5 ms·

I am torn. On the one hand I firmly believe that medicine should be evidence based. Treatments should be based on the best possible scientific evidence. Inevita

by jostmey 13y ago

I am torn. On the one hand I firmly believe that medicine should be evidence based. Treatments should be based on the best possible scientific evidence. Inevitably, such evidence will rely on large, randomized controlled clinical trials... On the other hand, I take it as my own personal responsibility to take care of my own health. This means that I have to rely on a sample size of one. If I try something, and I feel better then I try more of it. My prescription for myself may not work for anyone else, it could be specific to me. I personally believe that Western medicine is awesome because it is evidence based. At the same time, Western medicine has removed from the individual a sense of personal responsibility, and this must change.

icebraining 13y ago
Well, Eric Topol[1] argues that evidence-based medicine, coupled with copious amounts of data and better tools, will allow treatments to be much more individualized, not less. [1] http://www.scripps.edu/research/faculty/topol http://www.scripps.edu/research/faculty/topol http://www.econtalk.org/archives/2013/04/topol_on_the_cr.html http://www.econtalk.org/archives/2013/04/topol_on_the_cr.htm... http://www.amazon.com/Creative-Destruction-Medicine-Digital-Revolution/dp/0465025501/ http://www.amazon.com/Creative-Destruction-Medicine-Digital-...
Crito 13y ago
IMHO, the problem with "alternative medicine" is less what adults do (or do not do) to themselves, and more with what adults do to children that they have been entrusted with. Thankfully there has been progress in recent years on this front, with adults who neglected to seek evidence-based medicine for the children that they were entrusted with being charged with homicide (http://en.wikipedia.org/wiki/Kara_Neumann_case http://en.wikipedia.org/wiki/Kara_Neumann_case). There is more progress to be made however.
npsimons 13y ago
Western medicine has removed from the individual a sense of personal responsibility, and this must change. I must heartily disagree. Well, perhaps not so much disagree as clarify: Western medicine as it is practiced, perhaps discourages personal responsibility (and how many times would you tell patients to eat better and exercise more if they never did?). Evidence based medicine is just that: based on evidence. There's no "removal" of personal responsibility, there are simply facts, as in your case you have brilliantly demonstrated: when something works for you, you continue to use it. My immediate reaction to "trying something" that you mentioned, however was "how many things did you try?" How many people won't research different options, much less put them into practice, simply because it would require them to try something different, or something hard (like exercise)? How many people would rather take some snake-oil to lose weight than eat less and exercise more? How many people will refuse vaccines because they believe it's a government conspiracy? And let's not forget all the other confounding factors, such as big pharma with 85+% of their money dedicated to marketing, or the placebo affect, etc, etc.
- jostmey 13y ago
  Western medicine has removed from the individual a sense of personal responsibility in the following sense. We are told to ignore what may work for us and to instead try what works a large number of other patients. While the advice may be good advice, it leaves the patient with an attitude that their own ideas about how to treat themselves may be worthless. And this could encourage the patient to place their doctor upon a pedestal - only the doctor knows what is best for you. Of course, some advice is just always good advice - eat right and exercise. But you don't need a doctor to tell you that. I have observed that it is the same people who take the best personal care of themselves, by eating right and exercising, also engage in alternative medicine. The very act of trying to take control of your own health leads you to focus in on what works (or what you "think" works) for you.
  - kps 13y ago
    > it leaves the patient with an attitude that their own > ideas about how to treat themselves may be worthless. Well, they probably are.
  - pekk 13y ago
    How do you know what actually works for you, and what simply coincided with a change that happened for some other reason? It is literally impossible to tease out these questions without some kind of control. edit: For example, you like drinking diet coke and one morning you find you don't have cancer. Was it the diet coke that drove away the cancer? Did you even have cancer? Just doing things you want to do and approving yourself for them, claiming that they cured you or something, is not responsible and in many cases isn't really even honest
    - glenra 13y ago
      > How do you know what actually works for you, and what simply coincided with a change that happened for some other reason? It is literally impossible to tease out these questions without some kind of control. It depends on the question. For lots of medical issues you could serve as your own control. If your medical issue is a rash or acne or trouble sleeping well or high blood pressure or any other condition that persists over time and is measurable, you can just start tracking it then try various changes and see how the metric matches with the changes. Do two weeks on and two weeks off a few times - either there's a break in the chart - a big noticeable improvement - at the appropriate times or there isn't. I agree this wouldn't work for cancer, but it would work for a lot of things. If the effect magnitude is large enough you don't need a big clinical trial to see it. And if the treatment is cheap and available enough there's no chance in hell that anybody is going to fund a big clinical trial - trials are really only done for drugs that can be patented, so whoever sponsors the tests has a way to get their money back. So long as it takes hundreds of millions of dollars to get a treatment past the FDA's tests, there are inevitably going to be a huge number of perfectly valid treatment options that nobody has financial incentive to pay for testing in that particular way.
mchusma 13y ago
First, the concept of "Western Medicine" is a misleading one. It implies there it is the opposite of "Eastern Medicine". Evidence Based Medicine, the subject of this post, is a much better term. Any methodology is appropriate, so long is it is backed by science. I think Evidence Based Medicine puts personal responsibility on the individual. Individuals need to realize that Marketing does not Equal better care, all that matters is the science. Evidence Based Medicine has nothing to do with personalized medicine, it is simply a way of analyzing the efficacy of medicine...science.
- Crito 13y ago
  The "Eastern"/"Western" dichotomy also ignores the existence of many scientifically questionable/discredited practices that originated "in the West". Homeopathy and chiropractic are both examples of prominent "alternative medicine" from 'the West'. Similarly, plenty of medical techniques developed in 'the East' are backed by evidence.
- Alex3917 13y ago
  Western medicine or, more accurately, allopathic medicine, is actually a much better term than Evidence Based Medicine because most of medicine is not especially evidence based. There are countless studies and books on this topic.
  - vacri 13y ago
    because most of medicine is not especially evidence based This is nonsense. Most of medicine is evidence based. Most of what a surgeon does, for example, is being a glorified handyman - staple this bit to that, remove and replace this other bit, all of which has had ample opportunities for study and observation. Or riffling through a MIMS for pharmaceutical information, the bulk of which is backed by drug trials. Cut your finger? Apply some antiseptic perhaps, and cover with a band-aid, both items that have had plenty of testing. Some parts of modern medicine may have fallen through the gaps, but it's absolute nonsense that 'most' has. The bulk of medicine is boring stuff that no-one ever thinks about. Where modern medicine is weak is in preventative medicine.
dllthomas 13y ago
"If I try something, and I feel better then I try more of it." Conclusion: laudanum for everything!
fnordfnordfnord 13y ago
My favorite semi-facetious/sarcastic journal article: http://www.bmj.com/content/327/7429/1459 http://www.bmj.com/content/327/7429/1459 "Conclusions As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute." And a less facetious one http://www.bmj.com/content/333/7570/701 http://www.bmj.com/content/333/7570/701 Both of which point out obvious shortcomings of slavish reliance on large, randomized controlled clinical trials for every circumstance.

