Tag Archives: EBM

Alternatives to Opioids in Medication for Pain

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

  • prospective,
  • randomized-controlled,
  • blinded studies

on the use of non-opioid analgesics for the most common non-cancer chronic pain conditions.    Continue reading

Anti-intellectualism and its impact on physicians

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

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

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

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

Population Risk Does Not Equal Individual Risk

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 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

Renewing Medicine’s basic concepts: on ambiguity

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

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