fw5tape6kq

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May 28, 2012
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I am very pro evidence-based medicine. It seems to me that our decisions in medicine should be backed up by as much data as possible, lest we fly by the seat of our pants and do things simply because we subjectively think or feel that they are right. Medicine as a body of knowledge is a science, and needs to be treated as such.

Obviously, not every decision can be made with evidence to support it, but I think that, the more we can make medical choices in a rational, thoughtful way, the better.

Then I saw this quote on SDN:

…Today’s rigid reliance on evidence-based medicine risks having the doctor choose care passively, solely by the numbers. Statistics cannot substitute for the human being before you.
- Dr. Jerome Groopman, How Doctors Think.

I read that and really chewed on it for awhile. And you know what, after thinking it over, I'm not sure I agree with Dr. Groopman. Since when do evidence-based practices supersede or inhibit the ability to think about patients as individuals? Information is information, and the way we apply that information is totally independent of what that information happens to be.

Can you think of any examples where evidence-based medicine is actually harmful, not good, or worse than the alternative? Do you agree with Groopman that it has deleterious effects on our interactions with patients?
 

educ8r

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Jan 6, 2011
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I think evidence is better than no evidence. But, "No evidence for xyz" is not the same as "xyz is false." It is too easy to think that only the things that have been rigorously studied are true. Also, see Why Most Published Research Findings Are False for one of several papers on the (relatively low) positive predictive value and (relatively high) false discovery rate of scientific inquiry with "p<0.05."
 

heroesjourney

2+ Year Member
Jul 29, 2014
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I am very pro evidence-based medicine. It seems to me that our decisions in medicine should be backed up by as much data as possible, lest we fly by the seat of our pants and do things simply because we subjectively think or feel that they are right. Medicine as a body of knowledge is a science, and needs to be treated as such.

Obviously, not every decision can be made with evidence to support it, but I think that, the more we can make medical choices in a rational, thoughtful way, the better.

Then I saw this quote on SDN:

…Today’s rigid reliance on evidence-based medicine risks having the doctor choose care passively, solely by the numbers. Statistics cannot substitute for the human being before you.
- Dr. Jerome Groopman, How Doctors Think.

I read that and really chewed on it for awhile. And you know what, after thinking it over, I'm not sure I agree with Dr. Groopman. Since when do evidence-based practices supersede or inhibit the ability to think about patients as individuals? Information is information, and the way we apply that information is totally independent of what that information happens to be.

Can you think of any examples where evidence-based medicine is actually harmful, not good, or worse than the alternative? Do you agree with Groopman that it has deleterious effects on our interactions with patients?
He's critiquing a rigid reliance on evidence based medicine. Not the same thing as critiquing using evidence based medicine as a resource to influence patient care. The former is applying medical therapy in a algorithmic, robot-like fashion based on the latest studies, which generally study averages of large homogenized groups. This rigid reliance fails to remember that studies don't often prove something or only provide marginal support for a given therapy over another in a very rigidly defined system. In fact it's irrational to suppose that most double-blind trials are guaranteed to be right for all patients. The human body is a very complex, multivariate system, and most studies don't fully account for all of the variability that is the human body existing in it's own unique environmental context, so a lot of individual patients will fall through the cracks during the statistical analysis. It's hoped that the knowledge we gain from studying the body academically for 2 years will give us a biological/chemical/molecular intuition that we can apply on an individual basis to supplement knowledge from academic/clinical studies. Anyways, to the point: I think you've created a conflict where there is none. Dr. Groopman didn't critique using evidence-based medical practices as a tool. He made a more nuanced argument critiquing a rigid reliance on evidence based medicine because it can lead to passive, faulty care. 2 different things. To broadly answer your question about deleterious effects: applying evidence based medicine like a robot could harm a patient who would've been an outlier in the study you're using to guide treatment.

Not to mention there is a very real phenomenon going on where lots of unreproducible or fluffed up studies are being pumped out because there is so much institutional pressure for publishing quantity, with less regard for quality. This problem extends way beyond medicine to nearly every corner of academia.
 
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sb247

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I am very pro evidence-based medicine. It seems to me that our decisions in medicine should be backed up by as much data as possible, lest we fly by the seat of our pants and do things simply because we subjectively think or feel that they are right. Medicine as a body of knowledge is a science, and needs to be treated as such.

Obviously, not every decision can be made with evidence to support it, but I think that, the more we can make medical choices in a rational, thoughtful way, the better.

Then I saw this quote on SDN:

…Today’s rigid reliance on evidence-based medicine risks having the doctor choose care passively, solely by the numbers. Statistics cannot substitute for the human being before you.
- Dr. Jerome Groopman, How Doctors Think.

I read that and really chewed on it for awhile. And you know what, after thinking it over, I'm not sure I agree with Dr. Groopman. Since when do evidence-based practices supersede or inhibit the ability to think about patients as individuals? Information is information, and the way we apply that information is totally independent of what that information happens to be.

Can you think of any examples where evidence-based medicine is actually harmful, not good, or worse than the alternative? Do you agree with Groopman that it has deleterious effects on our interactions with patients?
Sepsis protocols called for 30ml/kg fluid. No. Matter. What.

Those are stupid when applied rigidly because the patient could also be a ckd with pulmonary edema