For correct URL: See below.
On 24-Sep-10 20:42:59, Piersante Sestini wrote:
> Dr. Carlos Cuello wrote:
>> Do you agree with the following sentence?:
>>
>> "EBM, in a nutshell, ignores prior probability_ (unless there is no
>> other
>> available evidence <http://www.bmj.com/content/312/7023/71.extract>)
>> and
>> falls for the “*p-value
>> fallacy<https://docs.google.com/viewer?url=http%3A%2F%2Fwww.annals.org%
>> 2Fcontent%2F130%2F12%2F995.full.pdf>
>> *”; SBM does not."
>
> I don't. I can't see anything in the EBM "disciplinary matrix" that
> endorses those fallacies: indeed, you will find more discussions about
> pre-test probability in EBM textbooks than in conventional
> "science-based" textbooks such as the Harrison or Cecil.
> What else is the "C" in a PICO question if not a pretest probability?
> Scott Richardson (certainly not unknown in the EBM community) published
> excellent works on pre-test probability.
>
>
> As for the p value fallacy, a famous paper about it is quite
> appropriately titled "Toward evidence-based medical statistics. 1: The
> P
> value fallacy" (Goodman SN. Ann Intern Med. 1999 Jun
> 15;130(12):995-1004) and AFAIK nobody in the EBM community ever
> objected. Neither I was charged of heresy when I presented an
> experience
> on "Exposing the p-value fallacy to young residents" last year at the
> 5th EBHC International Conference in Taormina, a qualified forum of
> distinguished EBMers.
> www.ebhc.org/2009/presenaions/10-29/session2/3.%20Sesini_.pdf
The above URL is incorrect. Try:
http://www.ebhc.org/2009/presentations/10-29/session2/3.%20Sestini_P.pdf
> I agree that those fallacies are present among EBMers as among
> practitioners of other disciplines, but those are individual fallacies,
> not systematic constituents of EBM itself.
>
> Of course, the fact that when a systematic review showed that some
> nonconventional intervention (homeopathy, it I remember correctly)
> showed a "significant" clinical effect, nobody (as far as I remember)
> in the EBM community objected that the given the doubtful background
> evidence that value had little meaning, did not help.
>
>
> But the major misunderstanding of the science-based blog seems to be an
> interpretation of EBM as a guide for conducting clinical research,
> rather than for using it in clinical practice, what in fact it is.
>
> The first time that I was confronted with the term "science-based" as
> opposed to "Evidence-based" was at an EBM workshop at the American
> Thoracic Society, about 10 years ago. A contributor of the GINA
> guidelines on asthma (an heavily sponsored guideline, in which you may
> bet that not a single line is published without prior hidden
> approval by commercial representatives
> through
> their well payed consultants), when I objected that the guidelines
> presented very little useful information for evidence-based practice
> (for one, they endorsed the regular use of peak-flow monitoring,
> despite
> clear evidence of its futility in most cases), answered that their
> recommendations were "science-based" (that is, based or filtered on
> expert opinion) rather "evidence-based".
> I don't know whether the name of blog
> is
> part of that ancestry, but I have remained suspicious of the term since
> then.
>
>
>
> Piersante Sestini
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Date: 24-Sep-10 Time: 22:03:55
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