by jostmey 13y ago

icebraining 13y ago

Well, Eric Topol[1] argues that evidence-based medicine, coupled with copious amounts of data and better tools, will allow treatments to be much more individualized, not less. [1] http://www.scripps.edu/research/faculty/topol http://www.scripps.edu/research/faculty/topol http://www.econtalk.org/archives/2013/04/topol_on_the_cr.html http://www.econtalk.org/archives/2013/04/topol_on_the_cr.htm... http://www.amazon.com/Creative-Destruction-Medicine-Digital-Revolution/dp/0465025501/ http://www.amazon.com/Creative-Destruction-Medicine-Digital-...

Crito 13y ago

IMHO, the problem with "alternative medicine" is less what adults do (or do not do) to themselves, and more with what adults do to children that they have been entrusted with. Thankfully there has been progress in recent years on this front, with adults who neglected to seek evidence-based medicine for the children that they were entrusted with being charged with homicide (http://en.wikipedia.org/wiki/Kara_Neumann_case http://en.wikipedia.org/wiki/Kara_Neumann_case). There is more progress to be made however.

npsimons 13y ago

Western medicine has removed from the individual a sense of personal responsibility, and this must change. I must heartily disagree. Well, perhaps not so much disagree as clarify: Western medicine as it is practiced, perhaps discourages personal responsibility (and how many times would you tell patients to eat better and exercise more if they never did?). Evidence based medicine is just that: based on evidence. There's no "removal" of personal responsibility, there are simply facts, as in your case you have brilliantly demonstrated: when something works for you, you continue to use it. My immediate reaction to "trying something" that you mentioned, however was "how many things did you try?" How many people won't research different options, much less put them into practice, simply because it would require them to try something different, or something hard (like exercise)? How many people would rather take some snake-oil to lose weight than eat less and exercise more? How many people will refuse vaccines because they believe it's a government conspiracy? And let's not forget all the other confounding factors, such as big pharma with 85+% of their money dedicated to marketing, or the placebo affect, etc, etc.

