Hi Amy
I think this is the opportunity within pre-registration curricula for true interprofessional learning; and EBP style journal clubs within the practice setting.
Jenny
Dr Jenny Morris
Associate Professor (Senior Lecturer) Health Studies
Faculty of Health, Education & Society
University of Plymouth
Knowledge Spa
Truro
Cornwall TR1 3HD
On 12 Feb 2012, at 15:41, "Dr. Amy Price" <[log in to unmask]> wrote:
> Jenny,
> I agree this is important, particularly given the day to day interaction others dealing with patients may not have. What are ways you see this could be progressed?
>
> Amy
>
> -----Original Message-----
> From: Jenny Morris [mailto:[log in to unmask]]
> Sent: 12 February 2012 04:39 AM
> To: Dr. Amy Price
> Cc: [log in to unmask]
> Subject: Re: Time to declare war
>
> I've been following the debate with interest. I teach EBP in the main to nurses, many of whom trained years ago and the problem they continually face is the lack of inter-professionalism in the context of clinical decision making and clinical practice. As well as teaching knowledge and skills around evidence informed decision making we need also to bring the focus back to inter-professionalism.
>
> Jenny
>
>
> Dr Jenny Morris
> Associate Professor (Senior Lecturer) Health Studies
> Faculty of Health, Education & Society
> University of Plymouth
> Knowledge Spa
> Truro
> Cornwall TR1 3HD
>
> On 12 Feb 2012, at 04:05, "Dr. Amy Price" <[log in to unmask]<mailto:[log in to unmask]>> wrote:
>
> Paul I agree and am so thankful for EBM. I have heard the same story in many countries but having EBM skills is like reading with the lights on! I so appreciate the excellent teaching , papers and mentoring. I really am thankful for the kindness and patience of those on this board who break down complex questions in the way that they bring understanding for all...I thought the same as you that Drs are good and they know their evidence but what I found is wrongly interpreted information harms people and drives wedges. Knowledge is our best resource, I think of it right up there with clean water!
>
> Amy
>
> From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Paul Elias
> Sent: 11 February 2012 10:26 PM
> To: [log in to unmask]<mailto:[log in to unmask]>
> Subject: Re: Time to declare war
>
> I think you are right Jo, there is financial pressures to keep the status quo...sadly...and this is not you or me or anyone bashing anyone in the medical field...thats why the area of EBM is so exciting and intriguing and attractive...for it offers really the first opportunity to hold all accountable and open up a secret place that many frolic in and lock the majority out..in Canada, big pharma and clinicians/specialists have a lock on the system in the sense that they control the purse strings...and this is not about "I studied for 12 years so I should be highly paid"....no, absolutely not...never...my take on this is " you chose this field and you swore to protect life first and do the best for the patient, your patient" ....if you entered the field for the financial compensation mainly, then this is wrong...but...this is my take...and this is why I love EBM for it has helped me understand that clinicians and specialists and the like are not much different that anyone...I think it were the dominance and distance between the knowledge that a doctor had, and I say 'had' that is now the thorn in their side for now they face patients who maybe are as informed as they are on their condition. I like that the field is now level somewhat but doctors must respond by upping their game and skills and if EBM offers the tool to help you get on top of the data and the evidence to make the best decisions for the patient, then do it...I actually until I entered the EBM arena, always thought doctors used best evidence to treat...what a shocker for me...daily...and what is even more stupendous is that it is as if you fight the medical establishment inch by inch to upgrade them...and help them advance and be on the cutting edge...its as though you must fight to make this argument that you should, all of you, all clinicians, all in the scientific field, must practice via the best evidence and remain on top of the science....
>
> I say well done and kudos and big huge props to the people like Haynes, Guyatt, Burls, Glazious, Mike Clarke, Sackett, Altman, Yusef, Julien Higgins, Henegen, and the people here...the stunning brilliant folk here who teach us daily and help us understand..big praise to all of you who push the EBM approach and I see a time when EBM will be the status quo..but it will take time and fights...for no one likes to work hard to to keep on top of things...and I know what I say can anger too but its just how I see it...
>
> thank you all here for allowing me the chance to learn from you for this forum is outstanding...
>
>
>
>
>
> Best,
>
> Paul E. Alexander
>
>
>
>
> --- On Sat, 2/11/12, jo kirkpatrick <[log in to unmask]<mailto:[log in to unmask]>> wrote:
>
>
> From: jo kirkpatrick <[log in to unmask]<mailto:[log in to unmask]>>
> Subject: Re: Time to declare war
> To: [log in to unmask]<mailto:[log in to unmask]>
> Received: Saturday, February 11, 2012, 5:43 PM
> Thanks Roy
>
> Well that's two of us, now I only have to persuade the rest of the world's medical and scientific communities. I would love to do either or both of these studies myself, but as I am a psychologist not a medical graduate, and for the sake of the world's addicts, I would love it even more if a team of top neuroscientists from somewhere like Oxford decided to do it, while scanning the brain using the latest imaging technology.
