Tag Archives: EBM

Misconceptions about Evidence-Based Medicine

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

Does EBM adversely affect clinical judgment?

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

Integrative Medicine Co-opts Pain Tx in Opioid Crisis

The effort of integrative medicine advocates to co-opt the opioid crisis to claim non-pharmacological treatments for pain as solely theirs continues apace – Science-Based Medicine – David Gorski on January 29, 2018

integrative medicine advocates are co-opting the opioid crisis as a “rationale” for integrating quackery into medicine for the treatment of chronic pain.

What we have here is an example of one of the most powerful forces promoting the “integration” of pseudoscience and quackery into medicine continuing to do so by, yes, taking advantage of the opioid crisis to present its unscientific, pseudoscientific, and mystical prescribed solutions to the crisis.   Continue reading

Spinal Surgery Does Not End Opioid Use for Pain

Expectations Versus Reality: Spinal Surgery Does Not End Opioid Use for Pain – RELIEF: PAIN RESEARCH NEWS, INSIGHTS AND IDEAS By Stephani Sutherland – July 2018

People seeking medical treatment for back pain often end up in a surgeon’s office.

Most of those individuals hope—and expect—that surgery will reduce their pain enough to make opioid painkillers unnecessary after the operation.

But that scenario seems to be the exception rather than the rule, according to a new report published in the journal PAIN.   Continue reading

Problems with Evidence Based Medicine

This is a collection of 5 articles I wandered through following links from an initial post on the healthcare blog Alert & Oriented by Michel Accad, MD, including excerpts from 3 linked blog entries and 2 linked PubMed articles.

The Statistical Alchemy of Meta-Analyses – Alert & Oriented – Michel Accad, MD – July 2011

remarkable article Alvan Feinstein wrote in 1995 “Meta-Analysis: Statistical Alchemy for the 21st Century.”  In a few clearly written pages, the founding father of clinical epidemiology brilliantly identifies the wishful thinking underlying meta-analysis and exposes its methodological fallacies.   Continue reading

Ban of the Term “Evidence-Based Medicine”

Why Evidence-Based Medicine is Not Going Away, Despite Alleged Ban of the Term – December 20, 2017 – By Angie Drakulich

The scientific community has been incensed—as well as confused—by the past week’s [Dec 2017] alleged ban/unban of certain words by the Trump administration in connection with the US Centers for Disease Control and Prevention’s 2019 budget proposals.

Among other terms, “evidence-based” and “science-based” were called into question.

Some practitioners have scoffed at the terminology, especially after the 2016 CDC guidelines on prescribing opioids emerged, noting that the most effective way to treat a patient is through a case-by-case, personalized approach .

Individualized medicine may be especially pertinent when long-term, large population studies are lacking for certain complex, comorbid, lifelong, or rare diseases and conditions.

Practical Pain Management collected feedback from its editorial advisory board members.

This group of clinical, pharmacological, research, and academic professionals work day in and out in to assess, diagnose, and treat patients living with chronic pain conditions.

The following comments contribute to the conversation at stake.

Administrators and politicians think it [evidenc-based medicine] means physicians using diagnostic and management algorithms developed externally for the purpose of standardizing medicine and lowering its cost.

There it is: our government is trying to standardize our medical care to save money.

If it only takes a blood test and computer algorithms to process the results to determine the correct diagnosis and treatment of a patient, expensive doctors would no longer be needed for most care.

They are essentially trying to replace our primary care providers with fancy equipment and computers.

This is what I’ve also been saying all along: the practice of medicine can’t be “standardized” because the proper practice of medicine involves the examination of and determination of care for individuals, who differ greatly in their presentation and internal biological situation.

“Before I would be willing to develop a response to any attempt—political or otherwise – to sideline EBM, I would require a better understanding of the argument against EBM and the logic behind the attempt. I would also wish the opponent to better understand EBM.”

-I. Jon Russell, MD, PhD, ACR Master, Fibromyalgia Research and Consulting, Texas

“These expressions come and go. The National Science Foundation has to find homonymous expressions that relay the same meaning.

For someone like me who spent his childhood behind the Iron Curtain, this was a favorite task that people actually enjoyed doing to fight the communists. 

So Dr. Sella implies that we are living during a time in American history where scientists must find clever expressions to describe phrases, like evidence-based medicine, in politically approved language.

Rules dictating what words cannot be used in federal documents is practically the definition of censorship.

The advent of the curtailing of freedoms in our country may give some room for thought to the people who looked down at those living under the Iron Curtain.”

