6 ms·

Evidence-based medicine. As opposed to what, speculation-based medicine? Call me old-fashioned, but shouldn't all modern medicine be 'evidence-based' by defini

• Crito 13y ago
  > As opposed to what, speculation-based medicine? Well, yes. The idea is that "speculation-based medicine" (better known as "alternative medicine") is, despite the name, not actually medicine. Hence the Tim Minchin joke: "You know what they call alternative medicine that's been proved to work? ...Medicine."
  • dllthomas 13y ago
    I wasn't under the impression that alternative medicine was the only thing that was not "evidenced based" - that while clearly it's an extreme example, there is plenty of traditional medicine that doesn't make the cut. Wikipedia seems, at a skim, to concur: http://en.wikipedia.org/wiki/Evidence-based_medicine http://en.wikipedia.org/wiki/Evidence-based_medicine
    • Crito 13y ago
      Evidence-based techniques can become discredited when the state of the science advances, and I would agree that those techniques would not then become "alternative medicine"... unless perhaps they remain in practice. Unless somebody is still doing it, I'd just call it "discredited". Things like psychoanalysis do not typically get the "alternative medicine" label, but they probably should.
• fishtoaster 13y ago
  You'd think so, wouldn't you? However: http://en.wikipedia.org/wiki/Alternative_medicine http://en.wikipedia.org/wiki/Alternative_medicine
• mturmon 13y ago
  I don't know, there are plenty of cases where the stuff we thought qualified as "evidence", and definitely turned into medical practice, turned out to be wrong. Examples: stress causing ulcers, cough medicine for children, diet (carbs good or bad? cholesterol horrible or inconsequential?), prostate cancer screening, certain kinds of corrective surgeries.
  • erkkie 13y ago
    and like many orthopedic surgeries have turned out to be not better than noninvasive alternatives ( my personal pet peeve is the knee: http://www.nejm.org/doi/full/10.1056/NEJMoa1301408 http://www.nejm.org/doi/full/10.1056/NEJMoa1301408 , http://www.nejm.org/doi/full/10.1056/NEJMoa0708333 http://www.nejm.org/doi/full/10.1056/NEJMoa0708333 ). In general surgical procedures are much more based on anecdotes and personal experiences (of the surgeons) than long term evidence of efficiency (for various reasons).
    • tensor 13y ago
      I remember hearing an interesting talk discussing this. I forgot the author, but I'll try to relate a bit of the content. Doing proper experimental testing for surgeries often has significant ethical problems. For instance, to do it correctly you need to do "fake" surgery on some patients. This is to account for the placebo effect. However, doing this exposes the patient to health risks, which is arguably not ethical. Then there is the tricky problem of the case where a technique does work, and not performing it causes a patient to die. Yes, they died in the name of science, but it still goes against the goals and ethics of many doctors. On the other hand, performing ineffective surgery also exposes patients to significant risk, and may even cause death. So it's a really difficult topic. Myself, I'd still like to see the experiments done, even if the cost if not saving some lives we could have at times.
    • mturmon 13y ago
      Yes, thanks for digging that up. My wife had a knee operation for chondromalacia that turned out to be a mistake, but it was earnestly recommended at the time.