tag:blogger.com,1999:blog-4519234397783312626.post2055412184141910984..comments2023-10-09T11:42:57.305-04:00Comments on Healthcare, etc.: The reality of "science-based medicine"Marya Zilberberghttp://www.blogger.com/profile/16080475886113209344noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-4519234397783312626.post-83799407937216093822010-10-28T14:54:59.182-04:002010-10-28T14:54:59.182-04:00Thanks, Schwarts, I think that these people are qu...Thanks, Schwarts, I think that these people are quite sincere about their love for science-based medicine. But then again, so is the Pope about his love for The Church.Marya Zilberberghttps://www.blogger.com/profile/16080475886113209344noreply@blogger.comtag:blogger.com,1999:blog-4519234397783312626.post-1191138305089745992010-10-27T21:18:11.720-04:002010-10-27T21:18:11.720-04:00Marya,
I think you really hit the nail on the hea...Marya,<br /><br />I think you really hit the nail on the head here. With Dr. Novella and his crew, there certainly appears to be a pattern of gross simplification and as you stated "leaps of logic" when it comes to accepting evidence. The behaviour is almost biblical in nature accompanied by the casual ommissions of acknowledging the limitations that comes along with much of it.<br /><br />My own observation supports your characterization of a dogmatic or at least belief based dismissal of alternate modalities based alone on an arbitrary definition of what they deem scientifically plausible.Schwartzhttps://www.blogger.com/profile/14672437377730410871noreply@blogger.comtag:blogger.com,1999:blog-4519234397783312626.post-23998953367802630952010-10-23T11:23:57.319-04:002010-10-23T11:23:57.319-04:00Thanks, Ed. What did you think of the recent Atlan...Thanks, Ed. What did you think of the recent Atlantic article about John Ioannidis' work? I did a post on it this past week titled "Lies and more lies: Are all lies created equal?"Marya Zilberberghttps://www.blogger.com/profile/16080475886113209344noreply@blogger.comtag:blogger.com,1999:blog-4519234397783312626.post-78872288722558988192010-10-22T21:14:37.753-04:002010-10-22T21:14:37.753-04:00Ooh maybe should be still more specific about CAM ...Ooh maybe should be still more specific about CAM as an area I don't address with patients. All I mean by CAM is theories and practices not covered by mainstream medicine ie. that taught in medical schools and discussed in medical journals. A deliberately vague definition. As it turns out I don't myself believe in any of the range of CAM theoretical frameworks and have not taken the time to look at them in more detail; but I don't believe a lot of what I read in medical journals either.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4519234397783312626.post-78926475004355766852010-10-22T21:07:41.382-04:002010-10-22T21:07:41.382-04:00Crikey! I have been meaning to respond for a whil...Crikey! I have been meaning to respond for a while and now you have put up about 4 new posts since this one! No way I could be that productive, I bet you have full-time clinical, research and teaching work as well.<br /><br />Anyway first and most important don't try to keep your equanimity. Proper vigorous discussion entails that no one is afraid of someone getting het up or afraid of offending the reader. Though dogma is bad passion is great, I reckon.<br /><br />Good point about vaccination not being one simple issue. Varicella and HPV vaccines are less critical than pertussis and pneumococcal. In general I'm more nihilistic and disengaged about CAM than most doctors, and probably more than you'd expect. What I mean is that I don't feel it's my role to address CAM either way. Many seem to feel that they should discuss or support or advocate with regard to their patients' CAM use and should therefore try to understand it better. I don't; patients rarely ask me about it and I never raise it. On the rare occasion it is raised my only response is simply 'sorry, I don't know anything about that'. Some might feel this a bit negligent but to me I genuinely value patient autonomy and that cuts both ways. I don't condemn patients for pursuing CAM and I don't feel obliged to help them out with it either. I can confidently say that while discussing or promoting vaccinations or any other alternative view on medicine I've NEVER invoked 'science' and 'scientific evidence' to try to bully the listener into behaviour change.<br /><br />This has become a pointed issue in the child protection work I've done in the past, where a specialist has been clearly angry with parents for pursuing CAM against their orders or simply not following their orders to the letter. Since they lack the legal and ethical discipline which child protection work necessitates they think they can call on the child protection paediatrician to use the power of the state to enforce their wishes. If the child is not in clear danger of significant harm they are quickly set straight (the few cases where parents really are horribly negligent and prosecuted are a small minority of those referred to us).