Bonjour everyone and especially Hilda and Andy
Hilda this legal 'optique' really rings bells . I have started recently
to think about 'the truth , the whole truth and nothing but the truth'
(looking at these US courtroom thrillers) every time I hear the word
evidence. Surely there are at least three similar meanings of evidence
as well : the evidence, the whole evidence and nothing but the evidence
. For me that helps to put the daily use of the word evidence in
perspective a little.
I work in clinical guideline making for resource constrained areas - all
singing and dancing (Western) gold standards are not that helpful when
the tools and technologies to implement such standards are not
available. Trials looking at different resource options and their
effect on outcomes are few and far between.So we think about what it is
we miss if there is no evidence.
And then I think ...oh well -- if there is no evidence for a statement
that really means nothing - it could still be the truth , the whole
truth and even nothing but the truth or it could be wrong.
I feel very stimulated by this note on 'Adverse anecdotes' - Evidence ,
for what it's worth is about DOs - these Adverse events seem to be about
Dont's . I think each of our Guidelines should consider adding the top
10 DONTs as well. And yes - I think these DOs are easier to learn than
the DONTs
Thank you for making me stop and think a moment -
Justus Krabshuis
France
On 07/07/2011 17:46, Hutchinson Andy wrote:
> Thanks Hilda
>
> It also occurs to me that when politicians (who often have a legal background, at least in the UK) talk about 'evidence-based policy making', they may well mean "well, we have taken testimonies from witnesses e.g. clinicians, members of the public". The fact that those people's ideas, thoughts, views, etc will be influenced as much by their mindlines, prejudices and assumptions as what we in this group might think of as evidence, does not always seem to be considered
>
> Andy
>
> Andy Hutchinson
> Education and Development Manager
> Tel: 07824 604962
> Web: www.npc.nhs.uk
> email: [log in to unmask]
>
> Please note new website address
>
> -----Original Message-----
> From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Bastian, Hilda (NIH/NLM/NCBI) [C]
> Sent: 07 July 2011 16:26
> To: [log in to unmask]
> Subject: Re: EBM Anecdote: Today's NEJM
>
> G'day!
>
> I think this is one of the problems with the word "evidence": so many people see any "fact" as "evidence", because that is, as you say, how the word is used elsewhere (as in "evidence of my own eyes"). However, an RCT, because it is a formal experiment, has probative value. That's a critical distinction that used to be made where I first learned about evidence - which was when I worked in courts. Just because information is organised and systematic, does not necessarily mean it has probative value.
>
> Yet, some of us see the word "evidence" as meaning "proof" (ie having probative value), but most people probably don't. It's often pointed out that evidence doesn't mean proof in languages other than English - but it doesn't really mean only specifically that in English either.
>
> In the world outside the EBM field, an eyewitness account and even circumstantial evidence are still evidence. It's a more complicated word in English than we think, and the community view of it must surely be more influenced by the legal use of the word (especially in a world where police and legal procedural TV shows are so widespread and popular), than by any re-purposing of the word health care tries to make.
>
> And that includes the different idea of the onus of proof. I had absorbed clearly when I worked in the courts, that proof means, more likely than not. It was called "the balance of probabilities" and it just had to tip 51%. When I entered the EBM world, I found out that "probable" in this world was set at 95% (or sometimes 90%). That's a gulf that is enormously wide.
>
> Suffice to say, I'm not sure evidence is a good term for what many of us mean, and I've started to avoid using it when I'm writing in English, too.
>
> Hilda
>
>
>
> From: "Bill Cayley, Jr"<[log in to unmask]<mailto:[log in to unmask]>>
> Reply-To: "Bill Cayley, Jr"<[log in to unmask]<mailto:[log in to unmask]>>
> Date: Thu, 7 Jul 2011 08:49:59 -0400
> To: "[log in to unmask]<mailto:[log in to unmask]>"<[log in to unmask]<mailto:[log in to unmask]>>
> Subject: Re: EBM Anecdote: Today's NEJM
>
> I think the most pithy part of the article is the phrase: "Informed adverse anecdote transforms scattered data into sound clinical judgment"
>
> To my way of thinking (OK, so we're starting w/ anecdote already!) evidence is simply "any observation" - the difference between anecdote and RCT and meta-analysis is simply the degree to which the evidence is ORGANIZED and SYSTEMATIZED. Still, it takes real-life, clinical experience to know where to look and have the perception of nuance to know how to organize the evidence.
>
> Bill Cayley, Jr, MD MDiv
> [log in to unmask]<mailto:[log in to unmask]>
>
> Work:
> Augusta Family Medicine
> 207 W Lincoln, Augusta, WI 54722
> Tel: 715.286.2270
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> A cheerful heart is good medicine... (Proverbs 17:22)
>
> From: Rakesh Biswas<[log in to unmask]<mailto:[log in to unmask]>>
> To: [log in to unmask]<mailto:[log in to unmask]>
> Sent: Wednesday, July 6, 2011 11:19 PM
> Subject: EBM Anecdote: Today's NEJM
>
> To quote from: http://healthpolicyandreform.nejm.org/?p=14876&query=TOC
>
> "The key is to use these flashes of physician anguish to illuminate the Level I evidence and identify the real risk factors for a bad outcome. I suspect the amygdala did not evolve to store odds ratios and heterogeneity P scores, but when an adverse event has prompted me to review the literature, I come away with a clearer understanding. There's nothing like a baby free-floating in the abdomen to drive home the lessons from a prospective study of risk factors for uterine rupture. And that clarity of understanding will serve the next at-risk patient I encounter."
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