“Don’t let the world around you squeeze you into its own mould, but let God re-mould your minds from within...”
Romans 12:2

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Hilary's Desk

Eminence based medicine - Part 1.

Hilary Butler - Wednesday, May 02, 2012

There is a fascinating video on medscape website which all parents should listen to, or read the transcript of. The article is titled: "Why Doctors Keep Doing Treatments That Don't Work".

The doctor concerned, states:

...."You have talked rather generously about evidence-based medicine. Most of medicine isn't evidence-based. The overwhelming majority is more "eminence-based," to steal from my colleague to the right [Eric Topol]. We do things because we have always done them. That is going to be less tenable, and you will be put under more and more scrutiny about "Why is that? Why is this happening to me?" or "Why, doctor, are you doing that as opposed to this?" You peel back the level that says, "Well, actually, there isn't any evidence to support that. That was merely my historical preference as opposed to my data-driven wisdom and decision-making." That will put pressure on what we do and will ask us to answer some of the questions about dominant practices that are founded largely by history".


He goes on to say:

...."If you go to your doctor at the moment with lower back pain, there is a pretty good likelihood that you will get some imaging for that, and there are pretty good data that say that no subsequent decisions hinge on the observations made in that imaging, or that those decisions will happen at some incredibly low likelihood. But it goes much deeper than the instances of known waste. We do a lot of things, as Eric [Topol] pointed out, that are population-based when we fully know that 30%-40% of the people to whom we provide such therapies derive no benefit but experience all the costs and all the adverse consequences. All it takes is understanding the genetic determinants, the historical determinants, or the epigenetic determinants that say, "In you, this therapy won't work, so skip it."

(Which comes back to what we were saying in "Back to the Basics") He then continues....:

"The opportunity to take potentially life-saving therapies and give them only to the 30%-50% of a cohort that deserves them, by virtue of having some positive impact, saves half of the expense."

and...... "Estimates of known waste are $700-$800 billion a year. The things we don't yet know are larger because we are doing things that are in the guidelines. But when you peel back a layer, those guidelines are derived largely from apocryphal suggestions in remote history, right? So, there is a tremendous opportunity, as we put pressure on the system, to justify why we do what we do. Importantly, we have a system with a bandwidth limitation living at the doctor. We can't keep up with the onslaught of information. We can't keep up with the patients we have to see. We are not really good at even figuring out which of the patients we are responsible for need to be seen at a particular time. We realize that "maybe I shouldn't be making those decisions because I can't comprehend all the diseases that my patients have. They are presenting information I don't yet know how to interpret."

Okay, so you've got all that ... have you?  Are you starting to understand the "limitations" of medicine yet? Later in this series evidence based medicine will be discussed, because it is not what you think it is....  But back to this blog.)  Guidelines are largely "apocryphal" suggestions from remote history, much of medicine is anecdote, and they often don't know how to interpret the information you tell them.  Hmmmm.... How does this apply to vaccines?

Part Two ....

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