>
> What really puzzles me is the anomalous reasoning that allows doctors to continue to prescribe Ritalin for children with ADHD in spite of the number of deaths from heart attacks in previously healthy children [because 189 unnecessary deaths in 10 years, is regarded as statistically negligible]. Yet finds that 2 deaths in 40 years out of many hundreds of successful outcomes renders Ibogaine as potentially too dangerous to use on addicts. It is very difficult to avoid the conclusion that the drug companies are pulling the strings that will keep their obscenely high profits flowing, in the same way that the oil companies blocked the discoveries of non-fossil fuels.
>
> By the way, it is known that as eating disorders, OCD, and depression also have the similar neural roots to addiction, Ibogaine might also be able to help to treat these conditions, so it is no wonder if the drug companies are scared of it.
>
> Jo
>
>
>
> ________________________________
> From: Marsh Roy <[log in to unmask]<mailto:[log in to unmask]>>
> To: [log in to unmask]<mailto:[log in to unmask]>
> Sent: Thursday, 9 February 2012, 9:43
> Subject: Re: Time to declare war
>
> I did a quick scan on Google Scholar and indeed found very little on either Ibogaine (mainly pharmacological, rats etc) or NET (one narrative review). I don’t want to provoke a debate that is likely to become quite heated and personal, but it does seem worth a small grant to do an up-to-date scoping review of one or both interventions.
>
> Roy
>
> From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Pranab Chatterjee
> Sent: 09 February 2012 06:14
> To: [log in to unmask]<mailto:[log in to unmask]>
> Subject: Re: Time to declare war
>
> Thomas deQuincey wrote Confessions of an English Opium Eater. Seems like that is the book you are referring to.
>
> I have never heard of Ibogaine or the NET and would like to hear what the EBHC community has to say about this. However, I must say whenever someone says "a drug that cures ALL xyz" I get a little skeptical about it.
>
> Regards,
> Pranab
> On Thu, Feb 9, 2012 at 6:39 AM, jo kirkpatrick <[log in to unmask]<[log in to unmask]>> wrote:
> Hi EBH
>
>
> It might be a hackneyed cliché but 'now' is the time to learn from the mistakes of the past and to plan for a better future. Evil prospers where good people keep silent and do nothing. Like so many of my generation, I kept silent and did nothing for 45 years, while one by one people I knew died. I am trying to make up for my previous apathy, and encourage others to join my declaration of war on 'the war on drugs', which as they can't really fight a substance, is actually a war on people - the addicted. The casualties since the 1967 Dangerous Drugs Act, are now in hundreds of thousands and still mounting.
>
> During the first years of my illness I needed round the clock care. I had moved out of my home for fear of infecting my daughter or her father. Hep C is so infectious and there was no cure back then, so I was afraid that if they were involved in my care it would put them at risk. I was looked after at various times by six people who had Hep C antibodies but were not ill. Within five years of my recovery all six of them were dead, only one, Ollie, died of hep C related liver failure at age 50. Another one, Nick, age 28, tried to break up a fight in the street between two women. They turned out to be a mother and daughter who both turned on him and he was stabbed. They both denied using the knife and the police were unable to prove which one caused the fatal wound so neither of them was charged.
>
> The other four died from: 'methadone related sudden death syndrome', which is not an overdose but a type of cardiac and/or respiratory failure that usually occurs without warning during sleep. If they are lucky they wake up in the throes of sleep paralysis, trying to sit up and gasping for air [I have actually experienced this several times and it is terrifying, it's as if I stopped breathing in my sleep]. I have heard it can even happen long after people have stopped taking methadone. There has been little research into this because this has only been realised recently but I was able to find a news report and an NIH report, here are the links:
>
> http://www.reuters.com/article/2008/01/22/us-methadone-death-idUSCOL27391920080122
>
> http://www.ncbi.nlm.nih.gov/pubmed/18187075
>
> Every year hundreds of people die because of the world's insane drug laws. In the UK NHS clinics stick rigidly to prescribing policies that are based on prejudice rather than evidence. A cure for all addictions, called Ibogaine was discovered in 1967. Since 2000, hundreds of people have recovered their lives in the many private Mexican rehab clinics, which are the only places Iborgaine therapy is available for about £5000. Unlike methadone or opiate reduction therapy, Ibogaine doesn't leave newly recovered addicts with an alcohol problem; or distracted by the cravings that cause most people to relapse. Cravings keep recurring, and continue for several years. The FDA banned Ibogaine in the USA because it is similar to LSD; and because there is a very slight risk for people with undiagnosed heart conditions. On two separate occasions people with undiagnosed heart conditions took it alone without supervision and died of heart attacks.
