The Rise and Fall of Evidence Based Medicine (1998) [pdf]
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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]
#2Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]
#3I thought all medicine is evidence based as long as it’s not homeopathic or chiropractic?
Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]
#4I thought all medicine is evidence based as long as it’s not homeopathic or chiropractic?
Not really, people probably have better examples but doctors quite often don't actually try to figure out what antibiotic is the best, they just pick something for no real reason (they remember the name) and write a prescription. There are studies on what antibiotic to use quite a lot of the time, but that takes effort. You get a Z-Pack, and you get a Z-Pack, etc...
Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]
#5I thought all medicine is evidence based as long as it’s not homeopathic or chiropractic?
https://pubmed.ncbi.nlm.nih.gov/9276585/
I conclude that attempts to classify medical decisions as justified
or unjustified by scientific evidence have no foundation in logic and
that the term 'evidence-based medicine' is logically indistinguishable
from the term 'medicine'. The use of the term 'evidence-based medicine'
calls for a new type of authoritarianism in medical practice.Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]
#6I 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 valuable than some statistical prediction.
Well, if I have understood their sentiment correctly; facts are facts. Today the best medical care in the world is driven by data-based adaption rather than subjective opinion. If a treatment has a robust statistical impact it will be preferred. If new methods produce outcomes no better than random noise then we must agree that they are not better. If the physician has anecdotes about why they think some trick works best then - in the words of Pearson - “statistics on the table, please”.
I am sorry to make the joke but it seems apt: “Dr Charlatan disgruntled about needing evidence for science”.
Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]
#7I thought all medicine is evidence based as long as it’s not homeopathic or chiropractic?
The ancient medical schools varied quite a bit when it came to questions of evidence. Something to think about perhaps.
>The Empiricists were sceptics in their attitude to causes, thinking that observation and report of evident conditions and their cures was sufficient for medical science, and thus eschewing causal theory. Rationalist doctors attacked the inadequate methodology of the Empiricists, and they try to explain why the antecedent cause should bring on such and such an effect, while emphasizing the need to decide rationally the proper use of induction, and the relevancy of similarities. The Methodists treat as irrelevant antecedent causes or factors, and they recognized just two pathological conditions—relaxation and constriction; the doctor's concern is to determine by direct observation in which state is the body.
Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]
#8I 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
Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]
#9I thought all medicine is evidence based as long as it’s not homeopathic or chiropractic?
Not really, people probably have better examples but doctors quite often don't actually try to figure out what antibiotic is the best, they just pick something for no real reason (they remember the name) and write a prescription. There are studies on what antibiotic to use quite a lot of the time, but that takes effort. You get a Z-Pack, and you get a Z-Pack, etc...
Probably one of the best known examples is the establishment as helicobacter pylori as the ultimate cause of ulcers, rather than stress, spicy food, and low pH. Marshall won the nobel prize for this, and it's often touted as a situation where there was a lot of initial non-scientific resistence "of course we know it's stress..."
Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]
#10I thought all medicine is evidence based as long as it’s not homeopathic or chiropractic?
"(effect sizes) Some of our favorite medications, including statins, anticholinergics, and bisphosphonates, don’t reach the 0.50 level. And many more, including triptans, benzodiazepines (!), and Ritalin (!!) don’t reach 0.875."
"There’s no anti-ibuprofen lobby trying to rile people up about NSAIDs, so nobody’s pointed out that this is “clinically insignificant”. But by traditional standards, it is!"
read more: All Medications Are Insignificant In The Eyes Of God And Traditional Effect Size Criteria ( MAY 31, 2023 ) https://astralcodexten.substack.com/p/all-medications-are-in...