<br /><br />Anyway I'd better get on and look at the rest of your posts or I'll fall even more behind. I can't seem to get my name on my responses on blogspot, just 'theykilledkenny', which is annoying so sorry about that.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4519234397783312626.post-16456574003638721192010-10-17T10:04:01.142-04:002010-10-17T10:04:01.142-04:00Dear Ed, thanks for your thoughtful comment. I cou...Dear Ed, thanks for your thoughtful comment. I could not agree with you more, and we really need to bring humbleness back to the profession. <br /><br />One issue I want to expand on that you bring up is my attitude towards CAM. First, I think that the umbrella of CAM is way too broad and heterogeneous to be a coherent rubric. The potential value of traditional Chinese medicine may be quite different from healing crystals, say. Second, as for vaccines, there are a number of issues. I am a great believer in vaccination as a public health measure. I do think that we have gone a bit overboard with vaccines such a chicken pox and HPV, where economic expediency seems to have trumped the clinical risk-benefit equation. And while I am truly appalled by the demagoguery surrounding the vaccination debate, in the same vein as acknowledging the realities of our science, I would like to acknowledge the nuances of the vaccine issues. <br /><br />Too often I feel that the "science-based" zealots lump everyone's objections to their dogma into the ignorance bucket and resort to insults and intellectual dishonesty to defeat the opposition. In this way many dichotomies are created which conceal the nuances of potentially enriching discussions. I concede that I am incensed by these attitudes, and I will try harder in the future to keep my equanimity.<br /><br />As always, thanks for your well thought-out comments -- they challenge me to keep examining my assumptions!<br /><br />MaryaMarya Zilberberghttps://www.blogger.com/profile/16080475886113209344noreply@blogger.comtag:blogger.com,1999:blog-4519234397783312626.post-17772971799114783002010-10-17T00:32:32.885-04:002010-10-17T00:32:32.885-04:00Good summary Marya. Too often the term 'scien...Good summary Marya. Too often the term 'science' is used as an authoritative trademark rather than indicating what it really is, a humbly questioning and critical striving to understand the world. The fact that some commentators such as in this example so relentlessly pursue 'woo' issues while largely ignoring many of the extremely difficult and complex controversies within mainstream science makes me wonder what their motivation really is; to expand human understanding or to pursue a social aim of confronting and defeating the now socially-powerful advocates of alternative medicine. These aren't the same objectives.<br /><br />I probably don't disagree as strongly as you about the possible harms of alternative medicine (anti-vaccine loons are pretty bad), I just don't see our role in the medical establishment to be to stamp out these heinous evils through all means available including government intervention. I don't think we have the power to completely change some of these beliefs in others and efforts like this example are probably counter-productive anyway. We can provide information and recommendation and these are likely work best in all ways if delivered humbly and engagedly. I've amended the one post on my blog referring to acupuncture to make this crystal clear.<br /><br />The tone of dogmatic paternalism which I'm sure is partly what set you off also makes me wonder what the author's mainstream clinical practice is like, since to my mind dogmatic paternalism is the enemy of good clinical practice. For whatever controversies exist in current neurology practice does he also come down hard on one side, overgeneralising research findings rather than taking interest in fine-grained detail, all fuelled by a personal disdain for those who practice in ways alternative to his own? This is speculation but the linked commentary makes me feel it is more likely the case in this sort of clinician than average.<br /><br />I of course have my own angle and I don't think the rise of the movement of 'evidence-based medicine' has been helpful in restraining complacent authoritativeness. This is ironic since a clear aim of the movement was to devalue the social authority of established 'experts'. Sadly I feel the overall effect has been negative and it has merely provided a framework for anyone to aspire to a position of discussion-stymieing authority, in place of the crusty ancient professors whose pronouncements were previously taken as gospel.Anonymousnoreply@blogger.com