>
> The majority of scientists refuse to get involved in RCT out of fear for their reputation if a patient dies, but many addicts I know of would be happy to sign a waiver. They take far greater risks of death from overdose, anthrax and other contaminants every time they inject heroin from a new batch. If Ibogaine was successful, not only does it cure all addictions but might also work with depression, PTSD and OCD. The drug companies are terrified of the impact it could have on their profits and will probably go to extreme lengths to prevent its production.
> http://www.ibogaine-research.org/Ibogaine-Research-Project/Areas/Media/JAMA.htm
>
> There is another treatment, that is drug free: 'Neuro-Electric Therapy' NET. This was discovered in the 1970s, and is reported to be able to get addicts through withdrawal symptoms. In 1982, the British public saw this treatment used by Meg Patterson on some famous pop stars, they all recovered and are still off drugs today. Over 189 addicts recovered using this method in Hong Kong, and then 72 in Somerset in the UK. After two years follow ups the 1982 study reported 90% success rate [the figure for methadone reduction after 2 years is 3%]. In 1984 a team from KCL, [Gossop, Strang, Bradley & Connell] did a comparison study with NET versus methadone, which only achieved a 33% success rate in both groups. There was no report of any follow up on these groups. As a result NET was shelved in favour of methadone programmes, with no regard for the added problems methadone causes, even those that were known about in 84.
>
> After reading the 1984 report I also concluded that NET was another red herring, but then I read a copy of a letter to the Lancet from NET's developer, Dr. Meg Patterson. She asked Gossop et al., why KCL had ignored her offer of help, and stated that according to their research report they had used the wrong settings. Too little stimulation wouldn't work and too much would be annoying, and would not ease withdrawal. Nobody else ever questioned the discrepancy in the 1984 KCL findings, or made any further attempt to see whether NET could be made to work with the correct settings. Thousands of people now use an identical device, a TENS Unit, instead of medication for pain relief, it can't be a mass placebo effect that would have worn off eventually. It has been suggested that if Patterson had been a man, or a psychiatrist instead of a surgeon, or if the device had come from the UK or USA instead of from Hong Kong it would have been taken more seriously and examined more objectively.
>
> The sociocultural war on the use of opium was begun in the early 19th century as a result of the Temperance Movement's knee-jerk reaction to the work of Martin De Quincey, 'Confessions of an opium eater' and some of the other Lake District poets.
>
> http://books.google.co.uk/books?id=9YdHjiovr9wC
>
> Their problem with opium was that it was described by De Quincey as a 'sensual pleasure', and thus must be as dire a sin as lust or drinking. They completely failed to notice or perhaps even read the narrative of isolation, hopelessness and desolation, which occupied most of the remaining pages. The writer describes his life of constant illness and the pain that drove his need for opium but all this is ignored. After World War I, the British Government banned the sale of opium, but allowed doctors to prescribe it to patients if it was needed. Since this book many others, and then plays, films, magazines, newspapers, and even pop songs, have built on the myth and added more confusion to the opiate delusion.
>
> I am all too aware that many addicts are criminals, some are sub-human morons, the very dregs of the Earth, but so are some black people, some gays, and some average white people. Society can't just carry on tarring all addicts with the same brush. The rest and probably the majority are just ordinary, honest, hardworking and normally sensible people who shouldn't be treated like criminals just because their lives have gone horribly wrong. Until addicts can be given a viable cure, they should be allowed to obtain the drugs they need legally but at their own expense, and left in peace. The book I am editing strives to inspire researchers to re-examine NET, using the settings that are recommended by Patterson as well as exploring other settings in different positions; and perhaps even set up Ibogaine trials in the UK. If that fails, it might encourage addicts to ask their clinics about options like NET and Ibogaine, or write to their Area Health Authorities, and M.P.s, which might also trigger some action.
>
> Best wishes Jo
>
>
>
>
> --
> Pranab Chatterjee, MBBS
> Medical College, Kolkata, India
>
> My Website<http://www.pranab.in>
> Scepticemia<http://scepticemia.com/blog>
> Cargo Cult Medicine<http://cargocultmedicine.org>
> Vagus Journalis<http://science3point0.com/vagusjournalis/>
> @Scepticemia<http://www.twitter.com/Scepticemia>
>
>
>
>
|
