Measuring vs. Knowing
Where does evidence-based care take us?
The evidence--which is a huge body of information-- is so inconclusive, it seems that nothing we can do will be supported or denied by the literature to an extent that satisfies our insurance companies.
This is the essence of the health care crisis that we are all in.
Who decides who needs what?
The people who have the power and the money, (ie. The insurance companies and the government) don’t have much trust in the people who have the training and know how (ie. Physicians) to deliver what is needed in terms of care.
How did this happen? We don’t really need some disembodied formula that will be easily read by all telling us what should be done in any given medical care situation. This does seem to be what evidence based care is after, that magic formula that is supposed to arise out of the meta-analysis of decades of diligent RCTs.
The scientific method and the art of medicine have not always seen things eye to eye. There is a complexity in the human body, it’s response and relationship to the human mind, that science has not been able to adequately address.
Medicine has been struggling with establishing standards of care and professionalism in the modern age. People want assurance that their doctor is not a quack. The expectation seems to be perfection and an ability to know everything about the body. Sorry, but that isn’t possible so far.
We just are not spending enough time getting the question right. The disenfranchised clinician doesn’t seem to care or see the need to be invested in this disembodied process of finding out what is supported by the process of science. This is because medicine as a science is stuck in the last century. So then how do we make a decision? We –physicians-and our patients, cannot wait for research to tell us what needs to be done. Instinct and intuition must be cultivated to be an effective clinician. Research supports this idea.
“The notion of imitating whole natural systems stand in stark opposition to reductionist science, which works by breaking such systems down into their component parts in order to understand and then manipulate them…….A healthy sense of all we don’t know –even a sense of mystery—keeps us from reaching for oversimplifications and technological silver bullets”. Micheal Pollan
GARLIC!
http://news.bbc.co.uk/2/hi/health/3344325.stm
"Dr Ron Cutler and his team discovered the effectiveness of allicin in laboratory tests five years ago.
They found it can cure MRSA within weeks.
It is even effective against the newer strains which cannot be treated by the "last line of defence" antibiotics Vancomycin and Glycopeptides."
Stay tuned as the modern medical research world catches up to what we have known clinically since the pyramids were built.
Absence of Evidence
The IOM --Institute Of Medicine-- just released the results of a meta-analysis of Post Traumatic Stress Disorder -PTSD-.
After searching thousands of studies and weeding out the severely flawed ones, the committee eventually reviewed 90 of them (53 pharmaceutical treatments and 37 psychotherapy treatments) and concluded that there is not good enough evidence to draw conclusions about the effectiveness of most treatments.
The question of design in the case of these studies is extremely important and it illustrates a major point about the way we collect data.
PTSD-ICD-9 code=309.81
Patients that are given this diagnosis are eligible to be studied as a group. The trouble here is that there is HUGE variation in what these people are presenting with. The underlying strengths and weaknesses of people, their health, their IQ, their social and cultural structure, before they experience any trauma, has a big role in the degree and type of symptoms they experience.
For many, diagnoses of anxiety, depression, personality disorder, and other psychiatric issues could be applied to their symptom picture just as well. Naturopathic treatments should be designed to treat the individual, not just certain symptoms. So these designation don't really count for what we should be focusing on.
The traumatic event is a trigger; most people have some type of response to that trigger. Physically we don't even have a definition of what happens during a traumatic event that may later lead to PTSD. What a persons response is, physically, as well as emotionally varies. We need to find out what the range of this variation is, and stop looking for a magic bullet. Treatment that is powerfully effective and long lasting DOES exist. People who are experience this reality and have good support that continue to struggle and experiment with various therapies often eventually get better.
We need to re-think the basic design of this research and test specific treatments based on the actual experience and issues that individuals are dealing with rather than ...309.81. otherwise we will never find it.
After searching thousands of studies and weeding out the severely flawed ones, the committee eventually reviewed 90 of them (53 pharmaceutical treatments and 37 psychotherapy treatments) and concluded that there is not good enough evidence to draw conclusions about the effectiveness of most treatments.
The question of design in the case of these studies is extremely important and it illustrates a major point about the way we collect data.
PTSD-ICD-9 code=309.81
Patients that are given this diagnosis are eligible to be studied as a group. The trouble here is that there is HUGE variation in what these people are presenting with. The underlying strengths and weaknesses of people, their health, their IQ, their social and cultural structure, before they experience any trauma, has a big role in the degree and type of symptoms they experience.
For many, diagnoses of anxiety, depression, personality disorder, and other psychiatric issues could be applied to their symptom picture just as well. Naturopathic treatments should be designed to treat the individual, not just certain symptoms. So these designation don't really count for what we should be focusing on.
The traumatic event is a trigger; most people have some type of response to that trigger. Physically we don't even have a definition of what happens during a traumatic event that may later lead to PTSD. What a persons response is, physically, as well as emotionally varies. We need to find out what the range of this variation is, and stop looking for a magic bullet. Treatment that is powerfully effective and long lasting DOES exist. People who are experience this reality and have good support that continue to struggle and experiment with various therapies often eventually get better.
We need to re-think the basic design of this research and test specific treatments based on the actual experience and issues that individuals are dealing with rather than ...309.81. otherwise we will never find it.
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