I think these are valid considerations and that 'do no harm' is primary
along with understanding of evidence joined with a good fit for
application to an individual patient. My hope is to help clinicians to
provide evidence so that treatments they have been found to work can be
made available to others and to fill the gaps where people slide off the
curve where it is effective for most so these populations needs can be
met. I see respect between research and medicine as critical to
accomplishing this and all the commandments in the world are not a
substitute for informed , equal and respectful relationships.
There is nothing much we can do about papers facing retraction, editorial
bias etc. In my opinion we need to do the best we can with the tools we
have and recognize that they are subject to error and politics no matter
how many cites they collect.
I still like Dave Sackett's original definition, he had a vision
Amy
On 4/14/12 10:02 AM, "Patricia Anderson" <[log in to unmask]> wrote:
>This was a prominent theme at this week's TEDMED conference, with
>speakers focused less on retractions and more on positive-findings
>bias in the published peer reviewed literature, with examples
>presented illustrating how that bias endangers the public. EBM/EBHC
>can only be as strong as the data it analyses. We make intense efforts
>to show that that we, as systematic review researchers, try to be
>comprehensive in our searches and avoid bias in our analysis, but if
>the research data isn't published because of bias at the level of the
>publishers and editors of the journals, well, how much is our work
>worth?
>
>There was a parallel presentation on the topic that the scientific
>method is broken in our emerging big data environment. Briefly, the
>question was whether the strategy of asking questions first and
>seeking data makes sense when data is so easy to come by. The thought
>is that we need to turn the scientific method on its head and come up
>with new strategies for analyzing data, visualizing data, and
>generating questions that allow us to look at big data in useful ways.
>
>Separately but also recently, I attended a presentation by a curator
>and manager at the United States Holocaust Memorial Museum on the
>topic of their Deadly Medicine exhibit. The focus of the exhibit is an
>examination of how the 3rd Reich successfully persuaded the healthcare
>and other helping professions to switch from "First, do no harm" to
>genocide. The elements that most struck me were these two:
> - 1) a strong focus, possibly the first intentional systematic
>government funded focus, on what would now be called evidence-based
>practices;
> - 2) discovering sympathetic researchers in closely related but
>slightly peripheral fields, and funding them like crazy to generate
>research in the targeted question areas.
>
>I know, I KNOW. I've heard the Soviet war prisoner story. I know that
>Archie Cochrane first came up with the whole idea of systematic
>reviews with a view towards freeing frontline clinicians from spending
>so much time digging through research and allowing them to focus on
>compassionate patient care. I worry how well that is being understood
>by the profession at large, especially when I hear things like "no
>treatment should ever be provided for a patient without a strong
>systematic review in support of it;" "insurance companies should only
>fund evidence based practices;" or "government should not waste its
>money funding research into areas where there is not strong
>evidence." Yes, I have really heard every single one of these, from
>highly educated, informed, influential professional leaders.
>
>My original mentor in evidence based methodologies and practice is
>Amid Ismail, who has won many awards for his influence in bringing
>evidence based methodologies and clinical practices to the profession
>of dentistry. He repeatedly expressed concern over several years that
>people were missing one particularly essential aspect of implementing
>EBHC: the best AVAILABLE evidence needs to be combined with expert
>CLINICAL JUDGMENT. He emphasized this, and often explained that in
>cases of a rare condition or a complicated presentation, there may be
>no systematic review and the best available evidence may very well be
>a single case report or expert opinion. In that case, you use the best
>available evidence, whatever that is (sometimes it means a consult)
>and integrated that with your judgment as a clinician as that
>particular patient, their needs and preferences. EBHC was never never
>intended to supplant or interfere with the doctor-patient relationship
>and the clinical decisionmaking process that grows out of that
>relationship.
>
>I have been planning a blogpost on this topic, but perhaps it would be
>just as well to post this message, if Jordan would give me permission
>to post his original question? Thank you for bringing this up here. I
>have been agonizing over this topic for a few months now, and I see it
>getting to be a bigger question. It is certainly not going away. I
>suspect that EBHC in its current form is either going to fade away
>over the next twenty years, or will have to drastically transform
>itself in the eyes of the professions and the public.
>
> - Patricia Anderson, [log in to unmask]
>
>On Sat, Apr 14, 2012 at 9:22 AM, Jordan Panayotov <[log in to unmask]> wrote:
>> Dear All,
>>
>> May I add an important detail that is missing in the discussion
>> about EBP/EBM/EIP/EIM/EIDM.
>>
>> How reliable is the Evidence? What happens with the Evidence when, for
>> example, 193 (one hundred ninety three) papers are RETRACTED?