-Gabe Sella, MD, MPH MSc, PhD, Ohio Valley Medical Center, Wyoming

The absurdity and wrongfulness of dictating what words can be used is an insult to science and our nation. If we don’t champion evidence-based or science-based medicine, we might as well return to the age of witchcraft, blood-letting, and snake-oil salesmen.”
-Don L. Goldenberg, MD, Oregon Health Services University, Oregon

“The lack of the use of evidence-based medicine is one of the many reasons for the travesty that is the CDC Guidelines. Failure to use evidence-based or scientifically based data to create guidelines or use them to write certain medical and scientifically based literature would, many times, reduce the work to anecdotal information, or even bobe-mayse (fairy tales) for those who care.”

-Gary W. Jay, MD, Neurology, University of North Carolina

“Interestingly, the ‘PharmacoMafia’ has to find evidence of only 5% above average placebo of 35% to claim a drug is ‘effective.’

No drug is 100% effective and virtually all produce complications called side effects. The bottom line is: What does effective mean? And what does evidence- or science-based mean?”

-Norman Shealy, MD, PhD, International Institute of Holistic Medicine, Missouri

I do believe that clinicians must use common sense and not always rely exclusively on evidence-based medicine in an effort to treat the individuality of each patient

To eliminate both in discussions and official documents propagates lawlessness to government and the clinicians that care for patients.

A case in point is the recent publication ‘Safety Concerns with the Centers for Disease Control Opioid Calculator’ (Fudin et al) which explains the Wild-Wild-West mentality that was allowed in the development of the controversial 2016 CDC guidelines on opioid prescribing, and the risk to patients from their non-evidence/non-science based online opioid conversion calculator.”

Safety concerns with the Centers for Disease Control opioid calculator – Free full-text PMC article
-Jeffrey Fudin, PharmD, DAIPM, FCCP, FASHP, Remitigate, New York; Western New England University College of Pharmacy; Albany College of Pharmacy and Health Sciences

“As a scientist, of course I am evidence- and scientifically based, but as a working clinician, I am much more open to the concept of new uses for older medications.

If we do consider ourselves as the pioneers of pain management, then we ought certainly do no harm, but we also owe our patients the best efforts, within our specialties and interests. And our strong desire is to help the ones in need.”

-John Claude Krusz, MD, PhD
Anodyne Headache, PainCare & Well-Being, Texas

As scientists and policymakers pave their way through the terminology of today, the most swaying impact comes down to the patient level and what treatment will provide them with the most safe, effective, long-term outcome.

When medicine no longer pursues that goal and is controlled by government policies instead of medical knowledge and experience, we are all in deep trouble.

Original article: Why Evidence-Based Medicine is Not Going Away, Despite Alleged Ban of the Term

 

“Evidence-Based Medicine”: Corporate Corruption

“Evidence-Based Medicine”: Corporate Medicine’s Corrupted Instrument. – Oct 2017 – Hooman Noorchashm MD, PhD

Science is being used against pain patients to satisfy legislative/corporate priorities, like reducing the milligrams of opioid doses instead of reducing pain’s impact on our functionality.

The idea of “Evidence-based medicine” is probably one of the most successful marketing tools ever commandeered by a corporate entity.

In its purest form “evidence-based medicine” is a clinical exercise in the scientific method — an attempt to make the “art of medicine” as scientific and “standardized” as possible.  Continue reading

What We Mean by Evidence-Based Medicine

What We Mean When We Say Evidence-Based Medicine – The New York Times– Dec. 27, 2017 – By Aaron E. Carroll

In medicine, the term “evidence-based” causes more arguments than you might expect. The mission of “evidence-based medicine” is surprisingly recent.

Before its arrival, much of medicine was based on clinical experience. Doctors tried to figure out what worked by trial and error, and they passed their knowledge along to those who trained under them.

Considering the current proliferation of guidelines for all kinds of medical care, perhaps the old method wasn’t so bad…   Continue reading

How Do We Know What Treatment Works?

How Do We Know What Treatment Works? – National Pain Report

We’re often told that alternative medicine is unproven and pharmacological treatments are well validated. Is this true?

It’s important for patients to understand

  • the many factors that go into creating the body of medical evidence available,
  • the degree of reliability of that information, and
  • its applicability to their specific situation.

I used to believe that “evidence-based medicine” was a good idea. Then I began noticing how poorly designed and numerically manipulated so much of the research is.  Continue reading

Got real rights? Not when seeking health care

Got real rights? Not when seeking health care – John T. James, PhD and Michael F. Mascia, MD, MPH | Patient | November 18, 2017

Until genuine rights are extended to all patients, the ongoing health-care-reform saga perpetrated by Congress and executive leadership will continue to fail the American people.

Many Americans have suffered and died because of a broken health-care-delivery system.

One of us lost a 19-year old son due to lack of certain patient rights – specifically the right to evidence-based medicine and the right to a complete discharge plan from his hospital. Continue reading