5 ms·

I thought all medicine is evidence based as long as it’s not homeopathic or chiropractic?

Vecr 3y ago
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...
- dekhn 3y ago
  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..."
hvs 3y ago
https://pubmed.ncbi.nlm.nih.gov/9276585/ 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.
5040 3y ago
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.
pella 3y ago
"(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-insignificant https://astralcodexten.substack.com/p/all-medications-are-in...
bedobi 3y ago
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
- msla 3y ago
  > they can just make it "evidence based homeopathic medicine" and so on and so on Only if the homeopaths lie about the evidence.
  - smegsicle 3y ago
    curious how combative some people seem to get about homeopathics when placebo has been shown to have consistent positive effect, without side effects, for almost every illness
    - metalliqaz 3y ago
      they aren't honestly trying to sell placebos (like Zeebo). They are marketing actual 'cures' for serious maladies that could respond to real treatments
    - technothrasher 3y ago
      If placebos don’t have side effects, why do the control groups in placebo-based trials always report side effects? And given that “homeopathic” to most casually informed people is the same as “naturopathic”, what those people are taking are not necessarily harmless placebos. As for your “almost every illness,” that’s just meaningless hyperbole.
    - msla 3y ago
      Yes, it's 'curious' how people with a sense of basic decency get 'combative' when the Alternative Medicine Industry lies to them to sell useless treatments for diseases that could actually be improved by real medicine. It really is odd how that works, isn't it?
Dma54rhs 3y ago
It's often based on authority and tradition, evidence based is a fairly new idea.

Vecr 3y ago

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...

dekhn 3y ago
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..."

hvs 3y ago

https://pubmed.ncbi.nlm.nih.gov/9276585/ 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.

5040 3y ago

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.

pella 3y ago

"(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-insignificant https://astralcodexten.substack.com/p/all-medications-are-in...

bedobi 3y ago

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

msla 3y ago
> they can just make it "evidence based homeopathic medicine" and so on and so on Only if the homeopaths lie about the evidence.
- smegsicle 3y ago
  curious how combative some people seem to get about homeopathics when placebo has been shown to have consistent positive effect, without side effects, for almost every illness
  - metalliqaz 3y ago
    they aren't honestly trying to sell placebos (like Zeebo). They are marketing actual 'cures' for serious maladies that could respond to real treatments
  - technothrasher 3y ago
    If placebos don’t have side effects, why do the control groups in placebo-based trials always report side effects? And given that “homeopathic” to most casually informed people is the same as “naturopathic”, what those people are taking are not necessarily harmless placebos. As for your “almost every illness,” that’s just meaningless hyperbole.
  - msla 3y ago
    Yes, it's 'curious' how people with a sense of basic decency get 'combative' when the Alternative Medicine Industry lies to them to sell useless treatments for diseases that could actually be improved by real medicine. It really is odd how that works, isn't it?

Dma54rhs 3y ago

It's often based on authority and tradition, evidence based is a fairly new idea.