>>
>> See Retraction Watch here
>>
>>
>>http://retractionwatch.wordpress.com/2012/04/10/193-papers-could-be-retra
>>cted-journal-consortium-issues-ultimatum-in-fujii-case/
>>
>> Countless number of practitioners and decision-makers around the world
>>try
>> to adhere to Evidence-Based Practice which is based on evidence, which
>>is
>> based on systematic reviews, which are based on peer reviewed
>>publications
>> (like Fujiišs papers).
>>
>> According to Microsoft Academic Search
>>
>> http://65.54.113.26/Author/54367026/yoshitaka-fujii Fujii has been cited
>> 5,735 times! Y. Fujii has collaborated with 512 co-authors from 1991 to
>> 2011; Cited by 18,519 authors!
>>
>> What is the VALUE of such Evidence? What is the impact of such
>>"Evidence" on
>> EBP/EBM?
>>
>> All the best,
>>
>> Jordan
>>
>> ----- Original Message -----
>> From: Djulbegovic, Benjamin
>> To: [log in to unmask]
>> Sent: Friday, April 13, 2012 3:17 AM
>> Subject: Re: Definitions of EBM/EBP
>>
>>
>>
>> Indeed, SELECTIVE use of evidence is greater threat to the practice of
>> medicine than not consulting evidence resources at all!
>>
>> bd
>>
>>
>>
>> From: Evidence based health (EBH)
>> [mailto:[log in to unmask]] On Behalf Of Ash Paul
>> Sent: Thursday, April 12, 2012 1:13 PM
>> To: [log in to unmask]
>> Subject: Re: Definitions of EBM/EBP
>>
>>
>>
>> Dear Rakesh,
>>
>>
>>
>> Your comment 'Is it possible that most practitioners would love to
>> understand EIP as (B) practice informed on the cumulation/totality of
>> research but unfortunately often end up with (A) practice informed by
>>any
>> piece (or pieces) of evidence' is not only very interesting but also
>>very
>> relevant, especially for healthcare commissioners.
>>
>>
>>
>> You might find this 2009 article published in the 'Journal of Health
>> Sceinces Education' interesting:
>>
>> Educational strategies to reduce diagnostic error: can you teach the
>>stuff?
>>
>>
>>http://www.isabelhealthcare.com/pdf/EducationStrategiesToReduceDiagnostic
>>Error.pdf
>>
>>
>>
>> The author Mark Graber refers to (here we go again, I'm wading into
>>Biblical
>> controversy once more!) The 10 Commandments To Reduce Cognitive Errors
>>
>> 1. Thou shalt reflect on how you think and decide.
>>
>> 2. Thou shalt not rely on your memory when making critical decisions.
>>
>> 3. Thou shalt make your working environment information-friendly by
>>using
>> the latest wireless technology such as the Tablet PC and PDA.
>>
>> 4. Thou shalt consider other possibilities even though you are sure of
>>your
>> first diagnosis.
>>
>> 5. Thou shalt know Bayesian probability and the epidemiology of the
>>diseases
>> in your differential diagnosis.
>>
>> 6. Thou shalt mentally rehearse common and serious conditions that you
>> expect to see in your specialty.
>>
>> 7. Thou shalt ask yourself if you are the right person to make the final
>> decision or a specialist after considering the patientšs values and
>>wishes.
>>
>> 8. Thou shalt take time to decide and not be pressured by anyone.
>>
>> 9. Thou shalt create accountability procedures and follow up for
>>decisions
>> made.
>>
>> 10. Thou shalt record in a relational data base software your patientšs
>> problems and decisions for review and improvement.
>>
>>
>>
>> Leo Leonidas MD (Pediatrics, Maine)
>>
>> Ref:
>>
>> Trowbridge, R. (2008). Twelve tips for teaching avoidance of diagnostic
>> errors. Medical Teacher, 30,
>>
>> 496500.
>>
>>
>>
>> Regards,
>>
>>
>>
>> Ash
>>
>>
>>
>>
>>
>> From: Rakesh Biswas <[log in to unmask]>
>> To: [log in to unmask]
>> Sent: Thursday, 12 April 2012, 15:34
>> Subject: Re: Definitions of EBM/EBP
>>
>>
>>
>> Thanks Neil for this great discussion.
>>
>> Is it possible that most practitioners would love to understand EIP as
>>(B)
>> practice informed on the cumulation/totality of research but
>>unfortunately
>> often end up with (A) practice informed by any piece (or pieces) of
>> evidence.
>>
>> This is again possibly due to the fact that cumulation/totality of
>>research
>> depends on 'as far as such cumulation exists' and is accessible to the
>> practitioner?
>>
>> regards, rakesh
>
>
>
>--
>Patricia Anderson, [log in to unmask]
>Emerging Technologies Librarian
>University of Michigan
>http://www.lib.umich.edu/users/pfa
>
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