Based Approaches.” Continue reading
Evidence-Based Medicine: Common Misconceptions, Barriers, and Practical Solutions – JAY SIWEK, MD, Georgetown University Medical Center, Washington – Sep 2018
More than 25 years have passed since the term evidence-based medicine (EBM) was introduced into the medical literature. Its original definition has been expanded to include not only the quality of the evidence, but also the two key players applying the available evidence—namely the clinician and patient.
A current working definition is: the integration of the best available evidence with clinical expertise and the individual patient’s values, preferences, and unique circumstances.
EBM is not dogmatic, “cookbook ” medicine.
Oh really? But that’s exactly how it’s being used. Continue reading
Risk In Perspective: Population Risk Does Not Equal Individual Risk – April 4, 2018 – This series is a collaboration between neuroscientist Alison Bernstein and biologist Iida Ruishalme.
Errors in risk perception are at the core of so many issues in science communication that we think this is a critical topic to explore in detail
Population risk is not the same as individual risk
We tend to think in very small sample sizes (after all, what happens to me and my family must be most important, right?) and not in terms of populations (which is how epidemiological statistics are calculated).
However, scientists measure population risks. Continue reading
Does evidence-based medicine adversely affect clinical judgment? | The BMJ
For practical and theoretical reasons, says Michel Accad, evidence based medicine is flawed and leads to standardised rather than excellent individualised care, but
Darrel Francis argues that it protects patients from seemingly rational actions that cause more harm than good.
This is an interesting conflict arising when EBM, which is population-based, runs into individualized medicine, which is mostly based on a doctor’s judgment. Continue reading
Renewing Medicine’s basic concepts: on ambiguity | Philosophy, Ethics, and Humanities in Medicine | Full Text – April 2018
Edmund Pellegrino lamented that the cultural climate of the industrialized West had called the fundamental means and ends of medicine into question, leading him to propose a renewed reflection on medicine’s basic concepts, including health, disease, and illness.
My aim in this paper is take up Pellegrino’s call. I argue that in order to usher in this renewal, the concept of ambiguity should take on a guiding role in medical practice, both scientific and clinical.
Ambiguity = reality. Especially in humans, there are endless variations of the intricate machinery that guides our internal bodily processes, but these are obscured when studies look only at cumulative averages. (an “average” human has one breast and one testicle) Continue reading