Maybe, Federico, but my intuition is telling me that your concession allows a false distinction, if you are indeed, both working with patients. I know this is dangerous teritory for a anthropologist-turned-sociologist, but it seems to me that perhaps RCTs do have a place regarding potential safety implications of new drugs but I think the issue is less about intuition with regards patients and more about listening to the needs of each patient.
Isn't it true that RCTs give us great information about what happens to a certain number (statistic) within a POPULATION when given a particular treatment? That is, my understanding of RCTs is that they don't actually deliver on INDIVIDUAL patient information and so somehow you must take that magical leap from statistical population data to helping that patient in front of you decide whether to have the blue pill or the green pill. To me, perhaps it is just intuition, but that distinction should not be glossed over. Also, I wonder, how often do RCTs tell you in black and white that the green pill will always be better than the blue pill for every single patient? From what I can tell, RCTs often reveal how little we know and how much more we need to know.
just some thoughts, all the best,
Jenny
Federico Barbani <[log in to unmask]> wrote:
> OK Paul: each method at its own field.
>
> dr. Federico Barbani
> Health Purchasing Unit
> Health Authority Modena
> via San Giovanni del Cantone n. 23
> 41100 MODENA - Italy
> tel. 059/435813 - 435313
> fax 059/435703
>
> ----- Original Message -----
> From: "Paul Glasziou" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Friday, September 30, 2005 3:41 PM
> Subject: Re: Broadening the view of medicine
>
>
> > Dear All,
> > Its "horses for courses". Intuition is great for many everyday
> > things; and QI is great to monitor whether local practice is
> > improving. But no one's intuition nor QI can tell you whether its the
> > green pill or the blue pill which is the effective one (or the killer).
> > Take care,
> > Paul Glasziou
> >
> >
> > At 30/09/2005, Rakesh Biswas wrote:
> > >Thanks for this great article. Truly thought provoking! Whether we
> > >learn from RCTs or from day to day personal experience (that if
> > >shared systematically has the potential to become good science), at
> > >the end of the day we retain what clicks with our internal being. As
> > >described in the article, no one learns parenting from laboratory
> > >results and practising medicine is akin to successfull parenting.
> > >How much does intuition play a role in this so called pragmatic
> science?Rakesh
> > >
> > >On 9/30/05, Mayer Brezis
> > ><<mailto:[log in to unmask]>[log in to unmask]> wrote:
> > >Attached is thought-provoking piece by Harvard Professor Don Berwick
> > >(viewed as one of the most influential people in US healthcare policy),
> > >related to our recent discussion on "outcome research".
> > >
> > >Teaching EBM, I tell my students that evidence is also to observe how
> > >knowledge is being applied. Am I wrong?
> > >
> > >Mayer Brezis, MD MPH
> > >Professor of Medicine
> > >Center for Clinical Quality & Safety
> > >Hadassah University Hospital
> > >Jerusalem
> > >
> > >
> > >
> > >
> > >
> >
> > Paul Glasziou
> > Department of Primary Health Care &
> > Director, Centre for Evidence-Based Practice, Oxford
> > ph: 44-1865-227055 www.cebm.net
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