Dear Frances,
Yes - the articles seem to include a hoard of straw men. And doesn't
seem well informed by evidence. For example, the claim that CAM can't be
tested by RCTs because "Randomisation and
standardisation are foreign, and often incommensurate, concepts in CAM"
has been neatly tested and refuted by Bensoussan[1], who did a 3-arm
randomised trial of (i) standard chinese herbs (ii) *individualised*
herbs (tailored to that persons unique constellation) and (iii) placebo
for irritable bowel syndrome. Both chinese herb groups did better but
individualisation did no better than standardised. This is *not* cited
by any author (thanks Alejandro for the pdf that allowed be to search that).
I also note there seemed to be no one from the clinical coalface in the
group of authors, which may help explain their apparent disconnection
from the realities of clinical practice and why we need EBM. But they
would have done well to first read Sharon Straus's review of the
criticisms of EBM[2], which might have saved them some time inventing
straw men.
Happy New Year,
Paul Glasziou
1. Bensoussan A, Talley NJ, Hing M, Menzies R, Guo A, Ngu M. Treatment
of irritable bowel syndrome with Chinese herbal medicine: a randomized
controlled trial. JAMA. 1998 Nov 11;280(18):1585-9.
2. Straus SE, McAlister FA. Evidence-based medicine: a commentary on
common criticisms. CMAJ. 2000 Oct 3;163(7):837-41.
Frances Gardner wrote:
> Hum. There are some marvellous phrases ["Efficacy as a Rhetorically Mobile
> Boundary Object" "RCT Reports as Idealising Genres"] in the paper by
> Derkatch, and very large straw men used to explain why we cant possibly have
> decent evidence to test whether complementary therapies (CAM) work eg on p50
> see below - all treatments must be the same for all patients in an RCT, and
> RCTs cant be done because double blinding cant be done. The first two papers I
> found more interesting and perhaps better informede.
> Frances
>
> Dr Frances Gardner, Professor of Child and Family Psychology
> Department of Social Policy & Social Work, Oxford University
> 32 Wellington Square, Oxford OX1 2ER, UK
> tel:44-1865-270334 [log in to unmask]
>
>
> From page 50:
> Studies of CAM pose significant methodological questions because the practices
> do not generally translate well into the “gold standard” RCT. Randomisation and
> standardisation are foreign, and often incommensurate, concepts in CAM
> practices, which, in contrast to biomedicine, tend to view patients as
> fundamentally unique, so two people with the same ailment might be treated
> altogether differently, depending on their unique constellation of symptoms
> and/or personal characteristics (Barry 2006, 2647; Degele 2005, 118). Corollary
> to this emphasis on uniqueness is that treatments can be difficult to
> standardise in experimental settings: while biomedical treatment is largely
> symptomatic in the sense that a person may be treated separately for different
> conditions (even by separate specialists), many CAM practitioners aim to
> address all symptoms together.6
> Controlling and blinding studies of manual practices such as acupuncture or
> chiropractic are also difficult because they involve unmistakable physical
> actions that are difficult to simulate (e.g. piercing the skin and moving the
> spine with an often audible
> popping sound). In a practice such as acupuncture, there is no available
> control that is both realistic and definitely inert (a la sugar pill), and
> practitioners usually cannot be
> blinded. These methodological problems leave researchers to puzzle out how such
> studies ought to be conducted, interpreted, and incorporated into practice
> because the practices do not fit easily with conventional scientific procedures
> or genres
>
> In message <[log in to unmask]>
> Alejandro Piscoya <[log in to unmask]> writes:
>
>> Got access "trough the grapevine". I feel intimidated by all the phylosophic
>> terms involved in these articles so I am waiting for your comment in order
>> to try to understand some of what is written here...
>>
>> Alejandro
>>
>>
>>
>> On Sun, Jan 4, 2009 at 2:47 PM, Dan Mayer <[log in to unmask]> wrote:
>>
>>
>>> Hi everyone,
>>>
>>> This looks suspiciously post modern. I'd love to read it and be able to
>>> comment. However, I can't get on any of the articles. Anyone have access?
>>> It costs $197 to purchase the issue and about $25 per article.
>>>
>>> Dan
>>>
>>> PS: Happy New Year
>>>
>>>
>>>
>>> ****************************************************************************
>>> Dan Mayer, MD
>>> Professor of Emergency Medicine
>>> Albany Medical College
>>> 47 New Scotland Ave.
>>> Albany, NY, 12208
>>> Ph; 518-262-6180
>>> FAX; 518-262-5029
>>> E-mail; [log in to unmask]
>>>
>>>
>
>
--
Paul Glasziou
Director, Centre for Evidence-Based Medicine,
Department of Primary Health Care,
University of Oxford www.cebm.net
ph - +44-1865-289298 fax +44-1865-289287
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