April 8th, 2010 by David H. Gorski, M.D., Ph.D. in Better Health Network, Opinion, Research
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One of the things about science-based medicine that makes it so fascinating is that it encompasses such a wide variety of modalities that it takes a similarly wide variety of science and scientific techniques to investigate various diseases. Some medical disciplines consist of mainly of problems that are relatively straightforward to study. Don’t get me wrong, though. By “straightforward” I don’t mean that they’re easy, simply that the experimental design of a clinical trial to test a treatment is fairly easily encompassed by the paradigm of randomized clinical trials.
Medical oncology is just one example, where new drugs can be tested in randomized, double-blinded trials against or in addition to the standard of care without having to account for many difficulties that arise from difficulties blinding. We’ve discussed such difficulties before, for instance, in the context of constructing adequate placebos for acupuncture trials.
Indeed, this topic is critical to the application of science-based medicine to various “complementary and alternative medicine” modalities, which do not as easily lend themselves to randomized double-blind placebo-controlled trials, although I would hasten to point out that, just because it can be very difficult to do such trials is not an excuse for not doing them. The development of various “sham acupuncture” controls, one of which consisted even of just twirling a toothpick gently poked onto the skin, shows that.
One area of medicine where it is difficult to construct randomized controlled trials is surgery. The reasons are multiple. Read more »
*This blog post was originally published at Science-Based Medicine*
March 30th, 2010 by Dr. Val Jones in Better Health Network, Expert Interviews, Opinion, Research, True Stories
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I recently wrote about an experience that I had with a reporter (Erica Mitrano) who interviewed me about energy healing at Calvert Memorial Hospital in southern Maryland. Erica was very friendly and inquisitive, and we had a nice conversation about the lack of scientific evidence supporting any energy healing modality. I thought it would be fun to post what we had discussed at SBM, and then wait to see what trickled down into the finished piece.
When the final article appeared I was very disappointed. Not only was I not quoted, but there was no skeptical counterpoint at all. The story read like an unquestioning endorsement of junk science, and I wondered if it was worth it to continue speaking to journalists to offer expert advice. It seemed to me that this experience was emblematic of all that’s wrong with health reporting these days. (Just ask Gary Schwitzer, who has recently given up on reviewing TV health stories in mainstream media since they are generally so inaccurate.) Read more »
*This blog post was originally published at Science-Based Medicine*
March 24th, 2010 by DrRob in Better Health Network, Health Tips, Opinion, Research
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Here’s some advice I have given teenage boys who are going toe-to-toe with their mothers about a health issue:
Don’t go toe-to-toe with your mother; it’s a no-win situation. Either you are right, and you are looked at as a “smarty-pants” or you are wrong, and have given her a huge “I told you so.” If, on the other hand, you keep quiet and listen to what she’s saying, it’s a win-win: either she’s right and you learn something, or she’s wrong, and you have been vindicated.
Fathers often pipe in that this applies to wives as well. Mom’s don’t seem to disagree (for some mysterious reason).
While this may be sound relational advice, it also needs to be heeded by the medical community in its relationship to “complimentary and alternative medicine” or CAM. I am not saying we shouldn’t be angry and frustrated with the CAM purveyors who are harming and even killing people (such as the anti-vaccine movement). I am not saying that we should embrace CAM and put it at anywhere near equal footing with our profession. What I am saying is that in our enthusiasm to win the argument, we can undermine our own credibility. Read more »
*This blog post was originally published at Musings of a Distractible Mind*
March 11th, 2010 by David H. Gorski, M.D., Ph.D. in Announcements, Better Health Network
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It’s been a rather eventful week here at Science-Based Medicine. I apologize that I don’t have one of my usual 4,000 word epics ready for this week. I was occupied all day Saturday at a conference at which I had to give a talk, and Dr. Tuteur’s departure produced another issue that I had to deal with. Fortunately, because Dr. Lipson is scheduled to do an extra post today, I feel less guilty about not producing my usual logorrhea. Who knows? Maybe it will be a relief to our readers too.
This confluence of events makes this a good time to take a break to take care of some blog business and make formal what I alluded to on Thursday in the comments after I announced Dr. Tuteur’s departure, namely that it’s time for us at SBM to start recruiting. Our purpose in recruiting will be to make this blog even better than it is already. We have an absolutely fantastic group of bloggers here, and it is due to their hard work and talent that SBM has become a force to be reckoned with in the medical blogosphere. Our traffic continues to grow, and reporters and even on occasion governmental officials have taken notice. Read more »
*This blog post was originally published at Science-Based Medicine*
January 29th, 2010 by Dr. Val Jones in Humor, Research
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Thanks to Harriet Hall, I found this hilarious spoof article from the BMJ which perfectly illustrates why “Evidence-Based Medicine” (EBM) alone is not sufficient for answering medical questions. The abstract perfectly illustrates why randomized controlled trials must be viewed within the context of general scientific knowledge rather than in isolation. The weakness of EBM has been an over-reliance on “methodolatry” – resulting in conclusions made without consideration of prior probability, laws of physics, or plain common sense.
EBM is valuable but not sufficient for drawing accurate conclusions… which is why Steve Novella and the Science Based Medicine team have proposed that our quest for reliable information (upon which to make informed health decisions) should be based on good science rather than EBM alone.
Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials
Gordon C S Smith, professor1, Jill P Pell, consultant2
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