jostmey 13y ago
Western medicine has removed from the individual a sense of personal responsibility in the following sense. We are told to ignore what may work for us and to instead try what works a large number of other patients. While the advice may be good advice, it leaves the patient with an attitude that their own ideas about how to treat themselves may be worthless. And this could encourage the patient to place their doctor upon a pedestal - only the doctor knows what is best for you. Of course, some advice is just always good advice - eat right and exercise. But you don't need a doctor to tell you that. I have observed that it is the same people who take the best personal care of themselves, by eating right and exercising, also engage in alternative medicine. The very act of trying to take control of your own health leads you to focus in on what works (or what you "think" works) for you.
- kps 13y ago
  > it leaves the patient with an attitude that their own > ideas about how to treat themselves may be worthless. Well, they probably are.
- pekk 13y ago
  How do you know what actually works for you, and what simply coincided with a change that happened for some other reason? It is literally impossible to tease out these questions without some kind of control. edit: For example, you like drinking diet coke and one morning you find you don't have cancer. Was it the diet coke that drove away the cancer? Did you even have cancer? Just doing things you want to do and approving yourself for them, claiming that they cured you or something, is not responsible and in many cases isn't really even honest
  - glenra 13y ago
    > How do you know what actually works for you, and what simply coincided with a change that happened for some other reason? It is literally impossible to tease out these questions without some kind of control. It depends on the question. For lots of medical issues you could serve as your own control. If your medical issue is a rash or acne or trouble sleeping well or high blood pressure or any other condition that persists over time and is measurable, you can just start tracking it then try various changes and see how the metric matches with the changes. Do two weeks on and two weeks off a few times - either there's a break in the chart - a big noticeable improvement - at the appropriate times or there isn't. I agree this wouldn't work for cancer, but it would work for a lot of things. If the effect magnitude is large enough you don't need a big clinical trial to see it. And if the treatment is cheap and available enough there's no chance in hell that anybody is going to fund a big clinical trial - trials are really only done for drugs that can be patented, so whoever sponsors the tests has a way to get their money back. So long as it takes hundreds of millions of dollars to get a treatment past the FDA's tests, there are inevitably going to be a huge number of perfectly valid treatment options that nobody has financial incentive to pay for testing in that particular way.

mchusma 13y ago

First, the concept of "Western Medicine" is a misleading one. It implies there it is the opposite of "Eastern Medicine". Evidence Based Medicine, the subject of this post, is a much better term. Any methodology is appropriate, so long is it is backed by science. I think Evidence Based Medicine puts personal responsibility on the individual. Individuals need to realize that Marketing does not Equal better care, all that matters is the science. Evidence Based Medicine has nothing to do with personalized medicine, it is simply a way of analyzing the efficacy of medicine...science.

Crito 13y ago
The "Eastern"/"Western" dichotomy also ignores the existence of many scientifically questionable/discredited practices that originated "in the West". Homeopathy and chiropractic are both examples of prominent "alternative medicine" from 'the West'. Similarly, plenty of medical techniques developed in 'the East' are backed by evidence.
Alex3917 13y ago
Western medicine or, more accurately, allopathic medicine, is actually a much better term than Evidence Based Medicine because most of medicine is not especially evidence based. There are countless studies and books on this topic.
- vacri 13y ago
  because most of medicine is not especially evidence based This is nonsense. Most of medicine is evidence based. Most of what a surgeon does, for example, is being a glorified handyman - staple this bit to that, remove and replace this other bit, all of which has had ample opportunities for study and observation. Or riffling through a MIMS for pharmaceutical information, the bulk of which is backed by drug trials. Cut your finger? Apply some antiseptic perhaps, and cover with a band-aid, both items that have had plenty of testing. Some parts of modern medicine may have fallen through the gaps, but it's absolute nonsense that 'most' has. The bulk of medicine is boring stuff that no-one ever thinks about. Where modern medicine is weak is in preventative medicine.

dllthomas 13y ago

"If I try something, and I feel better then I try more of it." Conclusion: laudanum for everything!

fnordfnordfnord 13y ago

My favorite semi-facetious/sarcastic journal article: http://www.bmj.com/content/327/7429/1459 http://www.bmj.com/content/327/7429/1459 "Conclusions As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute." And a less facetious one http://www.bmj.com/content/333/7570/701 http://www.bmj.com/content/333/7570/701 Both of which point out obvious shortcomings of slavish reliance on large, randomized controlled clinical trials for every circumstance.