made up?evidence based OM

[Guest guest]

Chinese Medicine , " Z'ev

Rosenberg " <zrosenbe@s...> wrote:

>

> A loaded question. What exactly would 'evidence-based' OM be?

Would

> the thousands of volumes of case histories throughout CM history

be

> acceptable? Or is 'evidence-based' just another buzz-word like

> 'integrative medicine', done superficially or with the political

> dominance of WM?

>

>

 

Of course it is loaded, but I didn't mean to offend nobody. So, to

make it up for you and others who might feel being offended I'm

posting this short report from BMJ 1999;319:1618 (Dec18). That's how

some WM doctors see evidence based medicine concept in a humorous

way (they are humans too). Hope you'll enjoy.

Happy Holidays.

EM.

 

Seven alternatives to evidence based medicine.

David Isaacs, clinical professor, Dominic Fitzgerald, staff

physician.

Departments of Education and Medicine, New Children's Hospital,

Westmead, NSW 2145, Australia

Clinical decisions should, as far as possible, be evidence based.

So runs the current clinical dogma. We are urged to lump all the

relevant randomised controlled trials into one giant meta-analysis

and come out with a combined odds ratio for all decisions.

Physicians, surgeons, nurses are doing it ; soon even the lawyers

will be using evidence based practice. But what if there is no

evidence on which to base a clinical decision?

 

We, two humble clinicians ever ready for advice and guidance, asked

our colleagues what they would do if faced with a clinical problem

for which there are no randomised controlled trials and no good

evidence. We found ourselves faced with several personality based

opinions, as would be expected in a teaching hospital. The

personalities transcend the disciplines, with the exception of

surgery, in which discipline transcends personality. We categorised

their replies, on the basis of no evidence whatsoever, as follows.

1.Eminence based medicine. The more senior the colleague, the less

importance he or she placed on the need for anything as mundane as

evidence. Experience, it seems, is worth any amount of evidence.

These colleagues have a touching faith in clinical experience, which

has been defined as " making the same mistakes with increasing

confidence over an impressive number of years. " The eminent

physician's white hair and balding pate are called the " halo "

effect.

2.Vehemence based medicine. The substitution of volume for evidence

is an effective technique for brow beating your more timorous

colleagues and for convincing relatives of your ability.

3.Eloquence based medicine. The year round suntan, carnation in the

button hole, silk tie, Armani suit, and tongue should all be equally

smooth. Sartorial elegance and verbal eloquence are powerful

substitutes for evidence.

4.Providence based medicine. If the caring practitioner has no idea

of what to do next, the decision may be best left in the hands of

the Almighty. Too many clinicians, unfortunately, are unable to

resist giving God a hand with the decision making.

5.Diffidence based medicine. Some doctors see a problem and look for

an answer. Others merely see a problem. The diffident doctor may do

nothing from a sense of despair. This, of course, may be better than

doing something merely because it hurts the doctor's pride to do

nothing.

6.Nervousness based medicine. Fear of litigation is a powerful

stimulus to overinvestigation and overtreatment. In an atmosphere of

litigation phobia, the only bad test is the test you didn't think of

ordering.

7.Confidence based medicine This is restricted to surgeons (table).

 

There are plenty of alternatives for the practising physician in

the absence of evidence. This is what makes medicine an art as well

as a science.