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The Rise and Fall of Evidence Based Medicine (1998) [pdf]

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Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#11
post #6

I am sure I miss the context but I guess the point is that authors were sick of hearing about the promise of statistical analysis and epidemiology which will outperform classical medical approach - slandering the BMJ several times for some reason. Even today we see some hanger-ons who assert that their way is the best way - that they know from personal medical cases and their opinion and interpretation is more valuab…

Yes and no,

Statistics have an inherent weakness when you don’t have consistent buckets to place everything into. If individual specialists classify cases differently they really can see statistically valid numbers from relatively few cases where double blind studies using different classification criteria see improvements below the noise floor.

Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#12
post #6

I am sure I miss the context but I guess the point is that authors were sick of hearing about the promise of statistical analysis and epidemiology which will outperform classical medical approach - slandering the BMJ several times for some reason. Even today we see some hanger-ons who assert that their way is the best way - that they know from personal medical cases and their opinion and interpretation is more valuab…

as someone currently suffering from something I statistically have no real justification for getting fixed, I'm grateful I have a Dr who's going to fix it statistics be damned

Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#13
post #8

I thought all medicine is evidence based as long as it’s not homeopathic or chiropractic?

homeopathic medicine, chiropractic medicine, folk medicine, traditional medicine, osteopathic medicine, crystal healing medicine... you can make an infinite list of nonsense and if you want to disambiguate and say "evidence based medicine" to refer to actual medicine, they can just make it "evidence based homeopathic medicine" and so on and so on can't beat these people

> they can just make it "evidence based homeopathic medicine" and so on and so on

Only if the homeopaths lie about the evidence.

Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#14
post #12
post #6

I am sure I miss the context but I guess the point is that authors were sick of hearing about the promise of statistical analysis and epidemiology which will outperform classical medical approach - slandering the BMJ several times for some reason. Even today we see some hanger-ons who assert that their way is the best way - that they know from personal medical cases and their opinion and interpretation is more valuab…

as someone currently suffering from something I statistically have no real justification for getting fixed, I'm grateful I have a Dr who's going to fix it statistics be damned

but if you got better, how would you know it was the doctor and not just random chance? base rate fallacy applies

Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#15
Evidence Based Medicine is one of those things that is a good thing, but was pushed so hard by its proponents that it ended up overemphasizing a particular kind of study as the only real way to know things in medicine.

Yes, absolutely, medicine should be evidence based. Yes, large randomized, double blind, placebo controlled studies provide a lot of information.

However, there are limitations with these kinds of studies.

First, it may not be ethical or practical to study some things in this manner. For example, antibiotics for bacterial pneumonia has not had a randomized, double blind, placebo controlled study.

Famously, there was an article discussing how parachutes in jumping out of airplanes had not been subject to a randomized, double blind, placebo controlled study. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC300808/

Later, somebody did that study: https://www.bmj.com/content/363/bmj.k5094 and found that parachutes made no difference, but it is not applicable to any real world case where you would use a parachute.

Which illustrates the second issue with evidence based medicine. Many times, the large trials's main thing they are measuring are different than what you really want to know, or the population they studied has significant differences from the patient who is right in front of you. How to apply the results of the large study to the individual patient in front of you is still more of an art than a science.

Finally, I think there is the example from machine learning. It has turned out that instead of creating more and more rules, feeding lots and lots of data to a neural network ends up performing better in a lot of machine learning cases. In a similar way, an experienced physician who has treated thousands of patients over decades has a lot of implicit knowledge and patterns stored in their (human) neural networks. Yes, these decisions should be informed by the results of trials, but they should not be discounted, which I think that Evidence Based Medicine did in at least a small part. During my residency, I worked with physicians who would examine and talk with a patient and tell me that something is not right and to do more extensive tests which would end up unearthing a hidden infection or other problem that we were able to treat before it caused major problems. They were seeing subtle patterns from decades of experience that might not even be fully captured in the patient's chart, much less a clinical trial without thousands of participants.

So yes, these clinical trials are a very important base for knowledge. But so is physician judgment and experience.

Source: I am a physician.

Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#16
post #13
post #8

Earlier quoted context omitted.

homeopathic medicine, chiropractic medicine, folk medicine, traditional medicine, osteopathic medicine, crystal healing medicine... you can make an infinite list of nonsense and if you want to disambiguate and say "evidence based medicine" to refer to actual medicine, they can just make it "evidence based homeopathic medicine" and so on and so on can't beat these people

> they can just make it "evidence based homeopathic medicine" and so on and so on Only if the homeopaths lie about the evidence.

curious how combative some people seem to get about homeopathics when placebo has been shown to have consistent positive effect, without side effects, for almost every illness

Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#17
I'd love the idea of science based medicine. There are a few issues:

>HIPPA has made it basically impossible to do science in Medicine without being part of the establishment

>The medical cartels hate change, its bad for business, they actively lobby against change and competition. They want authority based medicine.

>The scientist responsible for the discovery and treatment of an issue, can't even legally practice.

We should entirely be blaming the medical cartels here. They have been terrible for our health, technology, and wallets.

Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#18
post #11
post #6

I am sure I miss the context but I guess the point is that authors were sick of hearing about the promise of statistical analysis and epidemiology which will outperform classical medical approach - slandering the BMJ several times for some reason. Even today we see some hanger-ons who assert that their way is the best way - that they know from personal medical cases and their opinion and interpretation is more valuab…

Yes and no, Statistics have an inherent weakness when you don’t have consistent buckets to place everything into. If individual specialists classify cases differently they really can see statistically valid numbers from relatively few cases where double blind studies using different classification criteria see improvements below the noise floor.

Also, largely, there is no scientific evidence for the vast majority of problems.

The only evidential basis for causal analysis are experiments where (1) you intervene to bring about the cause deterministically; and (2) where you control all confounding causes.

Those conditions are impossible to meet for the vast majority of interactions in complex systems, such as people & medicine.

If you run associative statistics on counfounded data collected in observational studies, you may as well correlate star signs with outcomes -- no doubt people being treated under winter signs will do worse than those under gemini. Astrology QED.

Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#20
post #8

I thought all medicine is evidence based as long as it’s not homeopathic or chiropractic?

homeopathic medicine, chiropractic medicine, folk medicine, traditional medicine, osteopathic medicine, crystal healing medicine... you can make an infinite list of nonsense and if you want to disambiguate and say "evidence based medicine" to refer to actual medicine, they can just make it "evidence based homeopathic medicine" and so on and so on can't beat these people

when Western doctors visited China under Nixon, the great medical practices of Chinese medicine were on full view .. acupuncture, herbs, other parts.. The Western Doctors uniformly mocked the Chinese upon return.. oddly reminiscent of the Chinese mocking the "stone age" Tibetans at a later date. zero medicine anywhere but in your own guild, it seems
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