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.  

Cautious but Compassionate Approach to Opioids

This is a wonderful article and a pleasure to read. The author, Carlyn Zwarenstein, puts into words what it’s like to live with chronic pain and how opioids allow her to have a life that ankylosing spondylitis would steal from her.

I’ve only skimmed some excerpts from what is a thorough and clear-headed article:

Let’s Have a Cautious but Compassionate Approach to Opioid Prescribing A patient’s perspective on living with chronic pain in the midst of an opioids crisis – 4/4/18 – by Carlyn Zwarenstein  

Frustrating things about being chronically ill

The most frustrating things about being chronically ill – Toni Bernhard, JD | November 22, 2017

This piece focuses on frustrations that are unique to those with ongoing health issues.

I’ve experienced all of them as a result of being chronically ill with a debilitating illness that settled in after I contracted what appeared to be an acute viral infection in 2001.

Here are nine things I find most frustrating about being chronically ill — in no particular order of intensity; that depends on the day!  

In My Chronic Illness, I Found a Deeper Meaning

In My Chronic Illness, I Found a Deeper Meaning – The New York Times – Jan 18 – by Elliot Kukla

I’m not usually a fan of “I accepted my pain, so it got better” stories because they so often reach an overly optimistic and, to me, unrealistic, outcome. But this essay paints a far more realistic picture of what acceptance might look like and how it could be nurtured.

…I had discovered that I was no longer trusted by my doctors about my own body or experiences.

I reported odd, terrifying and sudden physical changes; they recommended cognitive behavioral therapy and Weight Watchers. I felt exiled from the world of the well, isolated by thick walls of suspicion.  

Pain management, Rx opioid mortality, and the CDC

Pain management, prescription opioid mortality, and the CDC: is the devil in the data? –  J Pain Res. Oct 2017; 10: 2489–2495.

Transparency, freedom from bias, and accountability are, in principle, hallmarks of taxpayer-funded institutions. Unfortunately, it seems that at least one institution, the Centers for Disease Control and Prevention (CDC), continues to struggle with all three.

What began with a prescribing guideline created in secrecy has now evolved to the use of statistical data and public statements that fail to capture not only the complexity of the problem but also the distinction between licit and illicit opioids and their relationship to the alarming increase in unintentional overdose.  

Pain – Thomas Dikel

Pain – Thomas Dikel – Medium

Pain is largely a misunderstood construct.

This is odd, as everyone has experience with pain, and it has been studied extensively. Nevertheless, it remains a mystery, even to those who believe they know it best.

What we understand as pain is not a unilateral function. There are in fact two basic and primary components to pain.  

Learning From Pain – Quinn Norton

Learning From Pain – Quinn Norton – Medium – Quinn Norton – Sept 2017 – On living a continuously interrupted life

This is a wonderfully accurate description of what it’s like to live with chronic pain:

I made a lot of big plans. Plans are hope. They necessitate a future that is not only different from, but also better than, the present.

But plans are fragile, little crystalline thoughts that must be carried from place to place cupped in a steady hand that is always slightly too small to carry them, breathing even, or even held, until they can be put somewhere safe.

The first and most persistent thing pain will teach you is patience, and that’s the hardest thing to learn when time feels limited. 

Being Sick versus Being Chronically Ill

The Differences Between Words That Describe Being Sick | The Mighty | March 2017 | by Ashley Seymour

When talking with someone coping with chronic illness, you might find yourself trying to relate to their experiences. You’re probably coming from a kind and caring place and looking to sympathize, but you may not realize that when you say things like “Oh I know just how you feel! I was so exhausted after work the other day!” or “I was so sick with the flu last week. It’s taken me forever to recover!” you make it obvious that you are far from truly understanding.

It’s not really your fault, though. 

CRPS, Chronic Pain and America’s war on painkillers

CRPS, Chronic Pain and America’s war on painkillers – BLB Soliciters – April 2017 | Written by Libby Parfitt

Headlines scream and terrify: “How the opioid epidemic became America’s worst drug crisis ever”, “America’s indiscriminate killer”, “Inside a Killer Drug Epidemic”.

The papers are full of hollow-eyed people telling their sad stories, starting with a doctor’s appointment for a bad back, ending with scoring heroin on a street corner.

If you heed only these headlines, you’d probably expect me to be a shambling, semi-conscious being, barely capable of functioning as an adult and concerned only with where my next tablet is coming from.

The Reality of Living With Fluctuating EDS Symptoms

The Reality of Living With Fluctuating Fibromyalgia Symptoms | The Mighty – April 2017 Mattea Sykes

This article was mistitled because it is actually about EDS. 

Many people start each day with a refreshing shower, and then go to work or achieve their tasks for the day, thinking of it as nothing more than a quick way to wake up.

But for some people, like those with Ehlers-Danlos syndrome, fibromyalgia, multiple sclerosis, rheumatoid arthritis or lupus SLE, it is the entire day’s chore, hard work and achievement that involves a great deal of time, pain, effort, endurance and spoons.  

 

Here is a summary of two consecutive days from this week to show the reality of living with a fluctuating condition.

Mattea goes on to deliver a blow-by-blow narrative of a couple of days with EDS: The Reality of Living With Fluctuating Fibromyalgia [EDS] Symptoms