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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]

#81

Post by eviks »

jbandela1 wrote: post #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 stud…

Given how much evidence-free stuff is being used in medicine, it's not having been pushed anywhere close to hard enough (and the parachute example is just silly)

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

#82

Post by WalterBright »

jbandela1 wrote: post #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 stud…

On the other hand, before 1800 and the advent of statistics based medicine, the practice of medicine was mostly barbaric and counterproductive.

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

#83

Post by WalterBright »

lazide wrote: post #74
DoreenMichele wrote: post #62

Ah, the human as a specimen in a petri dish approach to so-called health care. Flies directly in the face of study after study after study that says: diet and lifestyle are major factors in all deadly diseases. Probably driven by modern tech, completely inadvertently, because x-ray machines and MRIs and such demand that the patient go to the clinic or hospital rather than the doctor going to the patient's home. Star…

All interventions that don’t require a patient being in a coma first requires patient compliance . Diet and lifestyle are nearly impossible to address from the perspective of the Dr, as they require the patient to want to and be willing to change foundational elements of their life . Unless the patient comes to you requesting that, good luck. Many will get actively angry if you mention even obvious and severe issues…

My dad was sent to a nutritionist to deal with his spare tire. She gave him a meal plan, and told him to come back in a couple months for a followup. When he did, she was shocked that he'd actually followed the meal plan, and his spare tire deflated the expected amount. He kept it deflated for the rest of his life, though he said it was a constant struggle.

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

#84

Post by deltaninenine »

WalterBright wrote: post #82
jbandela1 wrote: post #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 stud…

On the other hand, before 1800 and the advent of statistics based medicine, the practice of medicine was mostly barbaric and counterproductive.

The GP didn't talk about a certain nuance and used evidence based medicine to cover all forms of science.

A double blind placebo trial is the gold standard for testing causality. We don't have to go that far. We can use a hybrid of intuition and correlational tests, we can maybe sometimes not always need a placebo. The point is the causal test comes with a lot of technical challenges and we have options for other tests that are less challenging.

There is a spectrum of correctness and rigor for science and we should know when to utilize something extremely rigorous or less rigorous. The barbaric practices you describe only come from an lack of awareness of what statistical rigor and science is.

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

#85

Post by tcmart14 »

WalterBright wrote: post #83
lazide wrote: post #74

Earlier quoted context omitted.

All interventions that don’t require a patient being in a coma first requires patient compliance . Diet and lifestyle are nearly impossible to address from the perspective of the Dr, as they require the patient to want to and be willing to change foundational elements of their life . Unless the patient comes to you requesting that, good luck. Many will get actively angry if you mention even obvious and severe issues…

My dad was sent to a nutritionist to deal with his spare tire. She gave him a meal plan, and told him to come back in a couple months for a followup. When he did, she was shocked that he'd actually followed the meal plan, and his spare tire deflated the expected amount. He kept it deflated for the rest of his life, though he said it was a constant struggle.

Glad it worked for your dad and I can definitely see it working for others. Part of the difficulty with being told that I need to make life style changes is how open ended it can be. It can make it hard to plan or know what to do or stick with it. I can definitely see it makes the on ramp to life style changes so much easier if you're given a plan and have to think little about it. This helped me. My doctor recommended a diet and gave me sites with meal plans so while I was trying to navigate my way through it, I had resources to get me going the first few weeks.

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

#86

Post by deltaninenine »

bjornsing wrote: post #39

The main flaw in EBM is that it inverts the scientific method: It’s no longer about hypotheses and falsification. Instead it’s about “scientifically proven facts” (aka “evidence”). Sadly this aligns much better with our dogmatic instinctive understanding of knowledge as a set of agreed truths.

It is true that in science nothing can be proven but this fact doesn't apply if you think in terms of statistics. Science is broad and doesn't always give answers in terms of a boolean falsification. You can be given a ratio as the result.

This result is usually A probability established to a degree within the context of a sample size. This is the closest thing to proof that science can offer and we just go with it.

EBM goes a bit further then just a probability in the context of a sample size. There's a further degree of rigor in the qualitative sense that the probability is causal and not correlative. It's subtle but causality is even closer to proof then a correlative study.

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

#87

Post by deltaninenine »

haldujai wrote: post #55
rgbgraph wrote: post #53

Earlier quoted context omitted.

In bullet-points: - Absolute risk reduction in CVD-caused mortality is mild at best ( - Percentage of people that get side-effects is higher than the percentage of people that receive a benefit from statins; as well, the side-effects are rather serious in affecting QoL -- making them a poor choice as a long-term prophylactic - Generic lipid panels that the vast majority of people take are generally worthless for esti…

What patient population are you talking about? Statins have excellent evidence behind them. > - Absolute risk reduction in CVD-caused mortality is mild at best ( It depends what your baseline risk is and what time point you're looking at. > - Percentage of people that get side-effects is higher than the percentage of people that receive a benefit from statins; as well, the side-effects are rather serious in affecting…

Long term damage to liver. You use it long enough your liver will die. But it's too hard to do a causal analysis on this as the timelines are measured in decades.

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

#88

Post by ramblenode »

rgbgraph wrote: post #30

There was a great book about Evidence Based Medicine, from a woman out of Oxford, I read a long while ago. Can't for the life of me remember the name, but Oxford does have a center for "Evidence Based Medicine," and the whole idea has been slowly coming back into fashion. Instead, all I can recommend is a collection of essays -- loosely -- related to the subject: Where's the Evidence? , Silverman --- On another note,…

> Of note: spinal fusions were not brought about on any scientific or experimental bases, but on hunches from surgeons (damnable bunch). Many do result in a reduction in pain, but it does bring to question how much of it is simply "placebo."

You might be interested in Surgery, the Ultimate Placebo by orthopaedic surgeon Ian Harris.

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

#89

Post by sohex »

rgbgraph wrote: post #71
haldujai wrote: post #61

Earlier quoted context omitted.

Do you have a single citation to back this claim up? Unless you’re talking about prophylactic statins in patients with no known risk factors (I.e. primary prevention which is not standard of care) this is complete misinformation.

Taylor, Fiona, et al. “Statins for the Primary Prevention of Cardiovascular Disease.” Cochrane Database of Systematic Reviews , vol. 2021, no. 9, 2013, https://doi.org/10.1002/14651858.cd004816.pub5 . Page 11. If you have an account at Cochrane: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD... If not, just get it from LibGen with: 10.1002/14651858.CD004816.pub5

The authors' own conclusion seems to directly contradict your overall argument here: "Implications for practice The totality of evidence now supports the benefits of statins for primary prevention. The individual patient data meta-analyses now provide strong evidence to support their use in people at low risk of cardiovascular disease. Further cost-effectiveness analyses are now needed to guide widening their use to these low risk groups."

And as haldujai mentioned this is explicitly regarding their use for primary prevention, not with regards to usage for secondary prevention which has strong supporting evidence.

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

#90

Post by sohex »

msla wrote: post #70
mistrial9 wrote: post #20

Earlier quoted context omitted.

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

https://slate.com/technology/2013/10/traditional-chinese-med... "Traditional Chinese Medicine" as we now know it was invented as a propaganda move by the CCP under Mao, who didn't believe in it himself.

For the sake of clarity for those not inclined to read the linked article: Historically over the two millennia prior to Mao traditional medicine in China was a highly individual and idiosyncratic practice. While there were some aspects which were generally held in common the over all practice was incredibly diverse. It wasn't until Mao that these practices were assembled into the more unified and systematic Traditional Chinese Medicine that people are familiar with today.
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